Catherine, 62, first began experiencing perimenopause, or the span of time when a woman’s body transitions out of its reproductive years, when she was in her early forties.
During perimenopause, a woman’s estrogen levels rise and fall irregularly, which can produce signs that the body is entering a new season of life: For Catherine, the early signal her body gave was irregular menstrual periods. “I never knew when I would get my period,” she says. “It was challenging because it would catch me off guard, and my period would show up when I was unprepared to deal with it. I finally started carrying tampons with me at all times so I could deal with ‘surprise’ periods.” In addition to an unpredictable menstrual cycle, Catherine encountered extreme hot flashes, both in the daytime and nighttime: “The night sweats [were] so severe that I would have to change my pajamas two to three times during the night because they would be so wet.” By the time Catherine’s symptoms ceased, she had endured them for 10 years, which she acknowledges was unexpected. “I started perimenopause in my early forties, and by the time the hot flashes finally stopped, I was in my fifties,” she says. Due to a family history of cardiac issues and breast cancer, Catherine chose not to pursue any treatments—like hormone replacement therapy—to manage her symptoms throughout menopause.
So, is it necessary for women to struggle with menopausal symptoms for years on end?
Menopause is a fact of life, yet many women feel unprepared or misinformed about the shifts their bodies will encounter as they move through this life change. They’ve heard the less-than-favorable remarks regarding menopause, though, which can make this natural rite of passage sound like a terrible experience. Below, we’ll take a more detailed look at menopause, its symptoms, and ways women can thrive during this transitional time in their lives.
Menopause Explained—and Some Signs and Symptoms
Megan Schmitt is a board-certified OB/GYN and an associate professor of obstetrics and gynecology at the University of Minnesota. Schmitt provides the following explanation of menopause: “Menopause is the permanent cessation of menstruation that occurs after the loss of ovarian activity. Basically, the ovaries stop the production of estrogen and progesterone—two main female hormones—to [below] the amount that it takes to prepare an egg and ovulate every month.” “To reach this definition,” she clarifies, “a woman has to have a lack of periods for 12 calendar months.” Yet symptoms associated with this transition appear much earlier than the twelfth month of no periods—often seven years prior, reports the National Institute on Aging, but occasionally up to 14. On the stages of menopause, Schmitt notes:
- In the United States, the average age of menopause is around 51, but the age of onset can vary widely among women.
- The symptom-laden time interval before the complete cessation of periods, as noted earlier, is called “perimenopause,” or the menopause transition. (The time after menopause, naturally, is called “postmenopause.”)
- The duration and severity of symptoms during the stages of menopause are different for each woman.
When entering perimenopause, Schmitt says, “It is the fluctuation of hormone levels and decreasing estrogen levels that causes the physiologic changes and the clinical symptoms.” These symptoms can include:
- Hot flashes
- Night sweats
- Irregular periods
- Itching and dryness
- Pain during intimacy
- Weight changes
- Sleep changes (due to night sweating)
- Mental changes
Additionally, the Mayo Clinic reports that woman may experience a slower metabolism, thinning hair, dry skin, a decrease in the fullness of breasts, and urinary incontinence throughout the menopause transition.
Rebecca, 48, was in her early forties when she experienced the first signs her body was undergoing a significant change. She began having hot flashes, and after seeing a specialist in gynecology/endocrinology, he confirmed she was perimenopausal. In the years that followed, Rebecca says she developed night sweats, anxiety, depression, mood swings, bouts of confusion, irregular periods, food cravings, trouble sleeping, and weight gain. Rebecca has sought assistance for her symptoms by trying hormone replacement therapy and increasing her antidepressant dosage. She hopes these treatments will bring her relief as she navigates the uncharted waters of menopause, but she fears these options may not be enough for her to feel in control of this time in her life. In reality, many women struggle with a whole host of undesirable symptoms as they approach and go through menopause. But what treatment options are available to support women, emotionally and physically, and make the second stage of their lives equal to or better than the first?
Ways to Reduce Symptoms
“Many women come to their routine yearly exam and say, ‘I want to talk about hot flashes [because they are] really bad,’” says Schmitt. She notes that many women are not aware of just how common their symptoms are. Yet no two women experience the stages of menopause in the same way. And because it is such a crucial and broad issue, Schmitt suggests that women make an additional appointment with their healthcare providers to discuss any uncertainties they have. Then, the provider can better understand their concerns and make the appropriate treatment recommendations. While it’s important to discuss your specific set of symptoms with your doctor, the following are non-hormonal possibilities that may warrant some consideration when looking to ease the transition from peri- to postmenopausal:
- Phytoestrogens: These are plant-derived substances with estrogen-like effects. Examples of phytoestrogens include soybeans, soy products, red clover, flax seeds, and yams. Schmitt says these foods, especially soy products, are popular choices for women because people who consume them tend to have fewer hot flashes.
- Herbal Remedies: There are many herbal remedies on the market, but some of the more common supplements used to reduce the symptoms of menopause include black cohosh, ginseng, St. John’s wort, and ginkgo biloba. “We do not recommend some of these herbal supplements for women on blood thinners,” Schmitt cautions, “as it can increase the risk of bleeding.” These remedies should also not be used to treat depression.
- Treatments for dryness/itching: During menopause, it’s not uncommon for women to experience symptoms like dryness, itching, and pain during intimacy. Localized moisturizers, Schmitt says, can help restore moisture to the tissues.
Though the above treatments can be obtained without prescriptions, note, again, that you should always consult your doctor before using them. They shouldn’t replace your doctor’s recommended treatment, though they may be able to supplement it and further increase your quality of life. In addition, women may want to incorporate the following:
- Lifestyle changes: Schmitt suggests that some lifestyle changes which may help women control their fluctuating body temperatures. Those changes include wearing layered clothing, decreasing the room temperature, and consuming cool beverages. Additionally, she recommends avoiding caffeine, as it’s associated with the increased severity and frequency of hot flashes.
- Exercise: Many women notice improvements in their symptoms when they add cardiovascular exercise and weight training to their workouts. Plus, weight training increases lean muscle mass, which can reduce weight changes associated with menopause. Additionally, introducing meditation and other relaxation exercises can reduce the occurrence of hot flashes.
- Non-hormonal prescription medications: In some instances, women find success using non-hormonal medications to mitigate the vasomotor (hot flashes, night sweats) symptoms of menopause. These medications include many antidepressants and the anti-seizure medication called gabapentin. Never take these medications without a prescription, and even then, make sure your doctor knows you’re using them to mitigate vasomotor symptoms.
On Hormone Replacement Therapy
The topic of HRT is vast. Many studies show a relationship between extended HRT and breast cancer, according to research in Obstetrics & Gynecology. Schmitt, though, notes (and The American College of Gynecologists & Obstetricians would agree) that it’s an effective treatment for hot flashes, night sweats, osteoporosis, and dryness/itching. “Systemic therapy, with estrogen alone or in combination with progesterone, is the most effective therapy for the treatment of vasomotor symptoms,” Schmitt says, though hormones “should not be used for the prevention of heart disease or strokes.” “The goal is to use the lowest amount of hormones to control symptoms for the shortest duration of time,” she adds. “HRT is a very safe and effective treatment when initiated at the time of menopause for the treatment of symptoms.” When used under the guidance of a knowledgeable practitioner, HRT can be a valuable tool for women to feel their best. But it needs to be tailored to each woman and at the lowest possible dose to achieve the desired outcomes. Talk with your doctor regarding the benefits and risks of taking HRT.
“I hear a [certain] quote from patients on a daily basis,” Schmitt says.
“‘There’s a lot about aging that people don’t tell you!’ [So] it is important for women to not only talk about these issues with each other but also with their healthcare professionals.” “Most women feel uncomfortable discussing [the symptoms of] menopause,” she continues, “but these are common issues, and treatment can improve women’s personal lives tremendously if they have the confidence to discuss these issues with their doctors.”