Menopause, strictly speaking, is when you stop having periods, but it is usually identified once it has been a year since your last period. When you've reached menopause, your body's hormonal mix shifts. Both men and women produce the female hormone estrogen and the male hormone testosterone. At menopause the ovaries begin producing more testosterone and less estrogen, and their egg production shuts down.
The changes in hormone levels begin before a woman has her last period and can cause a range of physical symptoms, including hot flashes, vaginal dryness, and sleep problems. For many women, this natural shift in the body passes with little notice. For others, including those who've had ovaries removed surgically, menopause symptoms can be dramatic.
The heat is on
Most people think of hot flashes when they think of menopause, and it's certainly among the hallmark symptoms. Here's a typical description: Suddenly you're way too hot and feel as though someone turned up the thermostat. It's not just a little bit, but like the Sahara desert in mid-summer. You might turn red in the face and chest and may perspire a little bit or be drenched in sweat. Some women may also experience heart palpitations and a feeling of anxiety along with a hot flash. Hot flashes can come and go quickly or last many minutes. One woman in San Francisco described a routine at home of opening the freezer and laying her head down on the frozen peas "until the hot flash passed." The intensity of a hot flash, how it affects each woman, how often, and where it strikes first on the body varies.
One survey found that women experienced hot flashes at different times of day and night. There was also a huge range in the number of hot flashes experienced daily. One woman clocked in 241 hot flashes over a two-week period. On the other end of the scale, another woman reported just two hot flashes in that same two-week period. The Harvard Women's Health Watch reported on a study of menopausal women which found that they experienced hot flashes for an average of more than five years -- much longer than previously thought.
To help manage hot flashes, try avoiding hot and spicy foods, caffeine, and alcohol -- they can trigger hot flashes for some women. Yoga, meditation, or other relaxation techniques may help, too. If you smoke, you have another good reason to stop -- those cigarettes may be contributing to your hot flashes.
Another typical symptom of menopause is difficulty sleeping. At a menopause support group at St. Mary's Hospital in San Francisco, women jokingly referred to the hours between 3 and 5 a.m. as their "alternate coffee klatch time," since several of them seemed to be wide awake during those hours. Between 35 and 60 percent of postmenopausal women have wrestled with sleep problems, according to a review of menopause studies by a panel of experts at the National Institutes of Health (NIH). Some studies suggest that night sweats -- the middle-of-the-night version of hot flashes -- may be one of the reasons that menopausal women awaken at night and can't get back to sleep, but the evidence on this link is unclear.
If you have trouble sleeping, here are a few things that may help: Cut back on caffeine, especially before bedtime, and get some exercise every day. Try relaxation techniques such as deep breathing, imagining a peaceful, sleepy scene, or progressive muscle relaxation. You can probably find relaxation tapes and books at your local bookstore.
Studies also show that after menopause many women experience vaginal dryness and pain or discomfort with sexual intercourse. Researchers have linked the changes in vaginal cells they observe under a microscope with lower estrogen in women who experience this complaint. With less estrogen, the tissue in and around the vagina becomes thinner, which could also cause discomfort or pain during sexual intercourse. In a study of more than 1,000 postmenopausal women, half reported problematic vaginal dryness, a third reported itching, and 40 percent of sexually active women reported painful intercourse.
Vaginal dryness becomes more of a problem over time. A study of nearly 5,000 Swedish women revealed that the highest rate of symptoms of vaginal dryness was 22 percent among women several years after menopause, compared with only 11 percent among premenopausal women.
Over-the-counter vaginal lubricants such as Astroglide or K-Y jelly can help with vaginal dryness. If they don't do the trick, talk to your doctor about whether vaginal estrogen may be right for you.
Estrogen helps maintain healthy bones, so it makes sense that the slowdown in estrogen production that occurs in menopause can be unwelcome news for your bones. According to the National Institute on Aging, women lose more bone than they replace during menopause. In time, this could result in weakened, brittle bones that are characteristic of osteoporosis. Your doctor can tell you if you should have a bone density test to gauge your risk of osteoporosis and can give you some tips on how to prevent or treat it.
Is it menopause or aging?
Science is still trying to grapple with which symptoms are the result of menopause and which are signs of aging. For example, women may notice that they gain weight in their bellies around the time of menopause, but men also suffer from middle-aged spread. Is it hormones or is it simply that people's metabolisms slow as they age or that many people don't move around as much in middle age as they did in their 20s or 30s, while eating the same amount of food -- or more.
Some women sail through menopause without a blip, while for others the physical symptoms -- whether attributable to menopause itself or aging -- can be pretty unpleasant at times. Getting plenty of exercise and eating a balanced diet can help you stay healthy and ease the way into your later years -- and may even lessen the severity of some menopausal symptoms. But if you feel overwhelmed and in need of some relief, ask your doctor or pharmacist for advice.
Love, S. and Lindsey, K. Dr. Susan Love's Menopause & Hormone Book. Three Rivers Press.
The Boston Women's Health Book Collective, Our Bodies, Ourselves: Menopause. Simon and Schuster, New York.
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National Institutes of Health. National Institutes of Health State-of-the Science Conference Statement: Management of Menopause-Related Symptoms, Annals of Internal Medicine, Vol. 142, Number 12 (Part 1), pp 1003-1013.
Li,Cairu, Wilawan, Kittisak, et al, Health profile of middle-aged women: The Women's Health in the Lund Area study, Human Reproduction, 17 (5): 1379-85.
National Institute on Aging. Menopause.
Mayo Clinic. Hot flashes: Minimize discomfort during menopause.
Huang, AJ, et al. Vaginal symptoms in postmenopausal women: Self-reported severity, natural history, and risk factors. Menopause.
Average duration of hot flashes may be longer than previously thought. Harvard Womens Health Watch; Vol. 16(11): p. 7.