For years, menopause remained closeted, a transition nearly all women experienced but seldom discussed. Today, menopause is transitioning, if you will, and women are more willingly sharing about the highs, the lows, and the effects this change in life can bring.
Menopause arrives during mid-life, when women are entering their 40s and busy reevaluating relationships and career goals, plans and dreams. For Astrid French, it was growing Lamplighter Montessori School, where she taught and later served as head of school for five years. This period proved a huge driver for change.
“My girlfriends call it Men on Pause,” she says with a laugh. Menopause is a frequent topic of conversation with her posse, who compare symptoms and discuss how best to manage the shifting ground brought on by hormonal changes. French describes hers as a spiritual awakening. To help manage the symptoms of hot flashes and mood swings, she sought hormone replacement therapy, saying, “I was trying to balance what I did to get an authentic connection with myself.”
The cycle of life
All of life is built on cycles and for women, menstruation is an important one, designed to pass on the gift of life. While we ovulate and have monthly periods during the childbearing years, by the 40s, the body is transitioning to menopause when ovulation ends.
On average, women experience menopause at age 52, although it can happen a few years earlier or later. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.
Prelude to menopause
Perimenopause begins during your mid-40s and is the prelude to menopause. During this phase, your body’s hormones — estrogen, progesterone, and testosterone — are slowly declining. Dr. Candice Hinote of Mid-South OB-GYN says what’s taking place in the body is affected by a gonadotropin-releasing hormone or GnRH. GnRH is essential to a woman’s reproductive health, as it stimulates the release of estrogen and progesterone.
“What changes is the tempo of how GnRH is released,” she says. “It loses regularity and is not as consistent, which means your menstrual cycle will fluctuate in its timing and flow.”
Since you are not ovulating regularly, your periods may become longer or shorter than normal and heavier or lighter than they were before. You will want to continue using birth control even as your periods become irregular, however, since you’re still able to get pregnant during this time.
Since every woman’s body is distinct, the symptoms you experience during menopause may differ from that of your friends, in both intensity and duration.
In addition to flow irregularity, some women experience other symptoms such as weight gain, hot flashes, night sweats, mood changes, and difficulty sleeping. Symptoms can last from two years to eight, says Hinote, though on average, the transition takes four years.
“The weight gain is because your metabolism slows during your 40s and 50s,” she says. The gain is typically 5 to 10 pounds, which settles around the hips. “My patients often tell me, ‘I don’t know why I’ve gained as I’m eating the same as I always have,’ but since your metabolism is changing, so you need to cut back. Your body isn’t requiring as much fuel, so you need to put in less.”
Since every woman’s body is distinct, the symptoms you experience during menopause may differ from that of your friends, in both intensity and duration. Some women notice only a periodic change in body temperature, for example, or may be aware of mood swings and yet, with the daily stressors of caregiving and job demands, they don’t necessarily attribute it to menopause.
For Irene Thomas, menopausal symptoms were more dramatic, punctuated by hot flashes and night sweats that began in her mid-40s.
“The flashing was crazy. During the worst years, I’d experience 50 to 100 a day,” she says. To compensate, Thomas learned to wear layers and seldom left home without a Chinese fan to keep her cool. She says a friend one day observed, “Irene has a broken thermostat. And I thought that was right; my body felt totally erratic.”
Thomas tried addressing her hormone fluctuation naturally with homeopathic remedies that included B-complex, black cohash and DIM (diindolylmethane) supplement, a natural compound found in cruciferous vegetables, like broccoli, cabbage, Brussels sprouts, and turnips. While DIM helped initially, nothing brought long-lasting relief. In fact, there is scant evidence that these products are very effective for treating symptoms, according to MedicalNewsToday.
One problem is that herbal supplements are not regulated by the Food and Drug Administration. Therefore, supplement makers are not required to put products through the rigorous clinical trials that prescription drug makers do to earn FDA approval. There is also no quality control, which can affect the potency and efficacy of a product. The National Institute of Aging notes, “Products often have proprietary blends, which means the company does not list the amounts of the ingredients on the product packaging. Additionally, products may contain active or inactive ingredients that are not listed.”
Thomas eventually spoke with her doctor, who recommended trying hormone therapy. It proved more effective. Though her hot flashes did not stop, they did lessen substantially, “It did make a difference,” she says.
Hormone replacement therapy
Hormone replacement therapy (HRT) is tailored to a woman’s individual needs and potential risk factors. Patients are prescribed HRT to replace the estrogen, and sometimes progesterone, that’s on the decline. It comes in various forms, including patches, topical creams and oral medications.
“One’s quality of life can be enhanced by taking hormones,” notes Dr. Susan Murrmann, an OB-GYN specialist with McDonald Murrman Center for Wellness and Health. She sees HRT as a tool that can help women feel better during menopause.
One question Murrmann frequently hears from patients is whether HRT puts them at greater risk for breast cancer or stroke with prolonged use. She says the answer depends on several factors, including one’s overall health and family history for cancer. However, when taking low-dose estrogen for less than five years during menopause, the risk is low and benefit high. It can improve one’s quality of life by lessening symptoms such as hot flashes, night sweats, and mood swings. Further, Murrmann says hormones also help to improve muscle mass and bone health.
She believes it helps to reframe how you view menopause.
“Menopause is simply one stage of life,” notes Murrmann. “This period is also about your quality of life, your attitude, and the way you view your life. Equally important is your environment, diet, exercise, and sense of community. Those are a big part of your overall health. Hormones are just one piece of the puzzle.”
Be sure to speak with your doctor before taking any product, from hormones and supplements to vitamins and minerals. By examining your medical history and blood work, your doctor can determine the best course of action and recommend medications that may help ease discomfort.
That cautionary note is particularly timely, as more products are being marketed to women seeking menopausal relief. Buyer beware when it comes to pop-up clinics, too, notes Hinote with Mid-South OB-GYN. They offer HRT but problems can arise if you receive an improper dosage of estrogen.
Some women do better than others. Lindsay Jones describes her perimenopausal time as “a superpower.” “Beyond the occasional hot flash, my biggest issue is just giving no cares. I’ve gone from a quiet little bookish mouse to Mousezilla,” she says. “And honestly, I kind of like it. Whereas once I might have hesitated to speak up about certain things, now I just say them.”
Postmenopause
Once you are fully through menopause, your ovaries continue to produce estrogen but the lower levels increase the risk for certain health issues such as heart disease and osteoporosis, as well as vaginal atrophy, the thinning and drying of the vaginal wall which can make sex painful. Vaginal moisturizers can help ease dryness.
Additionally, if you’ve given birth, you may experience pelvic-floor disorders such as pelvic organ prolapse, urinary incontinence or urinary frequency/urgency, and anal incontinence (accidental bowel leakage). Exercises such as Kegels, squats, and pelvic tilts can help strengthen your lower back and abdominal muscles but physical therapy is also available (and generally covered by insurance), as are certain devices, such as red light therapy, which can be a game-changer for treating incontinence. Ask your physician about these alternatives.
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Helpful Tips
Track your periods so you know the length of each month’s cycle, noting when you begin to bleed and when you stop. This also enables you to calculate your ovulation. After one year, you’ll have a better sense of what your normal flow looks like. Irregular periods during your 40s reflect the start of perimenopause.
Contact your doctor if you should experience the following:
- Heavy bleeding
- Bleeding or spotting after sex or between periods
- Periods that last longer than one week
- Bleeding or spotting after not having a period for one year
For good health during menopause and beyond:
- Eat a balanced diet of fresh fruits, vegetables, eggs, and other proteins
- Avoid constipation by drinking plenty of water
- Get enough calcium and vitamin D for bone health
- Stay physically active
- Maintain a healthy weight
- Limit or avoid alcohol and smoking
