Menopause remains a mystery to many
Cathy Hamilton remembers her years leading up to menopause. She was hot all the time, sleeping horribly for the first time in her life and had brain fog at a degree that she wasn’t used to.
“I remember a conversation I had with my mom where I called her one day to ask her if she went through this. She said to me, ‘Oh, I don’t know. I was so busy with my five kids that I don’t think I even noticed.’ That absolutely drove me up the wall,” Hamilton said.
Beginning in grade school, we learn about puberty and the reproductive cycle. We also spend a lot of time and money educating women on what to expect during pregnancy, but when it comes to menopause, you may feel as if you’re on your own to sort it out.
Fortunately, Hamilton, a local writer and Retirement Boot Camp drill sergeant at the Lawrence Public Library, was able to turn to her friends to discuss her experience, though she said being able to be open about it with other women brought her to a realization.
“The trick to these conversations is realizing that menopause is so different for everybody. What you’re going through isn’t necessarily what your best friend is going through,” she said.
If everyone’s experience is so different, how are you supposed to know what’s normal? Is there a normal? We turned to the experts at Lawrence OB-GYN Specialists and the LMH Health Women’s Center to learn more.
Menopause is the stage in life where you stop having your menstrual cycle. It’s a normal biological process that marks the end of your reproductive years. For most women, it happens around age 50, but every woman’s body is different and runs on its own schedule.
Michele Bennett, MD, FACOG
“The age range for normal menopause is anywhere from 40 to 58, but chronological age can be a poor predictor of the beginning or end of menopause,” said Michele Bennett, MD, FACOG, a physician with Lawrence OB-GYN Specialists. “Natural, spontaneous menopause occurs around age 51 or 52 and isn’t brought on by medical treatment, but it can also be induced earlier through surgery, such as removing the ovaries, chemotherapy or pelvic radiation therapy.”
So what happens exactly?
There are three phases of menopause: perimenopause, menopause and postmenopause. You might be entering the first stage – perimenopause - if you experience any or all of these symptoms:
- Irregular periods
- Vaginal dryness
- Changes in the skin, including acne or dryness
- Hot flashes
- Night sweats
- Trouble sleeping
- Mood swings
- Cognitive changes, including brain fog, anxiety or depression
- Thinning hair on scalp
- Unwanted facial hair
- Weight gain
Some women have only a few mild symptoms. Others have severe symptoms that disrupt sleep and affect their day-to-day activities.
“You can line several women up and some in their early-mid 40s may have periods but also hot flashes. You might have a woman who is on Mirena (a hormonal IUD) who is experiencing no periods at all but wouldn't know,” said Jan Morey, a nurse practitioner with Lawrence OB-GYN Specialists. “Family history and chronic health conditions also play a role.”
Menopause that’s not caused by surgery or another medical condition is called natural menopause. This normal part of aging is a point in time where your ovaries stop releasing eggs and producing estrogen.
“Menopause represents the FMP – final menstrual period – and is confirmed by 12 consecutive months without having a menstrual cycle (amenorrhea) in women who have a uterus. For women who have had a hysterectomy, there are lab markers we can use to identify when they’ve entered the menopausal stage,” explained Dr. Bennett.
The phase of life after you’ve gone through menopause is called postmenopause. During this stage, many of the menopausal symptoms begin to ease, though some women continue to experience them for years to come.
Jan Morey, APRN
If every woman’s experience is different, how are you supposed to know when you’ve entered any stage of menopause? Morey said making an appointment to talk with your doctor is a great first step. The team at Lawrence OB-GYN Specialists sees patients who are experiencing symptoms as well as those who are curious and want to get a feel to determine if they need care. She shared that the provider and patient will sit down for a conversation to talk about symptoms, overall health and options.
“I’ve also got patients whose partners or family members recommend they see us. They’re kind of moody, always hot, have no libido, so we address those particular needs and determine the best course of treatment,” Morey said. “Partners are welcome to join in these conversations, if the patient is willing. There can be a misunderstanding in what the partner understands about menopause because no one really talks about it. It helps them learn what’s really going on.”
What treatment options are available?
With every menopause experience being so different, the treatment that’s the right fit for one patient’s symptoms might not be right for another. Clinicians will focus on treating symptoms that disrupt your life through either hormone replacement therapy (HRT) or non-hormonal treatments.
HRT is prescription medicine that helps to relieve your symptoms, including vasomotor symptoms like hot flashes and vaginal dryness. It works by replacing some of the hormones no longer made by your ovaries with artificial estrogen and progesterone. It can be taken as a pill, skin patch or as a topical cream.
Dr. Bennett shared that a number of non-hormonal treatments have also been shown to help alleviate menopausal symptoms. These include:
- Avoiding triggers (alcohol, caffeine, hot drinks, spicy food)
- Maintaining a healthy body weight
- Getting a massage
- Not smoking
- Regular exercise
Some patients may take over-the-counter herbs or supplements because they believe they are safer since they are “natural.” Dr. Bennett said it’s still important to exercise caution.
“These supplements are still medications. While their active ingredients may be less concentrated than prescriptions, they can still have adverse effects and interactions,” she explained. “It’s important that you talk with your provider before starting anything new.”
Morey said no matter what road you decide to go down for your treatment, your provider will talk with you to help determine your best options.
“We want to be your partner and individualize it to what you want to do. We’ll determine if medication is appropriate or make recommendations regarding nutrition, exercise or the like and then follow up to see what’s working and what isn’t. It's just the beginning of a process that may take a couple of years, and we’ll make adjustments as needed,” she said.
Mental health and menopause
Melissa Hoffman, DNP, APRN, PMHNP-BC
Women in any stage of menopause may experience cognitive changes, including mild irritability, mood swings, becoming more emotional and issues with sleep or energy. Melissa Hoffman, a board-certified psychiatric mental health nurse practitioner with Lawrence OB-GYN Specialists and the LMH Health Women’s Center, explained that if your mental health changes, you may be entering the realm of having a mood disorder rather than just experiencing menopause.
“Women who have a predisposed vulnerability to mood disorders related to normal reproductive changes, such as Premenstrual Dysphoric Disorder (PMDD), are more vulnerable to mood changes during the reproductive changes in life,” she said.
Hoffman said this is particularly important if she’s working with a patient who had PMDD at any stage of their reproductive cycle or had a profound mood impact when starting birth control. She lays the foundation to let them know they’re more at risk for a mood disorder at other reproductive times in their life.
“It’s also important for women who have pre-existing chronic conditions like bipolar disorder to understand that reproductive life changes like menopause can exacerbate those mood disorders. Their perinatal disorder may be in remission, but they may be at greater risk during the perimenopausal period,” she said.
Hoffman understands that while we’re becoming more comfortable discussing mental health issues, it can still feel taboo for some. Having these conversations with friends, family and your healthcare providers can help to remove the stigma.
“Mental and physical health are very intertwined, so it’s important that your providers bring this up and talk about it. Know that these symptoms most definitely come with the menopausal stage in life,” Hoffman explained. “I encourage women to consider these cognitive symptoms the same as any physical ailment or concern and bring it up.”
Where can I turn for more information?
It’s important to talk with your healthcare provider to get answers to your questions about menopause and other reproductive changes in life. Other reliable resources include books and podcasts, as well as resources available through the North American Menopause Society (NAMS) website at www.menopause.org.
“Menopause is notable, but it doesn't have to take center stage or be a huge turning point,” said Dr. Bennett. “Women can optimize their health going into menopause by getting treatment for any underlying medical conditions, taking care of themselves through things like exercise, healthy foods, limiting alcohol intake, avoiding smoking/illicit drugs, getting regular dental exams, maintaining good sleep hygiene and talking to their doctors about new symptoms as they arise and adversely affect their quality of life.”