Better than you expect
You've made it this far, and that's a good thing. "There are ways to be comfortable through menopause, with treatment and lifestyle changes," says Rebecca Mendoza, a certified nurse practitioner at the Menopause Center of Minnesota. "It isn't a time to be miserable -- women do well." Menopause can be disruptive, though. Hot flashes are real, and shifting hormones can affect your sleep, sex drive, bone mass and mood. Even so, menopause is better than people expect, Mendoza says -- and support and solutions are out there. Here are 11 changes to expect:
Perimenopause: the beginning
The transition leading up to menopause, called perimenopause, is when the ovaries start producing less of the hormones estrogen and progesterone. It typically starts in women's 40s, but they can notice changes in their mid- to late 30s. Menstrual periods may get heavier or clottier, and crampy. Irregular periods are another early sign. However, women can still become pregnant in this phase. "We always recommend that women use some form of contraception for at least one year after their last period," Mendoza says.
Hormone fluctuations in menopause can lead to mood changes similar to premenstrual symptoms, says Dr. Lucy Puryear, medical director of The Women's Place -- Center for Reproductive Psychiatry at Texas Children's Pavilion for Women. "Women are feeling more irritable, more sensitive, more tearful," she says. Women don't need to hear hot-flash jokes, she says. Instead, kindness and compassion from friends and family help support women through this natural -- but challenging -- process.
Hot flashes and night sweats
"As the estrogen levels decline, the brain's ability to regulate your body temperature needs to get readjusted," Puryear says. "So women will have hot flashes and feel really hot." Hot flashes aren't just in a woman's head, she emphasizes -- they're bona fide physical symptoms. Cooling blankets and pillows may promote sleep for women with night sweats.
Hormone therapy can ease many symptoms of menopause. Systemic estrogen products are effective for night sweats and hot flashes, while low-dose estrogen products treat vaginal symptoms such as itching, dryness and discomfort during sex. Depending on whether women have had their uterus removed, progesterone is often prescribed along with estrogen. Natural hormone products are safer than synthetic forms, Mendoza says. Because of potential side effects, hormone replacement is a decision to make after careful consideration and discussion with your health care provider.
Clinicians are more cautious about prescribing hormone replacement than in the past. In 2010, results released from the Women's Health Initiative, a major 15-year study, showed health risks from hormone therapy in older postmenopausal women, including heart disease, stroke, blood clots and breast cancer. Since then, some research suggests hormone replacement may be safe for many women, depending on various risk factors like age. For instance, a large Swedish study suggests women who start hormone therapy early in menopause may reduce their risk for heart disease.
Menopause is tied to aging in a very concrete way. "For all women, it's such a marker of time when you stop having a period," Puryear says. "Men also age and have a transition, but they don't have a biological marker." Many women start to feel they're aging, she says -- physically, in terms of reduced sex drive and with changes in their role. Keeping a sense of humor and talking openly about menopause without shame or embarrassment can help women embrace this new phase, Puryear wrote in a recent blog.
During perimenopause, some women feel they're thinking less clearly, Mendoza says, and it's harder for them to come up with names and numbers. "Women will say, 'I used to be able to multitask at work -- and now I can walk out of a meeting and not even remember what I'm supposed to do or what we talked about,'" she says. "Estrogen helps with that; keeping you sharp." Some patients tell Mendoza they intend to stay on hormone therapy until they retire. Issues vary widely from woman to woman, she notes.
Depression and anxiety
Mild depression or anxiety symptoms aren't uncommon with menopause, Puryear says, and hormone therapy can be "really helpful." Research suggests that falling estrogen levels may affect brain receptors for serotonin, a chemical that helps regulate mood. With more severe depression symptoms, she says -- "crying all the time, lack of energy, not being able to function, a real hopelessness" -- antidepressants are needed. "There's some research that, in women who are having depression around the time of menopause, the combination of hormones and antidepressants together work better than either one alone," she adds.
Libido can take a hit from menopause for many reasons, Mendoza says. It's not always hormonal -- long-simmering relationship problems can erupt during this time of change. In her pratice, Puryear says, "I tend to talk to women a lot about sex, because [they] get underrepresented in terms of treatment for and help with their sexual needs. It's probably not going to be as frequent or intense as it might have been in your 20s, but sex still ought to be pleasurable and enjoyable -- and it's not just about men getting a Viagra or Cialis pill."
With estrogen loss, women can have low bone mass and an increased risk of osteoporosis. "The most rapid bone loss is the first five to seven years post-menopause," Mendoza says. She likes to order DEXA scans to gauge bone strength early, when women are about 50, insurance permitting. At any age, you can take preventive steps by getting enough calcium -- preferably from diet, not supplements. Mendoza recommends vitamin D supplements to help absorb calcium and build bone. Exercise -- weight-bearing, resistance, yoga, aerobics and cardio -- helps preserve bones and joints, with a mood-boosting bonus.
Opportunity and celebration
Menopause occurs at a time when many women are re-evaluating their meaning and role in life, as children leave home and families change. "The good news is, it's a time of your life when you can kind of reinvent yourself," Puryear says. For instance, you could pursue a different career, take up a new interest, volunteer or become a force for community change. "There are lots of opportunities in your 50s, 60s, 70s and onward that you didn't have in your 20s, 30s and 40s," she says. "I think menopause needs to be celebrated."