What to Expect When Going Through Menopause

Menopause, also known as the "change of life," presents itself differently in each woman. While your sister may experience hot flashes and sleep problems, for example, you may be feeling a new sense of freedom and energy, and your good friend may be hardly aware of her own change. Menopause is a normal, natural part of life and aging. Technically, it is the time of your last menstrual period, but symptoms may begin several years before that point with certain symptoms lingering for months to years after. These symptoms may be caused by changing levels of the female hormones estrogen and progesterone.

This period of change is called the "menopausal transition" or "perimenopause." As mentioned above, it may begin several years before you experience your final menstrual period. Perimenopause lasts for about one year after your last period, so after one full year has passed since your last period, you can say that you have been "through menopause." Postmenopause follows and continues through the rest of your life. The average age at which women go through menopause is 51, but some women may have their last period in their 40s while others have it later into their 50s.

Smoking and certain types of surgery can lead to early menopause. Having a hysterectomy (surgery to remove your uterus) will stop you from having any future periods, which is the definition of menopause. The difference is that, after a hysterectomy, you may not experience the symptoms of menopause since your ovaries are still producing estrogen and progesterone. When your ovaries start to make less estrogen, symptoms may appear. In some cases, your ovaries may be removed with your uterus. This is called an oophorectomy, and you will have menopausal symptoms afterward-regardless of your age-since you will have had your main supply of estrogen removed.

Signs

Since estrogen plays a role in many areas of the body and menopause decreases the amount of estrogen produced, a broad range of symptoms can occur due to menopause. Here are some areas in which symptoms may appear as a result of menopause, aging, or a combination of the two:

• Changes in your period. Your period may be shorter or longer than usual, and it may not come as regularly as you're used to.


• Hot flashes. This is a sudden rush of heat in the upper part or all of your body that may wake you up from sleep and last for about 30 seconds to 10 minutes.


• Problems with your bladder and vagina. Your genital area may become dryer and thinner, making sexual intercourse somewhat uncomfortable, and you may find it harder to hold in urine as long as you used to.


• Sleep. It may become more difficult to fall asleep and stay asleep through the night.


• Sex. You may feel more or less interested in sex, and you cannot get pregnant after one full year after your last period. You can still contract STDs, so be safe and smart about sexual partners and experiences.


• ood changes. You may become more irritable due to stress, family changes, depression, or feeling tired.


• Your body seems different. You may gain weight, develop memory problems and stiff muscles and joints, and your skin may get thinner.

Other factors

Two main problems that may not be as obvious may develop as you go through menopause:

• Osteoporosis. Since estrogen has a role in controlling bone loss, the loss of estrogen during menopause causes more bone loss than can be replaced. After some time, bones can become weak and break more easily-a condition known as osteoporosis. You can talk to your doctor about getting a bone density test as well as learning about ways to prevent or treat osteoporosis.


• Heart disease. Aging and losing estrogen due to menopause contribute to a higher risk of heart disease. You may gain weight and develop high blood pressure, which increase the risk of heart disease. Have your blood pressure and levels of triglycerides, fasting blood glucose, and LDL, HDL, and total cholesterol checked regularly by your doctor. Talk to your doctor about ways to protect your heart during this time.

Staying Healthy

Staying healthy after menopause may require some changes in lifestyle, including the following:

• Do not use tobacco. If you do smoke, it is never too late to reap the benefits of quitting.


• Eat a diet low in fat and high in fiber with a lot of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.


• Get enough calcium and vitamin D to maintain healthy bones. If you do not get these through your diet, take supplements.


• Figure out what a healthy weight is for you, and make an effort to maintain that weight.


• Do weight-bearing exercises such as walking, jogging, or dancing on at least 3 days of the week to maintain healthy bones, and be physically active in other ways to maintain your overall health.

Other tips:

• If your doctor prescribes medication, be sure to take it as directed.


• If you experience vaginal discomfort, use a water-based lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet.


• Get regular check-ups that include pelvic and breast exams, Pap tests, and mammograms. It is also a good idea to get screened for colon, rectal, and skin cancer. If you notice that you have a lump in your breast or a mole that has changed, contact your doctor immediately.

Coping 

Although menopause is not a disease and should not be treated, certain symptoms like hot flashes may bother you. Some ideas for coping with such symptoms may include:

• Keep track of when you get hot flashes using a diary. This will help you figure out whether they are brought on by a specific trigger that you can begin to avoid.


• If possible, go somewhere cool when you feel a hot flash begin.


• If you have noticed that night sweats wake you, keep your room cooler and use a fan.


• Dress in layers that are easily removable if you get too warm.


• Using sheets and clothes that allow your skin to "breathe" can make you more comfortable.


• When a flash begins, drink something cold such as water or juice.  

Hormone Changes

You may have heard varying opinions as to whether you should get hormone therapy to relieve some of your symptoms. There is information to help you decide, but it may still be a difficult decision to make. While you go through perimenopause, some doctors will suggest that you take birth control pills to help with heavy, frequent, or unpredictable menstrual periods. The pill can also help alleviate hot flashes and, of course, prevent pregnancy.

If your symptoms like hot flashes, night sweats, or vaginal dryness are bothering you and interfering with your lifestyle, your doctor may recommend taking estrogen and possibly progesterone, which is referred to as "menopausal hormone therapy (MHT)." You may hear people call it hormone replacement therapy (HRT) as well. Taking these hormones can help with your symptoms and prevent bone loss due to menopause.

Although taking hormones may seem like the perfect solution, it does come with certain risks. Because of this, the FDA suggests that women use the lowest dose that works for the shortest amount of time necessary. Unfortunately, your symptoms may return as soon as you stop taking hormones. Talk to your doctor or health care provider if your symptoms have been bothering you. He or she can help you decide how to best manage menopause with the options and treatments available. You can see a gynecologist, geriatrician, general practitioner, or internist to help you, but make sure that whomever you choose is supplied with your medical history and your family medical history, which includes your risk for heart disease, osteoporosis, and breast cancer.

Remember that your decision is never final. You can and should review your choices with your doctor during your yearly checkup. You may develop different needs over time, and since the medical field is always growing, our knowledge about menopause and its treatments can change as well.

Phytoestrogens 

Phytoestrogens are estrogen-like substances found in some cereals, vegetables, legumes (including soy), and herbs. They might work in the body like a weak form of estrogen. Researchers are trying to discover whether phytoestrogens relieve some symptoms of menopause and if they might also carry some risks. Be sure to tell your doctor if you decide to try eating a lot more foods that contain phytoestrogens or to try using an herbal supplement. Any food or over-the-counter product that you use for its drug-like effects could change how other prescribed drugs work or cause an overdose.