Menopause facts

Menopause Facts and Tips to Help You Through It

Karen Deighan, MD, FACOG  

Approaching Menopause? Here’s a pep talk.

Menopause is a natural part of life. Approaching it with a good attitude and a bit of humor can go a long way in making this time of life tolerable, and even rewarding.
With that in mind, here are answers to some frequently asked questio
ns: 

What exactly is menopause? And what about perimenopause?

Menopause is the final menstrual period. Once you go 12 months without a period, we say you are post-menopausal. Perimenopause refers to the span of time before menopause when periods can become irregular and some symptoms may occur.

The average age of menopause is 51. Genetics, smoking, surgery and ethnicity affect the age of menopause. The age your mom and sisters went through menopause should give you some clues about yourself.

What are some symptoms that I might experience?

Classically, women report hot flashes, night sweats, mood changes, irritability, sleep disturbances and vaginal dryness. Weight gain is common, especially in the abdomen. You may experience none, some or all of these symptoms. How long they last is variable, but they usually do not last more than 5 years.

Why is this sometimes a difficult time of life?

Menopause coincides with a lot of other life stressors. Children may be leaving for college. Or they may be moving back home! Aging parents may need extra or even constant care. And many women are then at the peak of their professional careers, which increases stress.

So what can I do to feel good during this transition?

The best thing is to continue or adopt a healthy lifestyle. Diet and exercise are more important than ever. Start by finding an exercise you like. Walking, running, swimming and biking are all great for cardiovascular health. Yoga, Pilates or a barre class can help with the mood changes. And don’t forget to use weights to strengthen the bones.

Friends and other social relationships are extremely important as well. Talk with confidantes who are experiencing the same things. A positive attitude and time just for you can be crucial components to maintaining mental health.

I’ve tried diet and exercise, but the hot flashes and night sweats are killing me. What can I do?

In women with significant menopausal symptoms that disrupt their quality of life — such as frequent hot flashes or night sweats that interfere with sleep — hormone replacement therapy may be appropriate. Your physician usually will prescribe an estrogen — to treat the symptoms — as well as a progesterone — to protect the uterus from the effects of the estrogen. (Progesterone is not necessary if you have had a hysterectomy.)

Many years ago, women were instructed to continue the hormones indefinitely. Now, the usual recommendation is to use the lowest effective dose for the shortest period of time necessary.

Can everyone take hormone replacement therapy (HRT)?

No. Women with breast cancer, a history of a deep vein thrombosis or a pulmonary embolism, severe liver disease, coronary artery disease or undiagnosed vaginal bleeding should not take HRT.

HRT really scares me. Are there risks?

As with any medication, there are risks associated with the use of hormone replacement therapy. There may be a slight increase in the incidence of breast cancer, heart attack and stroke. There is a reduced incidence of colorectal cancer and osteoporosis.

The potential risks of the medication need to be weighed against the effects that significant menopause symptoms are having on your quality of life. In the absence of contraindications, you may choose to take hormone replacement therapy for a finite period of time.

What if I cannot take hormone replacement therapy?

There are other medications that are normally used for other conditions that are sometimes used for menopause symptoms. Antidepressants such as Effexor and Paxil may help with hot flashes as well as sleep and mood swings. Gabapentin, which is used in some neurologic conditions, may also help with hot flashes. Clonidine is an antihypertensive that also has some benefit in treating hot flashes.

Other non-medicinal strategies include awareness of triggers that may increase symptoms. Typically stress, red wine and certain foods can be culprits. Pay attention and avoid these when possible. Dress in layers. A ceiling fan and light pajamas can also be useful in limiting the sleep disruption caused by night sweats.

My friend uses bioidentical hormones. Should I?

Bioidentical hormones are thought to be chemically identical to the hormones in a woman’s body. They are usually custom-compounded in certain pharmacies. Most have not undergone stringent evaluation of effective dose and frequency by the U.S. Food and Drug Administration.

Your body will metabolize standard hormone replacement medications and you’ll end up with a similar effect. Overall, there does not seem to be a benefit to bioidentical hormones at this time.

I’m a little hesitant to bring this up, but what about sex?

Women can — and are encouraged to — continue to be sexually active through the peri-menopause and beyond. Many women actually report increased interest in sexual intimacy.

This may be due to a change in hormones, as well as situational factors. Concern about pregnancy no longer applies once menopausal. And couples may find more time and opportunities without children in the house.

It is true that vaginal dryness can become a problem, especially as more time goes by. Moisturizers and lubricants can help with this problem. If need be, vaginal estrogen also can be used to help strengthen the vaginal tissue. Regular sexual activity does a great deal to limit this problem.

The bottom line: Don’t be afraid to talk to your physician about menopause. Together you can make a game plan to make this one of the best times of your life.

Karen Deighan, MD, practices general obstetrics and gynecology and has a special interest in menopause. Dr. Deighan is an associate professor in the department of obstetrics and gynecology at Loyola University Chicago Stritch School of Medicine and chairman of the department of obstetrics and gynecology at Gottlieb Memorial Hospital. She sees patients at Loyola Center for Health at North Riverside and Loyola Center for Health at River Forest.