What is Menopause?
It’s more than just hot flashes and the absence of periods
I take care of a number of women in various stages of menopause in my practice as a direct primary care physician at ImagineMD. Those who aren’t in menopause yet but who are about to enter it have many of the same questions and concerns as women already past it.
Women don’t enter or exit menopause according to a rigorous schedule. Also, the kinds of symptoms menopause causes can be quite different from one woman to the next. For these reasons, you should discuss any symptoms you’re experiencing that you think might be due to menopause, whether they’re physical or emotional, with your doctor. He or she should be able to help you through this very normal process.
Menopause is defined as 12 months of amenorrhea, meaning not having a period, without any other cause. Most women experience menopause around 51. Menopause before the age of 40 is considered to be abnormal, so if you’re under 40 and having symptoms you’re attributing to menopause, you should immediately bring them to your physician’s attention. The term “perimenopausal” is used to describe women who are transitioning into menopause. The average age at which this occurs is 47, but it’s highly variable. Most women who’ve had regular periods in the past will find the interval between their periods extending beyond the normal range of 25-35 days. Their periods may now occur every 40-50 days and then will skip months. It’s important to recognize that your periods will become irregular as you approach menopause.
Many of my patients will ask for blood tests to confirm that they’ve entered menopause. I typically recommend against this as such tests are unreliable. A diagnosis of menopause can be made on the basis of symptoms alone. Symptoms of menopause can include hot flashes, mood changes, and vaginal dryness. Hot flashes are the most common symptom and are reported as a periodic slight warming of the face at one end of the spectrum and as profuse sweating at night that soaks the bed sheets at the other end. Up to 80% of women will have hot flashes at some point while they go through menopause. Hot flashes last over one year for most women. Some women can experience them even into their 70s, but the good news is most will only have them for 1-4 years. Thankfully they usually stop spontaneously in 4-5 years even without treatment.
Other symptoms women may experience in menopause include sleep disturbances, depression, vaginal dryness, and sexual dysfunction. Sleep disturbances may be caused by hot flashes because, as mentioned above, many women will have them during the night. There are various treatments for hot flashes including simple ones such as lowering the temperature in the room and avoiding triggers like spicy foods and stressful situations for those women with mild symptoms. But certain women need a little more help, which could include hormones, weight loss, antidepressants, and certain antiepileptic medications. Sleep disturbances themselves may also cause mood swings or depression, which plague many women as they go through menopause. Discussing all of these symptoms with you doctor is important, as help is available.
Vaginal dryness also can occur due to the lack of estrogen that occurs in menopause. Estrogen deficiency can cause decreased blood flow to the vagina, which decreases vaginal lubrication. The vagina can also lose some of its elasticity, and the vagina may become shorter or narrower. I recommend that patients experiencing vaginal dryness continue sexual activity, if it is not painful.Vaginal moisturizers and lubricants as well as estrogen therapy can also be effective treatments.
For women over 45, the development of irregular menstrual cycles and symptoms such as hot flashes and mood changes most likely means they’ve become perimenopausal. Keep in mind, that pregnancy is still possible while perimenopausal. Therefore, any sexually active woman who does not desire pregnancy should continue to use some form of contraception. For women between 40-45 years old with irregular cycles with or without menopausal symptoms, pregnancy and other tests such as a thyroid test should be considered.
Menopause is natural and doesn’t mean the end of womanhood. Make sure you discuss your symptoms with your physician partner to ensure your mental, physical, and sexual health.