Explaining Menopause

Menopause brings changes and challenges — more than you might think.



ILLUSTRATION BY elizabeth ellis

Women gripe quite a bit about menopause, and you can’t blame them, really. No one wants to feel like her body, and in some ways, her life, has been hijacked. Sounds like hyperbole? Maybe, but they don’t call it The Change of Life for nothing.

Indeed, you might be forgiven for thinking that menopause is all about hot flashes, the symptom that we probably most commonly hear about. But there’s a lot more to this topsy-turvy stage of life than that, and one woman’s experience can be very different than another’s.

Menopause is a natural process that is preceded by a phase called perimenopause, during which levels of the hormone estrogen begin to drop off and the menstrual cycle becomes erratic, says Karen E. George, MD, director of the obstetrics and gynecology residency program and associate professor of obstetrics and gynecology at the Geisel School of Medicine at Dartmouth.

Perimenopause can linger for months or, more typically, years, but eventually, the ovaries no longer produce eggs, thus bringing an end to the woman’s fertile years. But even before menopause hits — at an average age of 51 and by definition occurring one year after the last menstrual period — a variety of short-term and long-term effects usually come along. Some of the changes might simply be part of aging, but others, such as a weakening of the bones, have been clearly linked to menopause. “Estrogen helps keep the bone from breaking down,” George says. When estrogen stores plummet, bones grow increasingly thin, making breaks more likely. Over time, some women will find that they’re not as tall as they used to be, and some will ultimately develop the rounded upper back that’s referred to as a “dowager’s hump.”

Other symptoms that can accompany the menopausal transition include heart palpitations, muscle pain, joint pain, irritability and the infamous hot flashes, which often occur at night and disrupt sleep, says Margarita Ochoa-Maya, MD, CDE, an endocrinologist and founder of Advanced Health and Wellbeing PC in Manchester.

Weight gain can come with menopause, too, although it’s not exactly clear why. “It seems like there’s a slowing of the metabolism with age that coincides with menopause,” George says. There can also be vaginal dryness that causes sexual dysfunction and urinary incontinence that creates the need to urinate more often or causes leaks brought on by a cough or sneeze.

And not to be overlooked is the emotional turmoil that menopause can produce. Shrinking amounts of estrogen creates a chemical change that can leave women feeling depressed, anxious or irritable. But timing often contributes to the emotional upheaval of menopause too. “Menopause comes at a time of life when other events are going on: your kids are going off to college or away,” and maybe your parents’ health is beginning to decline, George says. “There are a lot of emotional triggers around that time of life anyway for a lot of women.” Top that off with poor-quality sleep caused by hot flashes and matters only get worse. “I think that anybody who doesn’t get enough sleep is not going to feel as emotionally stable as if they did,” George says.

To be sure, it can be a rocky time. The biological changes that culminate in menopause “put the body in hormonal disarray, creating insecurity,” Ochoa-Maya says. During the menopausal process, some women “feel very helpless. It’s a period of a loss of control. You don’t really know what your body is doing.”

OK, faced with such a rosy picture, what can women do? Diet and exercise, those old trusty allies in our never-ending quest for health and wellness, can help. Women should include adequate amounts of calcium in their diet, limit alcohol and not smoke since all of those can affect bone density. Engaging in weight-bearing exercise will help to remodel good bone, George says, but also be sure to incorporate in your workout yoga or Pilates or another activity that involves spine flexibility and balance moves. Keeping the spine mobile will help prevent bone-thinning problems, and maintaining balance will lessen the chance of falls that can lead to broken bones.

If symptoms become too bothersome, there are treatment options, including hormone therapy, which can be particularly effective for relieving hot flashes, but is not a good fit for everyone and carries some risk. Certain vitamins and supplements can help, too, as can tending to your sleep habits; if you’re not sleeping well, do something about it. “Be very protective of your sleep,” Ochoa-Maya says. Don’t hesitate to reach out and talk with friends, loved ones or your doctor. Above all, “try to recognize that you’re in a sensitive spot and give yourself plenty of love and compassion,” Ochoa-Maya says.

Also, keep in mind that some aspects of the menopause experience are short-lived. Most women will find, for example, that their hot flashes fade and disappear completely within a couple of years. The vaginal dryness and sexual dysfunction, on the other hand, tend to get worse. Bone thinning occurs at a rapid clip in the five years following the onset of menopause, then continues, but more gradually.

And while the heart palpitations that some women experience as part of the menopausal mix tend to be temporary, the threat of heart disease does not go away. Estrogen appears to offer some protection against heart disease, but “once that estrogen is gone, you are as likely to get heart disease as your male counterparts,” George says.

For sure, there’s no denying that menopause brings change, but believe it or not, it is possible to coast through menopause feeling like it’s no big deal. “I always tell everybody as they’re entering into the menopausal transition that your experience is going to be your experience,” George says. “You can’t really compare yourself to anyone else. Most women will have some symptoms. Some women will have horrible symptoms; some women will wonder what everyone’s talking about. It’s really variable. Whatever it is for you is what it is for you.” 

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