By Carla Sandy, MD
Menopause, the stage of a woman’s life that marks the end of her reproductive years, is a natural part of aging, yet many women view it with fear and dread. They’ve heard the horror stories about insomnia, mood swings and the infamous hot flashes. The truth is, the degree to which women experience symptoms varies a great deal. In my 16 years as an obstetrician and gynecologist, I have seen some women sail through menopause while others struggle with various symptoms for years.
Most women fall somewhere between those two extremes when it comes to symptoms, and the good news is there are many options for managing discomfort. Whether you’re having symptoms now or just looking ahead to changes in your life, it’s important to understand what’s happening to your body and what you can do to make this phase of life as comfortable as possible.
How do you know when menopause has started?
Menopause happens when production of the hormones estrogen and progesterone has stopped. It is diagnosed when a woman has not had a menstrual period for 12 consecutive months. There is no one specific test for menopause, so we base the diagnosis on the woman’s symptoms and age. Menopause usually starts any time after age 40 through the mid-50s. The average age of menopause in the United States is 51.
Menopause is preceded by a transition stage known as perimenopause. During perimenopause, a woman is still having periods, but they may become irregular, and symptoms can begin as the ovaries begin to produce less estrogen. Perimenopause can last anywhere from a few months to 10 years but typically lasts just a few years for most patients.
What you can expect
The most common symptoms of menopause or perimenopause are changes to the menstrual cycle. Periods become irregular or erratic. You might also have trouble sleeping and difficulty concentrating. Some women begin urinating more frequently and urgently. Vaginal dryness is another problem.
Hot flashes affect nearly three quarters of women. During a hot flash, the blood vessels near the skin’s surface dilate or become larger. The result is a rush of heat, and some women also sweat profusely. Sometimes, women also get a red, flushed face. These flashes of heat last from a few seconds to a few minutes. When the flashes happen at night, they are known as night sweats.
Menopause is also often accompanied by mood swings. I call this “I’m watching TV and start crying at commercials” syndrome. Women can also struggle with concentration and memory lapses and become irritable or anxious. A lot of times patients will tell me, “I can tell my emotions are out of whack, but I don’t know why.” The answer: Fluctuating hormone levels affect the levels of mood-regulating chemicals in the brain such as serotonin.
A less common symptom is weight gain. Women also put on weight differently than they used to, typically around the midsection rather than the hips.
The time frame for symptoms is two to eight years. Each woman is different and may experience these symptoms differently. Just because your co-worker had to bring a fan to work for her hot flashes doesn’t mean you will. Some women have no symptoms at all.
Steps you can take
Often women who are having uncomfortable symptoms will tell me they feel like their body is betraying them. Here they are, having raised children and managed successful careers, and suddenly they feel like they’ve been thrown back into puberty with no coping skills. I assure them it gets better, and in the meantime, there are many remedies to try.
I recommend consistent exercise, such as 30 minutes of walking five days a week, to lessen hot flashes and insomnia. Exercise also strengthens the bones, which can become more fragile during menopause, and reduces the risk of heart disease, which increases after menopause.
Likewise, a healthy diet protects the heart and lowers the risk of breast cancer. Menopausal women should also be sure they get enough calcium and vitamin D for bone strength and to prevent stress fractures.
Studies have shown that women who smoke are more likely to have more frequent and intense hot flashes, so this is a great time to quit smoking. Nicotine-replacement therapies such as the patch and lozenges are available over the counter, and women can also talk to their doctors about prescription drugs that help ease cigarette cravings. Alcohol also can trigger hot flashes while also making it harder to sleep, so drinking in moderation is wise.
Some women report a decreased sex drive with menopause. Others experience no change. And there are those who, liberated from having to think about birth control, actually experience an increase in their sex drives. Most women experience some degree of vaginal dryness, which can make sex painful. To help ease dryness and make sex more pleasurable, I recommend using over-the-counter lubricants. And remember that because intercourse increases the flow of blood to the vagina and keeps it from becoming smaller and drier, the very act of having sex can make it more pleasurable.
If you’re leading a healthy lifestyle but your symptoms are still bothersome, especially to the point of interfering with your life, work and relationships, then it’s time to consider talking to a health care provider about treatment options.
Nonhormonal therapy
When my patients come in to talk about alleviating their menopause symptoms, I often suggest they start by trying an herbal option for three months or so, and if that doesn’t work, we can consider other therapies. One that I recommend is black cohosh, a plant that can lessen hot flashes and other symptoms. It comes in pill form, and there are also tea leaves containing this herb. You can also take over-the-counter dietary supplements that contain vitamins and combinations of herbs, including black cohosh, soy and red clover to treat symptoms.
One thing to keep in mind: Herbal supplements are not regulated by the Food and Drug Administration, and there are many brands and varieties out there. Be sure to consult your health care provider when choosing a supplement.
For some patients, short-term use of antidepressants known as serotonin reuptake inhibitors can work wonders in lessening or even stopping hot flashes. Likewise, I’ve found that some blood pressure medications also work well for alleviating hot flashes. Talk with your health care provider to help determine your best option.
Hormone-replacement therapy
For patients with moderate to severe symptoms who do not respond well to other treatments, I recommend considering hormone replacement therapy, which increases estrogen and progesterone levels. HRT is incredibly effective at treating symptoms, and it comes in many forms: pills, patches and creams.
Like any therapy, there are some risks associated with HRT. Women who have had blood clots, certain types of cancers, heart disease or stroke should not use HRT. Studies by the Women’s Health Initiative also show there is a very small increased risk of breast cancer and heart disease with HRT, especially when taking it for a long period of time, so try to limit the length of time you use it. A good rule of thumb is to not exceed five years of use. Always balance the use of HRT against the strength of your symptoms. Your doctor can help you decide whether HRT is a good option for you.
Whatever symptoms you find yourself struggling with during menopause, remember that you have many avenues for relief. If one doesn’t work, you can try another. And the reality is that this, too, shall pass. As I often say to my patients, it does get better.
For more information on menopause, visit the North American Menopause Society website.
Carla Sandy, MD, is chief of service for obstetrics and gynecology in the District of Columbia and suburban Maryland service area for the Mid-Atlantic Permanente Medical Group.
