September is National Menopause Awareness Month. With 6,000 women every day entering menopause, they are experiencing physical (changing bodies), emotional and hormonal transitions. While also dealing with changes for nutrition, exercise, and intimacy. Here are 7 things you should know about menopause.
1. Menopause is normal: It will happen to all of us, if we live long enough. Average age is 51+years of age; range of normal: 35-60. 1% of women are menopausal by age 40; 5% by age 45. Menopause is defined (for women who have a uterus) as no periods for one year; even 8 or 9 months doesn’t count. And when you get another period, you have to reset the one year clock. When you have had a hysterectomy, it is a bit trickier to define (no periods!). One can do some blood tests to check hormonal levels.
2. Not all women have the same symptoms: It is very much a variable. 20% of women get no hot flashes. 20% of women get severe hot flashes; the rest of the 60% get annoying but tolerable flashes. And the flashes may be worse in the perimenopausal time frame (the years leading up to that final menstrual period, which can go on for a while). They do tend to get better over the course of time; although 10% of women will persist with significant flashes for 10 years or more. No one knows exactly what causes hot flashes, believe it or not. Smokers and heavy women get the worst hot flashes.
3. Other symptoms that women may or may not talk about: In the premenstrual time frame, there are all sorts of menstrual irregularities: late periods, early periods, heavy periods. Sleep disturbances (typically, waking up from a sound sleep at 1-3 in the morning, sometimes sweating, sometimes not.) Irritability (which may be from lousy sleep). Some women get achiness-generalized, feeling like an arthritic type condition.
4. Hot flash havoc: Although the hot flashes tend to get better over the course of time, vaginal dryness (which is a direct result of a lack of estrogen) tends to get worse. That’s the bad news; the good news is that it’s straightforward to deal with. Most practitioners will recommend vaginal moisturizers such as Replens, which is over the counter, to start with. Women also may end up with an increase in urinary tract infections; from the bladder as well as the vagina getting dry.
5. Know your doctor: Most importantly, I recommend that women have a good relationship with their health care provider, to be able to talk about symptoms (gynecologist, family practitioner, nurse practitioner, midwife.) Good sources of information: menopause.org, the website of the North American Menopause Society, which has lots of information, and also a list of certified menopause practitioners, if you need one in your area. Another “fun” organization is RedHotMamas.org (for the website) which is a national support group for women going through menopause (just the realization that you are not alone can be quite helpful).
6. No symptoms but aging: Even if you are having no symptoms whatsoever (and yes, there are some lucky women in that category), it’s good to check in with a caregiver about menopausal health. Bone loss and cardiovascular disease can accelerate with menopause, and it’s a good idea to check in with your provider about nutrition (vitamin D and calcium particularly) and heart health (nutrition and exercise; lipids like cholesterol usually change for the worse after menopause, and it’s good to keep an eye on them).
7. Doctors can help: We can get help for just about everything. A menopause doc these days is fun and accessible. Vaginal dryness? No problem. Hot flashes? No problem. So don’t hesitate to speak with your health care provider.
Mary Jane Minkin, MD, is the Clinical Professor of OBGYN at Yale University and author of "A Woman¹s Guide to Menopause and Perimenopause" (Yale University Press).