Menopause

With the “silver tsunami” of aging baby boomers upon us, menopause has moved to the forefront as a vital healthcare issue. And, just as they have done with each stage of their lives, this generation continues to challenge the status quo.

Menopause is no longer a taboo topic and there is an abundance of information on the internet, on talk shows, in books, and in the daily news reports about menopause and its treatment. Yet, somehow, the common misconception persists that menopause should be feared and treated as if it were a disease. Menopause is nothing to fear and it is not a disease—it is a natural life transition.

What is Menopause?

Technically speaking, menopause is defined as the last menstrual period, which makes diagnosing it much easier in hindsight than while it is approaching (see Diagnosing Menopause.) The total menopausal transition is called perimenopause (“peri” meaning “around”). This overlaps with the time leading up to menopause, which is called pre-menopause. Women who have completed the menopause transition are referred to as postmenopausal. For simplicity, we will use the term menopause to refer to the entire transition, unless otherwise noted.

Menopause is a gradual life transition from the reproductive to the post-reproductive years. For most women, it lasts about 10 to 15 years, generally occurring between the ages of 45 and 60, with menstruation usually stopping somewhere between the ages of 48 and 52. Women who are overweight tend to stop menstruating a little later in life; heavy smokers tend to stop a little sooner.

Cessation of menstruation prior to age 40 is considered premature menopause; it is rare and, if it occurs, usually hereditary. Women who either stop menstruating or begin having irregular periods before age 40 should discuss it with their healthcare practitioner because it may be indicative of another health problem, such as an autoimmune disease, nutritional deficiency, chronic stress, or excessive athletic conditioning. With the information and technology now available, and even when the symptoms are related to menopause, women can often extend their reproductive years.

If menstruation continues into a woman’s mid-50s, it is considered late menopause. However, late menopause is also rare (except in women with diabetes) and often hereditary. Women who experience irregular vaginal bleeding at this age should discuss it with their healthcare practitioner because it can signal uterine cancer, for which they are also at greater risk. In addition, birth control pills can mask the onset of menopause because they artificially control a woman’s menstrual cycle.

Surgical menopause occurs when the ovaries are removed or damaged during surgery. According to Dr. Christiane Northrup, approximately one in every four American women will enter menopause due to surgery, usually meaning hysterectomy (surgical removal of all or part of the uterus), which also frequently includes an oophorectomy (surgical removal of the fallopian tubes and ovaries). Any surgery affecting the pelvic region can potentially damage the ovaries, or impair their function, or lead to pelvic organ prolapse.

Artificial menopause can occur if the ovaries are exposed to radiation or chemotherapy, but menstruation usually returns after treatment has stopped. Women subjected to surgical and artificial menopause tend to have more severe and debilitating symptoms than women who go through a natural transition to menopause because their ovarian function is suddenly terminated, providing their body with no opportunity to gradually adjust to the hormonal changes.

What Types of Changes Should I Expect?

Many women go through menopause without experiencing any symptoms at all. Some women experience subtle changes in how they think or feel, but don’t think of those changes as symptoms of anything “wrong” with them.

Today’s women are not content to give in to the notion that menopause signals “the end” of anything. Many women report very positive changes as they go through menopause. They embrace it as a natural ripening or maturation process according to Dr. Northrup, becoming “more motivated by the demands of our souls, not just those of society.” In fact, Dr. Northrup reports that “more than half the American women between the ages of fifty and sixty-five felt happiest and most fulfilled at this stage of life.” She states that menopause “is often accompanied by surges in creativity, vitality, newfound ambition, and the need to be of meaningful service to the community in a larger way.”

Approximately 20% of women experience no other symptoms than menstrual irregularity as they approach menopause. Those other symptoms can be physical, emotional, or psychological, and vary widely in frequency, duration, and severity. For some women, the symptoms are subtle and gradual; for others, they are intolerable because they interfere with daily living.

Menopause is a convenient “catch-all” for a wide range of symptoms, but only two are thought to be uniquely characteristic of menopause: hot flashes and vaginal dryness. Many other symptoms may occur, but they can usually be attributed to other health issues that women tend to experience as they approach menopause.

In fact, many symptoms of premenstrual syndrome (PMS) are similar to those associated with perimenopause, making it even more confusing. Some women experience PMS-like symptoms for the first time as they approach menopause. Those who have had PMS in the past may find that their symptoms (such as bloating, irritability, and headaches) get worse right before menopause.

Hot Flashes

Hot flashes are the most common menopausal symptom (although few Asian women have hot flashes, which may be related to diet or genetics). Some women never have any, while others may have hot flashes continually for a few months to several years. They may be frequent or sporadic and usually last about three to five minutes, typically ceasing within a year or two of the last menstrual period.

A hot flash is described as a sudden sensation of warmth or intense heat, which flows over the face, scalp, and chest area. It may include reddening of the skin in the affected area, perspiration, increased or irregular heart rate, nausea, or feeling chilled when it stops.

Researchers believe that a hot flash represents a temporary shift in blood flow, in response to fluctuations in hormone levels. Hot flashes can also be brought on by diet (especially one high in refined carbohydrates), alcohol, and stress. Avoiding these triggers may help reduce the frequency of hot flashes.

Night sweats are hot flashes that occur during sleep, sometimes resulting in a sweat so heavy that it soaks clothing and sheets. Because night sweats interrupt sleep patterns, they can contribute to fatigue and insomnia, and increased irritability and tension, all of which are also frequently reported symptoms during menopause.

Vaginal Changes

The lining of the vagina is very sensitive to changes in estrogen hormone levels. Estrogens encourage blood flow to the genital area and keep the walls of the vagina supple and elastic, and also help protect it against bacterial infection.

As levels of the estrogen hormones begin to decline, some women experience vaginal dryness, itching, or swelling, and/or pain during sexual intercourse. Leaking small amounts of urine while sneezing or coughing, or when engaged in strenuous physical activity may also occur. Due to changes in vaginal secretions, there is an increased risk of developing vaginal and urinary tract infections.

After menopause, vaginal and genital tissues become thinner, drier, and less elastic. Vaginal atrophy can also begin to occur.

Irregular Menstruation

During perimenopause, menstrual bleeding may stop for several months and then return, or it may increase or decrease in duration, intensity, and flow. Over time, cycles typically get farther and farther apart, until menstruation finally ceases. Some women suddenly stop menstruating without any irregularities at all.

Abnormal bleeding, including very heavy blood loss, thick clots, periods that last two or more days longer than normal, or bleeding between menses, may also indicate an underlying condition. Therefore, it is wise to track these symptoms carefully and discuss them with your healthcare practitioner whenever they occur.

Sex Drive

Irregular bleeding or vaginal changes can make women less interested in sex. However, with appropriate treatment, many women feel an increase in their sex drive during and after menopause. Having more privacy after children “leave the nest” and not having to worry as much about pregnancy may rejuvenate the sex drive for some women.

Dr. Sheldon Cherry notes that “the need for intimate relationships exists throughout life, especially during the middle and later years.” He also suggests that “continued sexual activity is important for the maintenance of vaginal health,” although pregnancy is still possible

Other Symptoms Related to Menopause

Emotional problems and minor psychological complaints are more frequent among menopausal women, but there may be reasonable explanations for this. Menopause is just one aspect of any number of mid-life crises that may be occurring, such as the death of a spouse or parent, empty nest syndrome, or career changes.

Other symptoms typically reported by women going through menopause may be related to but not necessarily caused by menopause. For example, insomnia, irritability, headaches, fatigue, and mood swings are all non-specific symptoms that can occur at all ages, in both men and women. These symptoms are often a result of hormonal imbalances brought on by a variety of other health conditions or life stresses.

At menopause our bodies become dependent on our adrenal glands for sex hormone production. If we are already dealing with chronic or long-term stresses, adrenal function will be compromised, further compounding the inter-relationships among various health conditions, hormone balance and symptoms.

Nevertheless, the following symptoms are often attributed to women going through menopause:

• Sleep disturbances, which may be related to hot flashes and night sweats.
• Depression, often brought on by other circumstances or changes. The incidence is much lower among post-menopausal women.
• Increased moodiness, irritability and anxiety, related to fluctuations in hormone levels. Some women say that they just don’t feel like themselves.
• Impaired concentration and memory can be a result of sleep disturbances and/or hormonal fluctuations.
• Headaches are more common among women than men, in general, primarily due to hormonal fluctuations. Migraines have been associated with PMS, but those cyclical symptoms can still occur during menopause.
• Heart palpitations, which are rapid or irregular heartbeats, may be related to stress, hot flashes or other hormonal fluctuations.
• Skin changes may become more noticeable, partially as a result of declining levels of the estrogen hormones. As we age, our skin becomes drier, thinner and less elastic. The skin aging process can be accelerated by sun exposure and smoking.
• Hair loss, which can also be brought on by stress and other hormone imbalances.
• Increased risk of osteoporosis tends to accompany menopause. The majority of cases of osteoporosis are found in post-menopausal women.
• Dental changes, such as tooth loss, is especially common among post-menopausal women. Tooth loss could also be related to osteoporosis, whereby bone loss in the jaw alters the tooth sockets.
• Increased risk of cardiovascular disease also occurs as women approach menopause. As women age, their risk of high blood pressure, abnormal heart rhythm, heart attack, stroke and coronary artery disease increases.

How Long Do Menopausal Symptoms Last?

How long symptoms last and how they affect your daily life will depend on a number of factors. Your menopausal experience will be influenced by your diet, your relationships with family and friends, your career and/or life satisfaction, and your heredity, among other things. Whatever else is going on in your life at the time, as well as your physical and emotional health, will affect your ability to deal with the transition.

With all of this in mind, Dr. Northrup explains that typical “symptoms of perimenopause (in a natural transition) last anywhere from five to ten years, with a gradual crescendo in the beginning, a peak as one approaches mid-transition, and a gradual decrescendo towards the end, as the body learns to live in harmony with its new hormonal and emotional milieu.”

It is important to remember that some of these symptoms represent a natural process, not a disease, and therefore are usually temporary. “The reassurance that comes from this knowledge will go a long way toward relieving the anxiety some women experience as they approach this stage of life” says Dr. Cherry.

In any case, if symptoms are so severe that they interfere with your daily life, consult with your healthcare practitioner. Many of these symptoms can be reduced or eliminated with treatment.

What Can I Do About My Symptoms?

Be informed! Today’s menopause treatments include everything from over-the-counter herbal and non-herbal remedies, such as creams and food supplements, to alternative approaches like acupuncture and meditation, to hormone replacement therapy (HRT) and bioidentical hormones (defined at right).

No matter which treatment option(s) you want to pursue, consult your healthcare practitioner for assistance. The decision to use—or not use—any particular treatment should be an informed one, based on fact and your individual hormone needs.

Unfortunately, many women turned away from all forms of HRT after the Women’s Health Initiative (WHI) study was halted due to concerns over the adverse effects of Prempro®. A study just published in the American Journal of Public Health indicates that the avoidance of HRT has led to a recent increase in premature death among women in their 50s who have undergone a hysterectomy, and chose not to supplement with hormone therapy.

Be forewarned! The FDA has just approved a potent and highly addictive SSRI (selective serotonin reuptake inhibitor) with extremely dangerous side effects—including suicidal thoughts—as a treatment for hot flashes, despite an advisory committee vote of 10-4 against it. Dr. Jeffrey Dach and other healthcare professionals are shocked and disturbed by this. In Dr. Dach’s opinion, “the use of psycho-active drugs such as SSRI anti-depressants for treatment of symptoms caused by menopausal hormone deficiency is an abuse and mistreatment of women bordering on criminal behavior by the medical system.”

Become an active partner in deciphering the clues represented by your symptoms. You will need to monitor and track your symptoms on a daily basis, probably for several months because symptoms can be cyclical or sporadic. Keep a daily log describing what happened, how long it lasted, and how severe it felt to you. For those symptoms that occur infrequently, consider whether you need to address them or if you can live with their passing. Pay special attention to the most debilitating symptoms.

Once you have a clear picture of your symptoms, discuss them, as well as your overall health and known risk factors, with your healthcare practitioner. She or he may suggest hormone testing to establish a baseline for determining which treatments are appropriate and for monitoring your hormone levels during the treatment.

If the treatment does not seem to be working for you, consult your healthcare practitioner again. Hormone balance is complex, so finding and maintaining the best hormone combination and dose for you may require some adjustments. Custom compounding, which allows for more fine-tuning, may provide you with better options (as explained in the box above). It is equally important to discuss and monitor over-the-counter and alternative therapies as it is for prescribed treatments because they all may affect your hormone balance.

What Else Should I Know about Menopause?

Menopause is a crossroads, of sorts. Saundra McKenna describes it as “our metamorphic evolutionary journey into who we are becoming for the rest of our lifetime.”

The choices you make at this time of your life have a significant impact on your future health, as well as on your menopausal experience. To improve the journey, you can:

• Decrease stress and invest time and energy in yourself, not everyone else.
• Improve your diet to reduce the amount of refined carbohydrates, increase the number of fresh fruits and vegetables, ensure adequate protein, and include moderate amounts of healthy fat, such as olive oil.
• Consider taking a multi-vitamin/mineral supplement because the need for certain nutrients skyrockets during menopause.
• Get regular exercise to reduce body fat, improve flexibility and balance, and strengthen bones and muscles.

As Mary Ann and Dr. Joseph Mayo suggest “the choices have always been there. But as we reach midlife, the importance of those choices becomes extremely significant.”