If your body has become a stranger to you when you’re “of a certain age,” you may be entering menopause. Signs include hot flashes, night sweats, crashing fatigue, sore muscles, dizziness, changes in hair and nails and, of course, shorter or irregular periods.

No longer whispered as the “M” word, menopause is talked about openly but not always accurately. Dr. Nicholas Sieveking, board-certified Stanford University plastic surgeon and also board-certified for fellowship training in anti-aging and functional medicine, cuts through the confusion to identify five menopause myths he hears patients repeating:

1. “I’m too young to be in menopause.” Just because you’re barely 40 or had a baby in recent years doesn’t mean you can’t be starting menopause. “The average age to begin menopause tends to be 52, but women can actually begin anywhere from their 30s to their 60s,” Sieveking reports.  Perimenopause, the “preview,” can precede menopause by up to a year.

2. “Since I was older when I got my period, I’ll be older when I go into menopause.” Actually, the opposite tends to be true—girls who get their period on the later side tend to begin menopause on the earlier side. However, Sieveking says, “predicting the age a woman will begin menopause is difficult. Pay attention to your body. After age 40 you’ll notice more and more changes and symptoms of menopause.”

3. “I can’t be menopausal, because I’ve had no hot flashes.” While most women experience hot flashes, that’s not always the first sign and some woman never experience them at all. Menopause can start with emotional and mental signals such as anxiety, depression, fuzzy thinking, an inability to focus, low libido, forgetfulness, a short temper or irritability. 

4. “Weight gain comes with the territory, and there’s nothing I can do about it.” As estrogen is depleted, the body tries to protect itself from hormonal imbalance by storing fat. Sieveking says you can maintain your premenopausal weight by making a few changes: choose high-fiber foods, which also should help with constipation, another ill associated with menopause; eat plenty of calcium-rich and vitamin D-rich foods like low-fat dairy products, green leafy vegetables, beans and fish to help keep your bones strong; take a daily calcium+vitamin D supplement; and exercise.

5. “Red wine is especially good for me now, and coffee will calm me.” Alcohol—especially red wine—can trigger hot flashes. It also can diminish calcium absorption and inhibit live enzymes that activate vitamin D, while caffeine increases excretion, and decreases absorption, of calcium. Both alcohol and caffeine are dehydrating stimulants that can make night sweats even worse.

One thing that’s not a myth is the tendency toward mood swings. When a patient tells Sieveking, “I yelled at the dog and then I cried about it for an hour,” he assures them that they’re not becoming terrible people but, rather, progesterone and estrogen levels are causing a bit of erratic behavior. “Also, don’t underestimate the power of what menopause really signals,” Sieveking adds. “With child-rearing days behind them, many women begin to think about the rest of their lives. No doubt, these thoughts can trigger feelings of anxiety and depression. But menopause is part of every woman’s life. Work closely with your doctor to create a plan that combines healthy foods, exercise, stress management and a commitment to enjoying life to its fullest. There is so much to look forward to. Having a positive outlook is the key to feeling your best regardless of age and stage.”