Women and their healthcare providers sometimes speak of “treating” menopause – defined as the time when a woman has not had a menstrual period for a full year — as though it were an illness or disease when, in fact, menopause is a completely natural life transition. That said, there are some physical challenges that arise around the time of menopause that may prompt a woman to seek advice from her health care provider.
According to Cortez gynecologist Daniel Bohle, MD, the average age of menopause for a woman who has not had a complete hysterectomy (which surgically induces menopause if the ovaries are both removed) is between 51 and 52, but it varies. “I’ve seen women not go through menopause until their late 50s, but if it happens before age 40 we call it premature menopause,” said Bohle. “If a woman goes through menopause and then begins to have periods again, that’s called post-menopausal bleeding and we have to investigate.”
Women are born with a defined number of eggs in their ovaries. During the reproductive years (except for when a woman is pregnant) each month a couple hundred eggs develop. All of those disappear naturally except for one that reaches the stage for ovulation, which is when pregnancy can occur.
“Back when women used to have 12-18 children, menopause would occur later because they had so many eggs left over, but many of those women didn’t live long enough to reach the age of menopause because of all the childbirths,” said Bohle.
The physical signs associated with menopause are related to a drop in hormone levels in a woman’s body. The ovaries produce estrogen and progesterone and around the time of menopause those levels decrease. Peri-menopause, the few years leading up to official menopause, are when most women begin experiencing some of the challenges associated with reduced hormone production.
The most common symptom of peri-menopause is hot flashes (also called hot flushes).
“About 80 percent of women will have hot flashes and they usually continue from one to five years,” said Bohle. “When they occur at night they’re called night sweats and this can be a big problem because of the sleep disturbances.” Even women who don’t wake up or remember having night sweats may find themselves tired and moody during the day because they haven’t gotten a good night’s sleep.
Hot flashes typically last 2-4 minutes and produce perspiration, heart palpitations, and sometimes fleeting anxiety. Natural remedies such as soy and black cohosh help reduce hot flashes in a few women, but according to Bohle, the majority of women don’t get relief using this approach.
During the peri-menopausal phase, a woman’s periods often become irregular. Women who are sexually active should continue to use birth control during this time because, while rare, pregnancy can occur in the late 40s.
“If a woman has uterine fibroids, sometimes they’ll grow and bleeding will become heavier during peri-menopause,” said Bohle. The good news is that once menopause occurs, fibroids usually shrink or no longer cause problems.
Other concerns that may arise around the time of menopause include:
Weight gain: Watch your diet and get plenty of exercise to curb middle-age spread.
Depression: A low-dose antidepressant and regular exercise may help.
Vaginal dryness resulting in painful intercourse and an increased incidence of bladder infections: Over-the-counter lubricants or low-dose locally applied hormone cream can reduce dryness.
Skin changes: Step up your use of moisturizers and always use sunscreen to maintain a healthy complexion.
Bone loss: Hormone replacement therapy may be recommended for this condition.
If peri-menopausal symptoms are severe (i.e., disrupting daily life or sleep patterns to the point of being intolerable), Bohle often recommends hormone replacement therapy. Most women going on replacement therapy will receive a combination of estrogen and progesterone in one of several forms — oral medication, patches, creams, or sprays. Patients who have had their uterus removed surgically need only estrogen.
Hormone replacement therapy is intended for short-term use and only when symptoms are problematic.
“We give them for hot flashes, night sweats that are disrupting sleep, significant vaginal dryness, and for bone protection,” said Bohle. “We tend to start therapy at around 50 or 51 and taper it off after five or so years.” If a woman wishes to continue hormone replacement therapy longer-term, she should discuss the benefits versus the risks with her health care provider.
Synthetic and bio-identical hormone therapy provide the same benefits, but Bohle said bio-identicals in transdermal form, absorbed through the skin, can produce a more steady level in the body and be used in lower doses.
“Bio-identical is what the ovaries used to produce,” said Bohle.
He warned, however, about getting bio-identicals from compounding pharmacies.
“These pharmacies are not well-regulated and, for example, women may not be warned about taking estrogen alone,” said Bohle.
If peri-menopause is presenting you with some of challenges you’ve read about here, take comfort knowing that life does eventually return to normal. Keep in mind the many positive aspects of being beyond menopause: no more periods, no worry about an accidental pregnancy, no more breast tenderness, shrinking fibroids, reduced incidence of migraine headaches, and the end of annoying cyclical mood swings and pimples.
Consult with your doctor or other health care professional if you’re concerned about any of the issues you’re dealing with related to menopause.
“Some women – or their husbands – think they’re going a little nuts around menopause,” said Bohle. “I encourage them to come in and talk about their symptoms and get some reassurance.”
Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health care provider.
