Understanding and Managing Menopause
Menopause is a natural bodily condition that brings with it sudden and often unexpected changes that can impact both physical and mental health. As a result, many patients feel reluctant to talk about it.
Menopause is a normal, natural event associated with reduced functioning of the ovaries, resulting in lower levels of ovarian hormones, primarily estrogen, marking the permanent end of menstruation and fertility. It typically occurs when a woman is in her 40s or 50s. The final menstrual period can be confirmed after 12 consecutive months without a period.
Raising awareness of menopause is important to highlight where women can go to obtain support, discuss their options, and not feel alone. The first step is understanding what menopause is.
There are Four Stages of Menopause.
- Stage 1: Premenopause is characterized by no menopausal symptoms and regular menstrual cycles.
- Stage 2: Perimenopause can begin 7 – 10 years before menopause and is characterized by the beginning of hormonal fluctuations, irregular menstrual cycles, mild hot flashes, and mood swings.
- Stage 3: Menopause is defined by no period for 12 consecutive months as the ovaries have stopped producing eggs. It occurs at an average age of 51. During this 12-month period (and beyond), it is common to experience symptoms such as night sweats, hot flashes, insomnia, mood swings/irritability, and vaginal dryness.
- Stage 4: Post-menopause is the period after one year since the last period. This is when a new “normal” arises. During this period, women may still be experiencing all the intense symptoms of menopause or, if lucky, symptoms may begin to mellow out.
Symptoms of Menopause
During stages 3 and 4 many women will experience the most bothersome, life-disrupting symptoms. The loss of estrogen is associated with vasomotor symptoms including:
- hot flashes/night sweats
- vaginal dryness
- sleep disturbances
- mood changes
- bladder issues
- bone loss
- weight gain
- skin and hair changes
- headaches
- joint pain
For some women, these symptoms are mild, and they do not feel compelled to seek help. Many women have come to believe that they should just tolerate these physical changes and “just get through it.” Many others want to let their bodies go through the process naturally, while some may want help to address their discomfort and questions.
Hormone Therapy (HT)
Hormone therapy for menopause, also known as menopausal hormone therapy or hormone replacement therapy, is a medical treatment that replaces the hormones estrogen and progesterone in a woman’s body after menopause.
Deciding to begin hormone therapy should be a discussion with your healthcare provider that encompasses past medical history, family health history, current medical issues, symptoms of concern, and all potential benefits and risks.
NAMS (North American Menopause Society (NAMS), menopause.org ) has provided clinicians with a position statement on hormone therapy that helps to guide practice decisions and stratifies risks to benefits of all available therapies to date.
In short, HT is best started within 10 years of menopause and younger than 60 years of age.
In general, the benefits of HT generally outweigh the risks. Hormone therapy might slightly increase risk of stroke or blood clots (especially if taken in pill form); therefore, transdermal is preferred for most women. If you have a uterus, estrogen must be taken with progesterone, and there is no increased risk of cancer of the uterus. HT (combined estrogen and progesterone) might slightly increase risk of breast cancer if used for more than four to five years. Using estrogen alone (for women without a uterus) does not increase breast cancer risk at seven years but may increase risk if used for longer. Some studies show that HT might be good for your heart if started before age 60 or within 10 years of menopause; however, after age 60, HT might slightly increase your risk of heart disease.
It should be noted that epidemiologic studies have consistently found an increased risk of breast cancer with increasing alcohol intake. Moderate alcohol intake (defined as one drink or less per day) has been linked to an approximate 30 – 50% increased risk of breast cancer (McDonald, 2013).
Non-hormonal Treatments
There are many non-hormonal options available that may be the best option based on a personal health history/family risk factors. These include pharmacologic treatments and cognitive behavioral therapy to address vasomotor symptoms of menopause.
Keep in mind that the first step is addressing the pillars of optimal health: quality sleep, anti-inflammatory diet, daily movement/exercise, and stress management. If these issues are not being addressed proactively then it will be quite difficult to achieve a good response from any of the treatment options.
- Sleep: Improving sleep quality may require hormone therapy but not necessarily. This can be addressed with good sleep hygiene practices and, when needed, medication.
- Nutrition: Adhering to a low-processed food, low-refined carbohydrate diet that is high in fiber and quality protein will do wonders for energy and body weight concerns.
- Exercise: Walking and strength training during this time of life is essential, as muscle that is not actively maintained is gradually lost, and with it, metabolism slows further unwanted weight gain.
- Stress management: Meditation, journaling, crafting, yoga, and playing music can help regulate the nervous system and manage stress.
Where to Find Help
Begin by educating yourself about your options by reviewing credible sources of information. One source of evidence-based, non-biased information is the North American Menopause Society (NAMS), menopause.org, a multi-disciplinary, nonprofit professional organization that provides a forum for evaluation of all scientific research with a focus on menopause. NAMS offers the information one would need to make a thoughtful, informed decision with patient education resources as well as a directory of certified menopause specialists nationwide. The website offers information for patients and professionals.
Learn more about menopause and don’t hesitate to talk to your primary care provider or gynecologist about menopause symptoms and treatments.
Linda McMurray, APRN, FNP-C, Community Health Rutland.
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