Take Charge of Your Health - Menopause Matters
It’s called menopause for a reason. Men should pause before they speak.
-Popular adage
While some very lucky women breeze through the menopause years, most women experience symptoms ranging from mild to severe. If you are struggling, support is widely available so be sure to consult your physician early for advice about potential treatments. Menopause is a time in your life when your body needs and deserves tender loving care and is a great time to remember that your health is your responsibility. According to the Harvard Health Letter, "The years leading up to menopause and the transition itself can bring changes to your body. But they can also have an effect on your mind, specifically your mental health."
Menopause is typically divided into three phases: perimenopause, menopause, and postmenopause. Each of these are transformative stages in a woman's life as the menstrual cycle stops and reproductive years come to an end. It is a reason why the incidence of depression doubles during this time and women who have struggled with depression or anxiety in the past may see a resurgence in symptoms.
The first stage – perimenopause -- can begin 8 to 10 years before actual menopause as the reproductive cycle prepares to stop. Irregular periods are a normal hallmark of perimenopause. In the last 1 to 2 years of perimenopause, the drop in estrogen and progesterone accelerates and while many women experience symptoms of menopause they are still having their period and can become pregnant.
The second stage – menopause -- is diagnosed when a woman does not have a menstrual period for 12 consecutive months. For most women, this typically occurs in their late 40s to early 50s when the ovaries no longer release eggs into the fallopian tubes, the production of estrogen slows, and the menstrual cycle stops. The average age in the US for menopause is 51. Menopause that occurs before the age of 45 is commonly called “early menopause” while menopause that occurs at 40 or younger is considered “premature menopause”.
Surgery which removes the ovaries will immediately start menopause. However, with a hysterectomy that removes the uterus and leaves the ovaries, women will no longer have periods - but their ovaries will still release eggs and estrogen and progesterone.
The main types of treatment for the symptoms of menopause are hormone and non-hormone therapies. Hormone therapies (HT) are Estrogen Therapy (ET) and Estrogen Progesterone/Progestin Hormone Therapy (EPT). With ET, estrogen is taken alone and typically prescribed in a low dose. Estrogen alone cannot be used if a woman still has her uterus. EPT provides doses of estrogen and progesterone. Hormone replacement therapy (HRT) is the most effective and widely used treatment for menopausal symptoms -- it is simply a way of replacing the hormones lost as a result of menopause.
Non-hormonal treatments can include changes to diet and lifestyle as well as using over-the-counter options. For example, limiting the amount of caffeine consumed every day and cutting back on spicy foods can make hot flashes less severe. More foods that contain plant estrogen including soybeans, chickpeas, lentils, grains, fruits, and vegetables can be added to your diet. A daily exercise and fitness program can help you sleep through the night and reduce insomnia, while calming exercises like yoga can lift your mood and relieve anxiety.
The third stage – postmenopause - follows menopause. As a result of a lower level of estrogen, postmenopausal women are at increased risk for a number of health conditions including osteoporosis and heart disease. Estrogen plays an important role in preserving bone mass. With the loss of estrogen, women lose an average of 25% of their bone mass from the time of menopause to age 60. Over time, this loss of bone can lead to bone weakness and even fractures as the bones become less dense and more fragile. Bone density testing is a way for you and your healthcare provider to measure the strength of your bones. Most physicians will recommend vitamin supplements with calcium and vitamin D after menopause to maintain bone health.
Reduced estrogen levels can also lead to changes in your blood cholesterol levels, including an increase in your LDL, the "bad" cholesterol, and a decrease in HDL cholesterol, the "good" cholesterol. After menopause, the risk for coronary artery disease can increase because of the loss of estrogen, increased blood pressure, and reduced physical activity. Since heart disease is the number one cause of death in women, it is important to speak with a physician about heart health and protection during each of the stages of menopause.
Everyone’s experience of these three stages is different; for some, symptoms related to menopause are mild; while for others, they can be severe. Women often experience some or all of the following challenges:
Hot flashes
Night sweats and/or cold flashes
Restless nights and difficulty sleeping
Decreased interest in intimacy
Vaginal dryness; discomfort during sex
A pressing need to urinate; more frequent urination
Loss of energy
Difficulty with focus and concentration
Emotional changes such as anxiety, irritability, mood swings, mild depression
Dry skin, dry eyes, dry mouth
Weight gain
Hair loss or thinning
Headaches
Mood changes including snappiness and sadness.
Beyond hormone therapies, lifestyle changes can also help many women better manage menopause symptoms. Recommendations include:
Communicating with other women about menopause and supporting one another. Don't struggle alone.
For hot flashes -- drink cold water, apply cool/wet towels, sit or sleep near a fan
Exercise regularly to sleep better and help prevent conditions like heart disease, osteoporosis, and diabetes
Strengthen the pelvic floor muscles and help prevent bladder leaks with Kegel exercises
Stay socially and mentally active
Do not smoke
Limit alcohol consumption
Maintain a healthy weight
Practice yoga, tai chi, deep breathing, meditation, and mindfulness to relax
Explore integrated and complementary treatments for menopause symptoms including: acupuncture, aromatherapy, herbal treatments, homeopathy, hypnotherapy, and reflexology
Monitor your mood and make note of patterns in other factors such as sleep and stress levels. Typically, the mood changes that accompany female hormonal changes during the menopausal transition won't last. Seek professional help if symptoms become severe and interfere with daily life.
Preventive health care visits and health screenings such as colonoscopies, mammograms and/or 3D ultrasounds of the breast, cholesterol testing, and triglyceride screening are all vitally important for women throughout their life cycles.