Over the years, menopause has been treated as taboo and a punchline. The good news is that this natural, but often misunderstood, transition is benefiting from better research and a more full and honest conversation—both medically and culturally. Steven Dakoyannis, MD, Chair of Obstetrics and Gynecology at MelroseWakefield Hospital, shares the facts about what to expect during perimenopause and menopause.
What is menopause?
Menopause is the natural process that marks the end of women’s and people assigned female at birth’s (AFABs) menstrual cycles and fertility. Women who have gone 12 consecutive months without a period are considered menopausal—their ovaries have stopped releasing eggs and producing hormones like estrogen and progesterone, and they’re no longer able to become pregnant.
When does menopause typically begin?
Menopause typically begins between the ages of 45 and 55. There is a familial component to the age of onset of menopause, so many women find they start menopause at a similar age to their mothers. The period of life between premenopause (when women get regular periods and can get pregnant) and post-menopause (one year without a period) is called perimenopause and can last anywhere from 2 to 8 years.
What are some common symptoms of menopause?
Many women struggle with symptoms during this transition, including:
- Decreased libido
- Difficulty sleeping
- Hot flashes—a feeling of intense warmth over your face, neck and chest
- Menstrual irregularities
- Vaginal dryness and painful intercourse
- Weight gain/changes in how you carry weight
It is important to see a clinician with expertise in menopause to ensure any symptoms you are experiencing are not due to other medical conditions. A full evaluation typically includes a comprehensive history and physical, lab work, Pap test, possible biopsy of the lining of the uterus and an ultrasound.
Do I just have to suffer through menopause symptoms?
No. If the symptoms you’re experiencing are affecting your quality of life, talk to your doctor about your treatment options.
In the past, some doctors recommended a hysterectomy to relieve irregular and heavy menstrual bleeding. Now, treatments include hormonal medication (a low-dose birth control pill or cyclic progestin) or a hormone-containing intra-uterine device (IUD) that lasts 5-7 years. Another option is a minimally invasive procedure called endometrial ablation, in which we cauterize the entire lining of the uterus. Many women never get a menstrual period after an ablation.
Hot flashes can be more difficult to treat. Herbal supplements with black cohosh and adding soy, yams, tofu, and other estrogen-containing foods can alleviate mild symptoms. Hormone Replacement Therapy (HRT) remains the mainstay for the treatment of hot flashes. We recommend using the lowest dose for the shortest amount of time (typically 2-5 years) to ease the menopausal transition. Some women may not be candidates for HRT, so it is important to discuss the risks and benefits with your doctor.
There are also non-hormonal ways to treat hot flashes—the most common is with SSRI medications. These medications help to stabilize the vascular system to prevent the flushing and sweating many women experience. SSRIs are antidepressant medications; however, we often use them in much lower doses to alleviate these symptoms.
Vaginal dryness and pain during intercourse can be treated with over-the-counter lubricants or prescription vaginal estrogen creams, tablets or rings.
Many women find they have difficulty getting and staying asleep during this time. Meditation and changes to your bedtime routine can help with sleep issues, but you should talk to your doctor if these issues persist.
Are there other health issues I should be concerned about during menopause?
It is important to identify any medical conditions that can mimic menopause and/or co-exist and treat them appropriately. Thyroid disease or imbalance can cause menstrual irregularities that mimic those occurring during menopause.
Cardiac disease is also more common in post-menopausal women. “Typical” symptoms of heart disease can include chest pain, shortness of breath, arm or jaw pain, and a sweaty feeling. It is important to note that women often present with symptoms different from men—a vague sense of “feeling unwell,” nausea and anxiety.
Many women regularly see their OBGYN throughout their reproductive years for annual gynecological exams, Pap tests and contraceptive visits. We often perform annual screenings for other medical conditions (thyroid, cholesterol, depression, etc.), but it is extremely important to get plugged into a primary care clinician to manage existing and developing medical conditions, and ensure you are up to date with immunizations and screening tests.
Can lifestyle changes help alleviate symptoms?
It’s important to maintain a healthy lifestyle as you approach menopause—eat a well-balanced diet and exercise at least 3 times per week. Limit your alcohol intake and don’t smoke. Smoking increases the risk of fractures in menopausal women.
When will menopause end?
The menopausal transition can last 2 to 8 years, but menopause is a natural process, and there is no definitive age at which it ends. If you’re having symptoms that are impacting your quality of life, you shouldn’t to ignore them. Talk to your doctor about what you’re experiencing and discuss your options.
The bottom line?
Just because menopause is a natural biological process doesn’t mean you need to suffer. Talk to your doctor about your symptoms and the tools you need to navigate menopause with confidence.
