Every woman of a certain age experiences menopause, and they each experience it differently. Some have an easy transition while others may have multiple, severe symptoms. But either way, it doesn't happen overnight, and there's more to it than hot flashes. (Let's Talk Menopause)
So what is menopause? What are the different stages? What are the symptoms? Is there anything we can do to make it easier?
(Note: Men, if you made it this far, good for you. Keep reading and you might learn something to help you better understand the women in your life.)
What is Menopause?
Menopause marks the end of a woman's reproductive years and the beginning of a new stage of life. The complete menopausal journey takes years and has three phases: perimenopause, menopause, and postmenopause.
It’s sometimes referred to as just “menopause”, “the change of life”, or “the change”.
Women typically reach menopause between ages 45 and 55. But as with puberty, it varies by woman and there are exceptions. The duration and symptoms for each phase are also different for every woman. It isn't a one-size-fits-all experience.
Different Phases
Perimenopause – In this phase (typically starts in her 40's) a woman's estrogen and progesterone levels begin to fluctuate erratically. It is in this stage she experiences most of her symptoms. It can last 4-10 years.
Menopause – A woman officially reaches menopause when she has not had her period for 12 consecutive months. If she stops for several months and then starts again, the clock resets. The average age of menopause is 51 for white and Asian women, 49 for Black and Latina women.
Postmenopause – The time after menopause. Most women's symptoms generally subside. Most women live an average of 30 years after reaching menopause and many report it to be the happiest time in their lives.
Start of Menopause
As stated above the menopause journey is different for every woman. She may start it early, late, or “on time”. It may come on slowly or abruptly. Below is a list of the different on-ramps to menopause:
- Premature Ovarian Insufficiency (POI) – final period occurs before age 40 and as young as the teens.
- Early Menopause – last period occurs between age 40-45.
- Natural Menopause – last period occurs between ages 45-55 with average of 51.
- Late Menopause – last period occurs after age 55.
- Medical menopause – like with chemotherapy or radiation. No gradual process, but menopause starts immediately. Often with severe menopausal symptoms.
- Surgical menopause – where ovaries are removed or hysterectomy is performed and both ovaries and uterus are removed. Menopausal symptoms are often severe.
Symptoms
Now, I could do a whole blog post on the physical, cognitive, mood, and urinary/sexual/vaginal symptoms of menopause. But below are some common ones that women may, or may not, experience (Symptoms):
- Hot Flashes
- Irritability
- Joint Pain
- Heart Palpitations
- Painful Sex
- Low Libido
- Period Changes
- Anxiety
- Brain Fog
- Migraines
- Urinary Tract Infections
- Weight Gain
- Sleep Issues
- Fatigue
Statistics
- 75 million women are in perimenopause, menopause, or postmenopause in the U.S. with 6000 more reaching menopause each day.
- 75% of women who seek medical care are left untreated
- 80% of OB-GYN residents admit to being ill-prepared to discuss menopause.
- 38% of those in late perimenopause experience symptoms of depression.
- 27 million, representing 20% of the workforce are in some phase of the menopause transition.
Estrogen
Due to the fluctuation of the hormones estrogen and progesterone, women are most vulnerable to mental health issues like depression and anxiety, during these three windows:
- Puberty and Periods
- Pregnancy and Postpartum
- Perimenopause
Although most women's menopausal symptoms eventually dissipate and even disappear, low estrogen levels after menopause can contribute to long-term health risks. This can take a toll on your heart, bones, brain and urinary/sexual/vaginal health. (Long Term Health Risks)
Treatments
Estrogen is one of those things you don’t really appreciate until it’s gone. For those who are going through menopause and having a rough time, there's a whole industry of products to help you with your symptoms. Some work, some don't.
Hot flashes affect 80% of menopausal women and usually last for at least 7 years. There are various options for dealing hot flashes (What’s the best nonhormonal therapy for hot flashes? Experts release new menopause therapy guidelines):
- Hormone Therapy (HT) is still the most effective treatment to help with the discomfort of hot flashes. It also helps prevent osteoporosis. But for some women there is an increased risk of blood clots, heart attack, strokes, breast cancer, and gall bladder disease.
- There are FDA approved nonhormonal medications (e.g. Fezolinetant) that might be a good alternative if you aren't a good candidate for HT.
- Cognitive Behavior Therapy (fancy way of saying talk therapy) and clinical hypnosis can help with hot flashes and night sweats.
Dietary supplements and over the counter "natural" hormone creams are not approved by the FDA and may be harmful, unhelpful, or just a scam. Consult with your doctor. (Menopause From the FDA Office of Women's Health)
There is no strong evidence that lifestyle changes help relieve hot flashes. There is little or poor evidence that yoga, exercise or diet can help improve symptoms. Weight loss may help though.
Personal Experience
I developed POI in my early thirties, so my doctor immediately put me on hormone therapy (HT). She thought (wisely, in my opinion) that 40+ years was too long to go without estrogen. And that in my case, the benefits of HT outweighed the risks. I was on it for almost 20 years, and it really helped me.
For those who are going through "the change", don't be afraid to talk to your doctor. And if they won't talk to you about it, get another doctor.
For those who are postmenopausal, congratulations. You made it!
Any advice, warnings or remedies you would like to share?
Excellent. Every woman should read this.
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