Women with periods spend decades dealing with their bloody companions, whether that’s by maintaining a cabinet full of tampons or using birth control to help manage painful menstruation symptoms. Periods can show up during vacations, important work events, when you’re out with friends; they can be heavy, light, short, or lingering. Basically, they can range from slight annoyances to real day-ruiners.

But while those who do get periods have an average of 450 in their lifetime, they don’t last forever.

What is menopause?

On average, toward the end of our 30s our bodies start producing less of the hormones estrogen and progestin, according to the Mayo Clinic. This starts to affect the length and quality of our periods until, eventually, we stop producing eggs and no longer menstruate.

When that last period stops, you’re officially in menopause. It’s even in the name — “meno” for menses, “pause” for stop, says Wen Shen, M.D., assistant professor of gynecology and obstetrics at Johns Hopkins University School of Medicine. In the United States, the average woman enters this stage of life at age 51, she adds.

Of course, your period stopping isn’t the first sign that menopause has arrived. Your body also gives you warning signs, or menopausal symptoms, that start occurring during the perimenopause or menopause transition. This is the time — usually between four to eight years — leading up to the last period.

How long do menopausal symptoms last?

Irregular periods, hot flashes, night sweats, vaginal dryness, sleep problems, and mood changes all fall under the umbrella of menopausal symptoms that can begin during the perimenopause transition, says Susan D. Reed, M.D. chief of service for obstetrics and gynecology at Harborview Medical Center in Seattle, Washington. The severity of these symptoms ranges from person to person, as does which specific symptoms you’ll experience. (Though hot flashes are the most common, with about 75 percent of people experiencing them, reports Johns Hopkins Medicine.) “I have patients who never had a hot flash, and I have patients in their 70s who are still having hot flashes,” Shen says.

The most intense symptoms — typically period changes and night sweats — last for approximately four years, and they tend to feel the worst during the perimenopause transition, Reed says. All symptoms, however, can last for an average of 10 years, she adds.

What are my menopause treatment options?

In most cases, doctors will start with non-prescription treatments that make symptoms more bearable as they pop up. Dressing in layers so that you can remove clothing during a hot flash, always having ice water with you, and having a personal fan by your bedside are all recommended, Shen says.

Lifestyle changes can also help. Weight loss may be encouraged, Shen says, as a 2013 study in Menopause found that women who lost 10 pounds or more than 10% of their body weight experienced fewer hot flashes. You also want to avoid triggers for hot flashes, including spicy foods, caffeine, smoking, alcohol, and , according to Cleveland Clinic.

For those interested in natural treatments, Shen says that mindfulness, paced breathing, and acupuncture seem to work. A 2011 study also published in Menopause found that while mindfulness-based stress reduction didn’t decrease the number of hot flashes patients were experiencing, it did improve their quality of life, sleep habits, anxiety, and perceived stress levels significantly. A 2012 study in Evidence-Based Complementary Alternative Medicine also showed similar effects in those who practiced yoga.

“It’s almost like [these practices] helped women to modulate their perceptions of what they were feeling,” Reed says.

While many people have turned to herbals like gingko, St. John’s Wort, and black cohash, Shen says these haven’t been proven to be effective. The FDA also doesn’t regulate their ingredients, so there isn’t a way to ensure they’re safe for consumption.

If those recommendations aren’t enough, your doctor may also suggest medical options. This could include hormonal and non-hormonal therapies, such as low-dose birth control, SSRIs (a form of antidepressants), and both prescriptive and over-the-counter treatments for vaginal dryness, according to the Office on Women’s Health.

Medical treatments may also be necessary for those who enter menopause because of chemotherapy and radiation, oophorectomy (the surgical removal of the ovaries), or premature menopause, which is when women enter menopause before the age of 40. In these cases, your doctor may recommend treatments that lend support to the brain, heart, and bones until your body would have naturally had lower hormone levels, according to the Mayo Clinic. That’s because a lack of estrogen has been linked to dementia, heart disease and osteoporosis, and patients who enter menopause prematurely spend less time with normal levels of estrogen.

Most importantly, Shen says that the menopause transition is a sign that it’s time to invest in your health more than ever. “Going through menopause is sort of a beacon to let [you] know that [you] need to start really reviewing [your] health issues and to discuss healthy aging with [your] physician,” she says. If you feel your current doctor isn’t helping, switching to one that’s in good standing with the North American Menopause Society may help.