Some women welcome it. Some women are wary of it. Everyone's talking about it because all women go through it: menopause. This biological change is every bit as natural as puberty, yet menopause is often misunderstood and involves more symptoms and treatment options than you can make sense of. But by educating yourself about the available treatments and some common sense lifestyle adjustments, you can make this transition more easily than you might expect. You may find out that, just like your favorite wine, you keep getting better with age.
The word "menopause" comes from two Greek roots meaning "month" and "a cessation." So in its most basic form, menopause means the ending of your monthly cycles. Allison Cochran, a physician assistant with New Vitality Medical Institute, gives the technical definition: "A woman is considered to be in menopause once her menstrual periods have ceased for 12 months."
If the process of menopause were truly that simple – no more periods, cramps, chocolate cravings or spontaneous sappy movie marathons – women would surely welcome the change. Unfortunately, menopause can bring with it a whole slew of new symptoms. "Some of the most common are hot flashes, night sweats, mood swings and difficulty sleeping," says Sheila V. Garnica, MD, a NAMS Certified Menopause Practitioner with North Fulton Women's Specialists. "However, some women may also experience fatigue, irritability, anxiety, vaginal dryness and weight gain." Suddenly, "no more periods" doesn't sound so fun.
Cause of the Pause
"A woman's body goes into menopause when her ovaries stop producing estrogen, the hormone that controls the reproductive cycle," Cochran says. The slowed production and eventual lack of estrogen are responsible for the symptoms associated with menopause. In America, the average age of menopause is 51, though women often experience changes several years before, during the years known as perimenopause.
However, if you are younger than 40 and are experiencing menopausal symptoms, your body might be getting a little ahead of itself. Premature ovarian failure can occur for a variety of reasons. "Chemotherapy and radiation are common causes of toxin-induced ovarian failure. Another possible cause is an autoimmune disease where the immune system may produce antibodies against one's own ovarian tissue," Cochran says. She also notes, "Smoking can contribute to early menopause due to the anti-estrogen effects it has."
In addition to cancer treatments and lifestyle factors, Piedmont OB/GYN Melissa Counihan, MD, states that genetic disorders such as Fragile X or Turner's Syndrome can contribute to premature menopause, as can surgical removal of the ovaries.
In centuries past, women's physical development and changes were grossly misunderstood and were often treated as mental health issues. As medical understanding of hormones grew throughout the 1900s, treatments became more appropriate to the biological changes of menopause. By the 1960s, the go-to treatment was hormone replacement therapy (HRT), which was thought to help prevent coronary artery disease as well as help manage menopause symptoms.
Today, Dr. Counihan explains, "Since the Women's Health Initiative study was published, we have come to have a better understanding of the risks of HRT. We believe there are risks associated with estrogen-containing therapy such as blood clots, stroke and breast cancer." As recently as 2010, the National Institutes of Health and the Women's Health Initiative have analyzed this type of treatment and reported "a trend toward an increased risk of heart disease during the first two years of hormone therapy among women." To try to minimize those risks, Dr. Garnica says, hormone therapy has gone through significant changes. "The most important has been the individualization of hormone therapy and the shift to limiting the dosage of HRT to the lowest effective dose for the shortest period of time."
In addition to these changes, Dr. Counihan says, "We now have medications available in various delivery systems including oral pills or patches, sprays or gels that are applied to the skin." She also adds that another way to minimize your intake of estrogen-containing compounds is to treat symptoms with some of the same medications that typically treat depression.
Sharon Bent-Harley, MD, of the Harley Anti-Aging Institute notes that bio-identical pellet therapy is a breakthrough for the modern woman dealing with menopause symptoms.
This hormone treatment, she explains, "is made from wild yams, and the treatment lasts anywhere from three months to one year without having to remember to take a tablet or apply a cream every day." Though the research is not new, today's busy women are increasingly taking advantage of this option. Make sure to discuss all of these options with your doctor to be sure you're receiving the most appropriate treatment.
Help Yourself at Home
If the medical approach is not for you, Dr. Garnica points out, "There are many non-pharmacologic alternatives and non-hormonal therapies as well." One recommendation is to keep a close watch on your diet. "There are a few common food triggers for hot flashes that all women should avoid if hot flashes are problematic: spicy foods, alcohol and caffeine," Dr. Garnica says. "It is helpful to keep a food diary and note if a particular food triggers a hot flash."
Fonda Mitchell, MD, Chief of Women's Services at Kaiser Permanente agrees that diet has a large impact on your experience of menopause, as does your activity level. "By focusing on a diet high in fiber and calcium, menopausal women can ensure healthy bones and a healthy digestive system. By incorporating exercise into your daily routine, natural endorphins can promote weight loss, boost your energy and improve sleep patterns."
Start the Conversation
Dr. Garnica encourages open dialogue, especially with your doctor. "Don't be shy about discussing the symptoms that are most bothersome, whether it is painful intercourse, dry skin, loss of interest in sex, heart palpitations, increased anxiety or fatigue," she says. Dr. Mitchell recommends another topic to cover with your doctor: contraception. "Until menopause is confirmed (more than 12 months without a period or by a blood test), women should understand they can still get pregnant," she says. If you don't currently have a doctor who you feel comfortable speaking with about these topics, look for a provider from the American Academy of Anti-Aging Medicine. Cochran says medical providers who are board-certified from this academy have undergone extensive training in age-management medicine and will be able to address your needs.
You can also find support through the Red Hot Mamas online forums, where women take to the keyboards to discuss every angle of this transition. Online resources are also available from the American Congress of Obstetrics and Gynecology and the North American Menopause Society. Some of the best resources might already be stored in your cell phone. "Your mother, aunts or older siblings can provide insight into what the women in your family may experience," Dr. Mitchell notes. "Talk to them about the onset of menopause, duration of their symptoms and treatment options they found most effective."
Laughter is the Best Medicine
There's no doubt that women are all in this together. In 2001, Jeanie Linders created "Menopause The Musical" to convey just that. In this musical, an all-female cast humorously reworks familiar tunes to reflect women's shared experiences about menopause."Stayin' Alive" becomes "Stayin' Awake," along with "Puff, My God I'm Dragging," and "Change, Change, Change." Women have laughed their way through this show in 450 U.S. cities and 15 countries, proving that no one is alone on this journey. Linders says that, after watching the show, audience members "know what they are experiencing is normal. They aren't alone or crazy. It becomes a sisterhood."
Whether or not you can look at menopause humorously yet, it's helpful to have a positive attitude about the transition. While your body makes these changes, you can make changes of your own: make self-care a top priority by eating healthy foods, getting regular exercise and meeting with a supportive doctor who can address your needs. With all of these resources, you can start to view menopause as a new beginning and a new opportunity to make these years the healthiest yet.
Menopause Around the World
Menopause symptoms vary by person, of course, but also by culture. UK-based medical doctor and public health specialist Elinor Thompson rounded up a variety of studies proving that menopause and its symptoms are different around the world.
- In Japan, women frequently attribute shoulder stiffness to the change.
- In China, women complain more of numbness in their hands than of hot flashes.
- In India, most women report no symptoms other than menstrual changes.
Sharon Bent-Harley, MD – Harley Anti-Aging Institute www.harleyantiaging.com
Allison Cochran, PA-C, MPAS – New Vitality Medical Institute www.newvitalitymedical.com
Melissa Counihan, MD – Piedmont Atlanta Hospital www.piedmont.org
Sheila V. Garnica, MD – North Fulton Women's Specialists www.northfultonwomensspecialists.com
Fonda Mitchell, MD – Kaiser Permanente of Georgia www.kp.org
National Institutes of Health – www.nih.gov/PHTindex.htm
Elinor Thompson, MB, ChB, FFPH – www.natural-menopause-journey.com