I was "pre-menopausal" at 46. At 48 I was into it...and I luckily did not have really severe symptoms. I have always been a sound sleeper, so the few times I woke up early (middle of the night?) or could not go to sleep, I took Tylenol PM and went right to sleep. That lasted for a few months. The hot flashes were annoying, but never super-bad. I guess I had a pretty easy time of it. Pre-menopause weight - 145. Weight now (several years after) 190. Several attempts to lose the weight resulted in loss of approximately 3 pounds after a full two weeks of exercising and dieting. After that, I say life is too short to give up the food I love. So, if I'm going to be 190, then that's what I am going to be. I bought bigger clothes!! :-)