Your Guide to Managing Menopause

Embrace life's changes

Hot flashes, mood swings, night sweats… If you know someone who has experienced menopause, you might know these symptoms.

This life transition can be scary, but menopause is a natural part of a woman’s life cycle. Knowing what's in store can make the experience less daunting. Learn what to expect before and after menopause and how to make the transition smoothly.

Just What Is Menopause?

Menopause is the time in a woman's life when she stops menstruating. The stage preceding menopause is called perimenopause, which is when the hormones estrogen and progesterone naturally and gradually decline in production. Perimenopause can last anywhere between two and eight years.

Perimenopause often starts with irregular periods. Menstruation can occur more than once a month or stop for months before starting again. But bear in mind that conditions other than menopause, like pregnancy, anemia or even stress, may also lead to irregular periods. Consult your doctor if you start having irregular periods. Also remember that as long as you still get periods, even irregular ones, you're ovulating and can become pregnant. If you wish to prevent pregnancy, use a birth control method. When a woman goes 12 consecutive months without a period, she officially reaches menopause and is considered infertile.

There's no sure way to determine when you will enter menopause. The average age women naturally enter menopause is 51, but some women may begin the transition in their 40s, while others don't start until their mid-50s.

To estimate when you're likely to enter menopause, find out when your mother or grandmother naturally entered menopause. Why is this? Although more research needs to be done, several research studies have suggested that genetics play a significant role in determining your age at menopause. However, keep in mind that this life transition is not completely driven by genetics — lifestyle choices, such as smoking, may also impact age of menopause. Also, be aware that while most women enter menopause naturally, medical treatments that suppress your ovarian function — like surgical removal of the ovaries, some cancer treatments and certain hormonal treatments — may cause menopause. Women who have had a hysterectomy in which the ovaries are preserved will enter menopause naturally but possibly at a younger age than average.

Managing Menopause Symptoms

Every woman experiences menopause differently. Keep in mind that the severity and length of time that you experience symptoms will vary by individual. You may find that your symptoms are mild and last only a year or two, or they may continue for several years after your period has been absent for months or even years.

There are many ways to ease uncomfortable and inconvenient menopause symptoms. If your symptoms are particularly severe or are impacting your quality of life, ask your healthcare provider for help.

Hot Flashes

What they feel like: Sudden spikes in body temperature that can last for as little as 30 seconds or up to a few minutes. They can cause the skin on your face and neck to become red. After a hot flash you may start shivering and break out into a cold sweat.

What causes them: The exact causes of hot flashes are still not well understood. However, doctors believe that falling estrogen levels during menopause affect the hypothalamus, which plays a role in regulating body temperature.

What you can do: Avoid excessively warm environments, hot and/or spicy food, caffeine, alcohol and stress to reduce hot flashes. Dress in layers so you can make yourself comfortable if you feel a hot flash coming on. Keep a fan with you or drink cool water to ease your hot flashes. At night, light pajamas and cooler room temperatures may help you sleep more comfortably.

Trouble Sleeping

What it feels like: You may have difficulty falling asleep or wake up throughout the night. Hot flashes cause night sweats and can make it difficult to fall and stay asleep.

What causes it: The link between menopause and sleeplessness has not yet been clearly determined. There's some evidence that the brain experiences a withdrawal syndrome when estrogen levels drop, releasing adrenaline to spark the "fight-or-flight" stress response. When this happens at bedtime, it's very difficult to fall asleep.

What you can do: Crack open a window at night or use an air conditioner in warmer months to keep your bedroom comfortably cool. Maintain a regular sleep schedule and avoid caffeine, alcohol, large meals, working and working out close to bedtime.

Vaginal Dryness

What it feels like: An uncomfortable dry feeling that may itch or burn. Sexual activity and sexual intercourse may be difficult without artificial lubricants due to the dryness, and you might experience some light bleeding during intercourse. Finally, you may find that you are dealing with recurrenturinary tract infections (UTIs).

What causes it: Low estrogen levels cause thinning of the vaginal walls and dryness, which can make sex uncomfortable. Vaginal dryness also puts you at greater risk for vaginal infections, internal abrasions and UTIs.

What you can do: Use a glycerin-free, water-based vaginal lubricant (not petroleum jelly-based) when engaging in sexual activity or when the dryness is uncomfortable. Ask your healthcare provider for a prescription for estrogen-containing cream — applying the cream a few times per week can help alleviate symptoms of vaginal dryness.

Sexual Changes

What it feels like: Every woman reacts to menopause differently. Due to fluctuating hormones, some women develop a more active sex drive while others may experience a lower libido than is normal for them.

What causes it: Declining estrogen levels can lead to a lower sex drive, although some women discover a renewed interest in sex once their menopause symptoms fade and a sense of normalcy returns.

What you can do: If you're concerned about the sexual changes you experience during menopause, don't be afraid to ask for help. Healthcare providers help menopausal women cope with sexual changes every day. Open communication with your partner about your sexual desires also helps. Remember to protect yourself against sexually transmitted infections. Just because you can no longer get pregnant doesn't mean you're safe from diseases like HIV, chlamydia or syphilis.

Urinary Incontinence

What it feels like: You may find that you can no longer hold urine long enough to get to a restroom. Urine may also leak out when coughing, sneezing, exercising or laughing.

What causes it: Urinary incontinence is more common as people age. Bladder muscles weaken, and the bladder's capacity to store urine decreases. Urinary incontinence may occur during menopause because low estrogen levels weaken the lining of the bladder and urethra.

What you can do: Avoid alcohol and caffeinated drinks such as coffee, soda and energy drinks, as these increase urination. Ask your doctor if you are taking medication that can cause or worsen the condition. Pelvic floor strengthening exercises (such as Kegel exercises) can relieve or even cure urinary leakage. A healthcare practitioner can teach you the proper way to do them.

Mood Swings

What they feel like: Sudden changes in your mood, frequent bouts of irritation, or crying spells are all symptoms of mood swings. If you became moody around your period you may experience similar feelings when in menopause.

What causes them: Fluctuating hormone levels cause mood changes around your period and during perimenopause. Other menopause symptoms can aggravate mood swings.

What you can do: Learn how to manage stress. Track the presence and severity of your mood swings as you go through menopause to see if there are any unpleasant triggers you can avoid. Get enough sleep and physical activity. See a healthcare professional if you think you may be depressed.

What About Hormones?

Some women opt for menopausal hormone therapy (MHT) to relieve their menopause symptoms. Formerly called hormone replacement therapy (HRT), MHT involves taking estrogen for women who have had their uterus removed or both estrogen and progesterone for women who still have their uterus. A doctor must prescribe these medications. Given the vast number of medications on the market, your doctor will prescribe the right type and dosage for your specific symptoms.

While hormone therapy can work wonders for your symptoms it also carries some risks. Side effects range from inconvenient to possibly life-threatening. Some women report breast tenderness, cramping, bloating, spotting or their periods coming back while on MHT. Studies have also found that certain forms of MHT can increase a woman's risk for heart disease, blood clots, stroke and breast cancer, and that taking MHT at 65 years or older can increase one's risk for dementia. Women who have or had breast or uterine cancer or liver disease; have had a stroke, heart attack, blood clots or vaginal bleeding; or who think they might be pregnant should not take MHT.

There are claims that bioidentical, or so-called natural, hormones made using plants and compounded by a pharmacist are better for the body, but there are no reliable scientific studies that have proven their efficacy and safety. In addition, be aware that these types of hormones are not regulated by the FDA. There are drug companies who use plants to make FDA-regulated hormones that are chemically identical to the body's natural hormones. Ask your doctor if this option is available to you.

Overall, the FDA recommends that women take the lowest effective dose of hormones for the shortest amount of time possible to relieve their menopause symptoms.

Visit the Department of Health and Human Services' National Institute on Aging and the womenshealth.gov topic on menopause hormone therapy for more information on MHT.

Staying Healthy After Menopause

Once menopause is over, you can say goodbye to the monthly bloating, cramping and other PMS symptoms that accompany periods, and welcome in a new phase of your life! Here are some tips to stay healthy in your 50s and beyond:

Keep up with doctor's appointments and have your essential health tests and screenings done on time.

Try to get at least two and a half hours of moderate exercise a week, and two days of strength exercises. Find an activity you enjoy so you can do it consistently.

Quit smoking and drink alcohol moderately.

Maintain a healthy diet of whole grains, lean meats and colorful fruits and vegetables, and try to keep meals low in fat and cholesterol.

Learn different techniques to manage stress>, like meditation. Keeping a healthy social life can also keep your spirits up.

Lower levels of estrogen in your body can put you at risk for osteoporosis, a disease that causes brittle bones and increases your risk for fractures. To help keep bones strong, you need adequate amounts calcium and vitamin D. Women need at least 1,000 mg of calcium per day up to age 50, and 1,200 mg of calcium per day after age 50, and 600 IU (international units) of vitamin D daily up to age 70, and 800 IU daily after age 70. You can also ask your doctor about medicines that can help slow down bone loss.

Eirish Sison is a health writer based in the San Francisco Bay Area.

Reviewed by Shira Goldenholz, MD, MPH on June 10, 2014

Sources

https://womenshealth.gov/menopause/menopause-basics/index.html#b

https://www.uptodate.com/contents/absent-or-irregular-periods-beyond-the-basics

https://www.cpnonline.org/CRS/CRS/pa_menstrua_pep.htm

https://www.mayoclinic.org/medical-edge-newspaper-2011/sep-16a.html

https://www.mayoclinic.org/diseases-conditions/menopause/basics/definition/con-20019726

https://womenshealth.gov/menopause/menopause-basics/index.html#a

https://www.ncbi.nlm.nih.gov/pubmed/20071357

https://www.ncbi.nlm.nih.gov/pubmed/22695707

https://womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.pdf