The journey through menopause can be challenging with its confusing symptoms, unclear treatment options, and changing emotions. But it's also a stage in life where some women find a new sense of empowerment and liberation.
Menopause, often described as a woman's transformative passage, is a natural stage in the intricate journey of life. Typically occurring between 45 and 55, it marks the end of a woman's reproductive years.
Yet, despite the obvious postmenopausal perks, such as no menstrual cycles to contend with, the process of going through menopause can be challenging. As hormonal shifts bring physical and emotional changes, women may begin experiencing hot flashes, mood swings, and other confusing symptoms. Some of these symptoms can even cause a woman to wonder if she's dealing with menopause or a concerning health condition.
Still, menopause can usher in new opportunities for growth and renewal. And for many, it's the beginning of a vibrant and fulfilling second act.
For World Menopause Day, Healthnews asked Arianna Sholes-Douglas, a board-certified OB-GYN and esteemed expert in women's health in Arizona, to provide more insight by answering a few questions about this multifaceted journey.
Q: What are the stages of menopause?
A: Defining menopause can be a little tricky. But you can simplify the math by recognizing that menopause represents the official end of your reproductive stage. We go through several stages as women — pre-puberty, puberty, reproductive stage, and finally, the post-reproductive stage (post-menopause).
Menopause, by definition, is a cessation of the menstrual cycle for 12 months. And the period leading up to menopause (lasting up to 8-10 years) is called "perimenopause," which translates to "around-menopause."
Many women assume that they will not become symptomatic until they are menopausal, but in fact, their symptoms of perimenopause are just as significant. Perimenopause is the stage where your fertility declines [and] menstrual cycles can become irregular.
For some women, they will experience heavier bleeding, and then ultimately less bleeding [as] cycles become more erratic.
Post-menopause is simply the period after menopause [where] symptoms [stabilize].
Q: What are the symptoms of menopause?
A: Symptoms include but are not limited to hot flashes, night sweats, mood swings, genitourinary symptoms, joint pain, irritability, insomnia, decreased libido, depression, anxiety, heart palpitations, changes in cholesterol, increased blood pressure, decreased attention span and memory, and pain during intercourse.
Q: Are there any surprising symptoms that women may not be aware of?
A: Some of the most surprising symptoms that women may not be aware of are joint pain and frozen shoulders. Heart palpitations also tend to surprise many patients, and they end up in the emergency room wondering if they are having a cardiac event.
Q: Are there any tests to determine if a woman is approaching menopause?
A: Believe it or not, there really isn't any specific test to determine if a woman is approaching menopause. A woman's hormones are going to fluctuate and become pretty erratic during that perimenopause period. For this reason, if you measure hormones on any given day, you are going to potentially get significantly different values.
However, there is one test, follicle-stimulating hormone (FSH), that consistently rises over time, and once a woman has two elevations of FSH three months apart, we can safely assume that she is approaching menopause. Many women believe that they need to go to the doctor's office and be tested. But during perimenopause, your hormones are fluctuating and are really a moving target.
Q: Is hormone replacement therapy (HRT) still an option for symptom relief?
A: The term hormone replacement therapy has now been replaced with hormone therapy. Specifically, in the treatment of menopausal women, we describe it as menopause hormone therapy (MHT). Menopause hormone therapy is the gold standard for the treatment of symptomatic perimenopause and menopausal patients. [But] there's a lot of confusion about the safety and efficacy of estrogen.
Subsequent analysis of [study data] has found that estrogen does not increase a woman's risk for breast cancer, especially in the first five years of taking it. [However], estrogen with a synthetic progesterone — a progestin — had a slightly increased risk for breast cancer.
Estrogen with natural progesterone has some questionable data, but for the most part, estrogen with a natural progesterone taken within 10 years of a woman's last menstrual period for five years or less is safe and recommended for women who are symptomatic.
Q: What are the health risks of oral vs. transdermal HRT?
A: Transdermal hormone therapy typically delivered in the form of a patch — is the safest because it bypasses the liver. The health risks associated with oral hormone therapy include increased risk for blood clots. This risk does not appear to be the same for transdermal hormonal therapy.
The benefits of hormone therapy include decreased risk of colorectal cancer, bone production, decreased cardiovascular disease, decreased risk of Alzheimer's, cognitive decline, and an overall sense of well-being.
Q:Are there holistic, non-drug options for managing menopause symptoms? If so, which approaches are most effective?
A: There are many holistic and non-drug options for managing menopause symptoms. A healthy diet and lifestyle are first and foremost. This includes foods that are low in inflammatory properties [such as] sugar, dairy, and processed foods. Supplements can be very helpful, particularly for the symptomatic relief of hot flashes and insomnia in many patients.
Supplements, which include Black Cohosh, Chaste Tree Extract (Vitex), Ashwagandha, L-Methylfolate, and Vitamin D, can be very helpful. You want to look for supplements that have minimal binders and fillers and that are carefully sourced. Eu Natural's Staying Cool is one of many great supplements to consider.
Q: What would you say to a woman going through menopause who feels sadness about getting older and the end of their reproductive years?
A: I would say to a woman going through menopause that she should embrace the journey and recognize that she is moving into the best time of her life.
Although I am slowly starting to see the narrative changing around women and aging, women have long since been misled about menopause. The language around it is confusing and incomplete at best.
We have a long way to go, but there is one thing that I know to be true. There is an undeniable presence and knowing in a wise woman. And that wisdom was only attained through life experience.
Menopause is not the beginning of the end but rather one of the best chapters in life we get to experience. It's time we release ourselves from the negative stereotypes surrounding menopause and explore what feminine power really looks like.
- U.S. Department of Health & Human Services: Office on Women's Health. Menopause symptoms and relief.
- Medicina. The Controversial History of Hormone Replacement Therapy.