Menopause: Head to Toe
Menopause is not a matter of if, but when.
Your grandmother experienced it, as did your mother. And you may be in the midst of it right now.
Still, you might be uncertain about precisely what to expect from this phase of your life — in part because myths about menopause are as plentiful as accurate information.
Often women approach menopause with unnecessary wariness. “Many see it as the start of something disruptive,” says Barbara Soltes, MD, a gynecologic endocrinologist at Rush University Medical Center.
“It doesn’t have to be that way,” she says. “Symptoms are often only temporary, and they can be controlled.”
And while some women see menopause as an unwanted reminder of aging, many others report feeling more confident and empowered than in their younger years, says Soltes.
Even the very definition of menopause might surprise many women. “You are not menopausal until your periods have stopped for 12 consecutive months. It can only be defined retrospectively,” Soltes explains.
This 12-month milestone is a pertinent detail if you want to avoid an unplanned pregnancy, says Soltes. Until you have stopped menstruating for a full year, you may still be able to conceive.
On average, women in this country experience menopause at age 51. But for a more personalized prediction, talk to your mother: “Typically, mothers and daughters reach menopause at roughly the same age,” says Soltes.
That’s unless, of course, either one has a “surgical” menopause — occurring immediately after a procedure in which both ovaries are removed.
More information, please
One of the most important things to know about menopause is that there is advance notice. On average, about four to six years before menopause, women enter a time of transition called perimenopause. During this period of hormonal flux, estrogen levels gradually decline, triggering a number of physical changes.
One common change is menstrual irregularities. For most of their premenopausal years women generally can count on fairly regular periods. But all that changes in perimenopause.
Periods may become lighter, heavier, shorter or longer. Late in perimenopause, you may even skip periods. “But don’t be surprised if you miss several cycles only to start menstruating again,” says Soltes. Any pattern is possible as you transition into menopause — as is no pattern.
Still, certain menstrual irregularities may be a warning sign of endometrial cancer and require a doctor’s immediate attention, Soltes says. These include:
- Vaginal bleeding after intercourse
- Bleeding between periods
- Postmenopausal bleeding — vaginal bleeding after 12 continuous months without periods
Hot flashes and other symptoms
Hot flashes and their nighttime counterparts, night sweats, are another indication of perimenopause, meaning it is possible to have hot flashes and periods simultaneously.
Altogether, about 75 percent of women experience hot flashes, generally for two to five years before they taper off, says Soltes. These sudden surges of heat, sometimes accompanied by a rapid heartbeat, can last from seconds to minutes.
While some women easily tolerate hot flashes, others find them extremely uncomfortable, even debilitating. Women who have both ovaries removed during a hysterectomy — resulting in an abrupt loss of estrogen — invariably have severe and frequent hot flashes unless they use hormone therapy.
As estrogen levels decline during perimenopause, women may also experience:
- Vaginal dryness, which may make sex uncomfortable
- Difficulty falling or staying asleep
- Mood swings, memory lapses and problems concentrating
Know your options
Symptoms often can be managed fairly simply. For vaginal dryness, over-the-counter vaginal lubricants and suppositories that release estrogen locally can help.
Certain antidepressants or a change in diet (such as avoiding spicy foods or caffeine) may help reduce hot flashes, according to the National Institutes of Health (NIH). Regular exercise can help improve your mood and memory; and provided it is not too close to bedtime, exercise can help you sleep better as well, as can avoiding caffeine and large meals.
Most important, if your symptoms are difficult to manage, remember that effective treatments exist. Talk to your doctor to find one that works for you.
“More than ever before, women have choices about managing menopause,” Soltes says.
Hormone therapy: The latest thinking
In 2002, a long-term study sponsored by the NIH, the Women’s Health Initiative (WHI), stunned many women by finding that a common hormone therapy did not protect against heart disease — as many believed — and actually increased the risk for several health problems, including breast cancer, heart attacks and stroke among some women.
“When it comes to hormone therapy, there are risks and benefits that each woman must consider in light of her own family history and health,” says Lynda H. Powell, PhD, co-principal investigator of the WHI at RUSH. RUSH is one of 40 U.S. centers participating in the study.
The WHI cautions that if you choose to use hormone therapy, do so for only a short time and in the lowest dose that helps — and check with your doctor regularly to see if you still need it.
Most women will live about a third of their lives after menopause. Do your best to make your postmenopausal decades healthy — and happy — ones. Blurb: For new findings from the SWAN* study at Rush on a woman’s increased risk for cardiovascular disease during the transitional years, visit www.rush.edu/discover. *The Study of Women’s Health Across the Nation (SWAN) is a multiethnic, interdisciplinary study of women’s health during their middle years.
Read more about caring for yourself in “Stay Strong and Protect Your Health After Menopause.”
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- Looking for more information on care for women's health issues at Rush? Visit our Women’s Health Services home page.
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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.
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