Q+A ON MENOPAUSE

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By Lisa Larkin, MD, FACP, NCMP, IF Founder and CEO, Ms.Medicine

As we close out October, Menopause Month, we thought we’d answer some common questions about menopause.

What is Menopause?

Menopause is an important, although sometimes unwelcome, milestone in a woman’s life that includes physiologic changes due to the significant change in hormone levels and marks the end of fertility. At menopause, the aging ovaries become inactive; estrogen and progesterone production dramatically decline, and ovulation ceases. Menopause is defined as no menstrual bleeding for 12 consecutive months. It is the decline in hormone levels, specifically low estradiol levels, that result in the common menopause symptoms of hot flashes and night sweats that occur in 85% of women. In the US, the average age of menopause is 51.

What is Perimenopause?

Perimenopause is the transitional period of time prior to menopause and a woman’s final menstrual period (typically 4-6 years) marked by inconsistent hormone production from the aging ovaries and declining fertility. Many women are symptomatic during perimenopause and note irregular periods, a change in menstrual bleeding (heavier or lighter) and in the late perimenopause, intermittent hot flashes and night sweats.

How is perimenopause/menopause diagnosed?

Laboratory testing is generally not indicated or necessary to confirm if a woman is perimenopausal or is post-menopausal. The diagnosis is a clinical one, based on a woman’s menstrual history and symptoms. In post-menopausal women, estradiol levels are consistently low, but measurement is generally not indicated. In the perimenopause, laboratory tests can be misleading, as hormone levels are highly variable, and can change day to day. In some women, such as those who have had a hysterectomy or a uterine ablation, when menopause can’t be defined by 12 months of absent bleeding, laboratory testing to confirm menopause may be helpful.

I just keep gaining weight. What can I do?

A healthy diet is important at any age, but for mid-life women, proper nutrition along with regular exercise is more important than ever.

All of us tend to gain weight as we age due to decreased activity and loss of muscle mass. Unfortunately, we find that the calorie counts that worked for us in our younger years are likely too high as we get older. For menopausal women, the decrease in estrogen leads to a shift of fat to the mid-section. Obesity, especially this deeper “belly fat” obesity, has been linked to serious health conditions such as certain cancers, heart disease and type 2 diabetes.

Following a Mediterranean-style diet that is rich in fruits and vegetables, legumes, fish and low-fat dairy – combined with regular physical activity—can help menopausal women maintain a healthy weight. And eating a diet high in vegetables and fruits has been shown to reduce the risk of breast cancer and other cancers.

What about my mood swings?

Many midlife women experience mood swings, occasional depressed mood and even prolonged periods of depression. In particular, the perimenopause period is considered to be a “window of vulnerability” for depressive symptoms and major depression, for a number of reasons.

Fluctuating hormones, as well as other physiological changes during perimenopause, such as hot flashes, insomnia and low libido, can all contribute to a depressed mood. Additionally, changes associated with aging, such as “empty nest” issues or the stresses of caring for an aging parent, also may impact a midlife woman’s mental state. Women who experienced a depressive episode earlier in life are also more susceptible to experiencing depression during perimenopause.

Fortunately, there are treatments. For mild mood swings and occasional depressed moods, research suggests exercise, healthy diet, and stress-reducing techniques such as mindfulness and yoga or other activities can help improve moods. Research also shows that for some perimenopausal women, low-dose oral contraceptives (estrogen-progestin combination) can help stabilize hormone levels and help mood swings (smokers over 35 should not use oral contraceptives.) Lastly, for severe depression, anti-depressants might be effective.

Talk with your healthcare provider about your mental health, especially if your depression is prolonged and severe.

My doctor never asks me about menopause symptoms. How can I start a conversation with him/her?

Menopause and women’s sexual health, unfortunately, are not addressed regularly in today’s healthcare setting. Many patients—and providers—avoid discussions about these topics because they are embarrassed, feel uncomfortable, or in the case of many providers, lack the training and knowledge to address women’s sexual health concerns.

Fortunately, today more than ever, women and their providers are beginning to recognize that sexual health is an important part of overall health. If you would like to discuss your sexual health with your physician, there are things you can do to address your needs.

  1. Prepare a phrase in your mind to help raise the subject in a way that’s comfortable for you. “Doctor, I would like to address a personal issue today” or “Doctor, I’m experiencing symptoms I’d like to discuss.”
  2. Be specific, then, about your concerns. “I’m experiencing pain during sex,” or “I’m concerned about my sexual health and my lack of desire.” The more specific you can be about your symptoms or concerns, the more specific the treatment your doctor can provide.

Use other resources to help guide the conversation. Read a magazine article about menopause symptoms that illustrates your concern? Bring it. Had a conversation with your friend that raises questions about your own experience? Take some notes while the conversation is fresh and bring them with you to discuss at your appointment.

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