The following is based on a conversation with Nazaneen Homaifar, MD, MBA, FACOG, System Division Chief of Routine Obstetrics for Inova and certified menopause specialist at Inova Obstetrics and Gynecology – McLean, who shared her insights on perimenopause and menopause.
Women typically spend about 40 percent of their lives in menopause. Yet, many women – and many healthcare providers, for that matter – don’t know much about it. Since menopause defines such a significant percentage of a woman’s lifespan, it’s important to know what to expect.
The average age of menopause in the United States is 51 years old. A woman is in menopause when she has not had a menstrual period for one year. However, it makes sense to think of menopause not as a single event, but rather as the culmination of a process that can take 10 to 15 years, during which women’s bodies make less estrogen and progesterone. We call this transitional period perimenopause, when a woman’s hormones are shifting toward eventually reaching menopause. That means perimenopause symptoms can begin as early as a woman’s late 30s.
1. Perimenopause and menopause can cause a range of symptoms.
The hormonal shift that takes place through perimenopause and into menopause is like a second puberty. It can cause significant disruption at a time when women want to feel their most confident in their lives and careers. Symptoms vary and can include:
- Irregular periods
- Abnormal uterine bleeding
- Hot flashes
- Night sweats
- Decreased fertility
- Weight gain and changes in fat distribution
- Sleep disturbances
- Vaginal dryness and changes in libido
- Joint pain
- Tinnitus (ringing in the ears)
- Urinary symptoms like urinary urgency and frequency
- Changes in mood including increased irritability, anxiety and depression
- Trouble with memory and concentration (known as “brain fog”)
After the transition into menopause is complete, many of these symptoms decrease or go away altogether. However, postmenopausal women face higher levels of osteoporosis, cancer and heart disease, so it’s important to stay on top of your health both during and after menopause.
2. There are safe and effective hormonal treatments available to address menopause symptoms.
Fortunately, women don’t have to spend 10 or more years suffering with symptoms that interfere with their quality of life. There are effective treatment options available for most individuals. (Keep in mind, hormone therapy is not recommended for some patients.)
Systemic hormone replacement therapy (HRT), typically taken in the form of a pill, patch, or gel, is considered the gold standard. It’s generally a very safe, effective treatment that includes estrogen as well as progesterone (which is a hormone that helps protect against uterine cancer in people who have a uterus).
Many patients worry about breast cancer and hormone therapy, but the actual risk is low. For healthy women using estrogen and progesterone, the added risk of breast cancer is fewer than one additional case per 1,000 women per year. Taking estrogen alone may even lower breast cancer risk.
Another hormonal option is vaginal estrogen, which is localized estrogen that addresses vaginal dryness, increased risk of urinary tract infections and pain. As a localized hormone, it works differently than systemic estrogen and is very safe to use, even in patients with breast cancer.
3. Consider other treatment options, too
There is a wide variety of nonhormonal medication options for menopause symptoms as well. Examples include fezolinetant (brand name Veozah) and some antidepressants, including selective serotonin reuptake inhibitors (better known as SSRIs). Vaginal moisturizers and lubricants can also be helpful in addressing vaginal dryness symptoms.
Lifestyle changes can also have a big positive impact on reducing bothersome menopause symptoms. They include eating a diet rich in fiber and protein, engaging in exercise that includes both cardio and weight-bearing exercises to keep bones strong, practicing mindfulness, and using stress reduction techniques. Cognitive behavioral therapy, for example, has been shown to be effective in reducing some symptoms of menopause including hot flashes and night sweats.
Be wary of supplements that promise relief from menopause symptoms – they can be pricey, and we don’t have reliable data on effectiveness.
4. Expensive lab testing or saliva tests are not necessary to get treatment for menopause and perimenopause.
In many cases, we don’t need to conduct expensive tests to determine hormone levels. That’s because much of our management strategy is based on an individual patient’s symptoms, and knowing hormone levels would not change the way the patient’s symptoms are addressed. Hormone testing can be helpful in younger patients who are experiencing irregular periods or other menopausal symptoms.
5. Not everything is caused by menopause
Perimenopause and menopause cause a wide range of symptoms, some of which can be debilitating. But it’s important to remember that not every symptom an individual has is menopause related. Night sweats and joint pain, to give two examples, are common menopause symptoms that can also be caused by other common conditions.
So-called menopausal weight gain is another example that gets a lot of attention in the news and on social media. Here too, menopause might not be the only culprit. While hormonal changes during the menopause transition are significant and cause changes in fat distribution, the data does not show that menopause in itself is slowing the metabolism. Weight gain during this time period is also attributable to aging. It is likely that some people are becoming more sedentary, and symptoms, both of menopause and other conditions, may be preventing them from exercising.
6. Pay attention to mood changes, especially if you have a history of mood disorders.
For patients with a history of mood disorders such as depression, anxiety, obsessive compulsive disorder, attention deficit disorder, bipolar disorder, and others, be careful. Symptoms of these conditions can be worse during perimenopause.
Like the hormonal changes that happen during the period after childbirth, drops in estrogen can lead to a spike in mood disorder symptoms. It’s smart to plan ahead and discuss this possibility with your healthcare provider. The good news is that once menopause is complete, the symptoms should improve.
7. Arm yourself with information.
Menopause is finally coming out of the shadows, as more healthcare providers are gaining specialized training, more women are sharing their experiences, and more information is available. It can be hard to sift through misinformation and evidence-based sources. Check out free evidence-based informational resources such as the patient education available through the Menopause Society.
Another area to learn about is the impact of menopause on the workplace. One study found that 80 percent of respondents identified menopause as a major workplace challenge. During a time that can feel unpredictable, staying informed and regularly checking in with your gynecologic provider about your symptoms and their impact on your quality of life can empower you to navigate this phase with clarity and confidence.
Learn more about women’s care at Inova.
Feature image, stock.adobe.com
