Menopause: Symptoms, helpful hints and accepting the “new normal”
Menopause is strictly defined as a woman (of an appropriate age, generally 45- 55+) not having a period for 12 months. The time leading up to this transition is frequently called “peri-menopause”. Just as there were many changes in our bodies at the time of puberty (and the age and experience may have been different for everyone), the peri-menopause and menopause are the other end of that reproductive life bell-curve. Peri-menopause can also be more like a “dimmer” switch, up and down, rather than a light switch, in that symptoms can wax and wane over a few years before final menopause occurs. However, unlike puberty—where young women are just adapting to changes—peri-menopause comes at a time when women are more in-tune with their bodies, and so changes may seem more disruptive and distressing to some. Irregular periods, hot flashes, sleep disruption, vaginal dryness, mood changes, brain fog, and even joint aching can be common peri-menopausal symptoms.
Let’s take a look at some of these transitional symptoms surrounding menopause and how to deal with some of the most frustrating symptoms.
When does menopause begin?
Peri-menopause is more of a concept, in that the entire reproductive lifespan has changes from puberty to menopause. Many times one’s periods are not the same in the 30’s as they were in their 20’s, for example. While there are some common threads, the types, duration and degree of symptoms vary widely from person to person, and many women transition fairly easily into menopause.
The average age for menopause is 51, and there is some correlation with your mother’s and sisters’ ages of menopause. One of the first clues that you are entering this phase and nearing menopause is an irregular pattern of periods in the mid- to late-40’s.
Read our article about perimenopause and irregular periods in your 40’s
Menopause Hot Flashes
What are hot flashes?
A hot flash is a sudden, uncontrollable rush of heat, usually starting in the upper chest or neck and rising into the face. This wave can last anywhere from a few seconds to a few minutes. It can occur frequently throughout the day or night, or even sporadically. At night, these are sometimes felt as a “night sweat.”
As your ovaries begin to produce less estrogen as menopause approaches, your pituitary gland gives off more of the hormone FSH (follicle-stimulating hormone), which is like the “thermostat” of your reproductive system. As the FSH goes up, it may trigger a hot flash. Again, this can come and go over days, weeks or months.
Hot flashes can feel disorienting, frustrating and embarrassing. Night sweats that wake you up can leave you groggy and tired the next day.
When will my hot flashes go away?
The frequency and intensity of hot flashes vary for everyone. Often, they become less frequent the further you are into menopause and many women stop having them. However, some women occasionally will continue to experience hot flashes to a lesser degree even into very late life.
How can I treat hot flashes?
Once you start experiencing hot flashes, the easiest thing you can do is prepare for them so they are less uncomfortable.
- Dress in layers so you can remove the outer layer as needed
- Wear sweat-wicking clothes and pajamas
- Carry a small cloth, tissue or handkerchief to blot your face if you sweat
- Keep a cool drink or ice water nearby, and sip if you feel a hot flash coming
- Sleep with a pillow that has a space for a cooling or ice pack
- When you feel a hot flash starting, take slow, deep breaths as it “rolls over you”, which can sometimes make it feel less severe
- Regular exercise may help with decreasing the severity of hot flashes in some studies
Learn and avoid things that easily trigger hot flashes, such as:
- Stress
- Certain foods (spicy foods are a common culprit)
- Certain alcohols (possibly red wine)
Some women get some decrease in hot flashes by taking an herbal supplement called Black Cohosh, which has a good safety record, although some studies have not shown a significant benefit. Some anti-depressant medications in low doses have been shown to help also with hot flashes. Of course, hormone replacement therapy (estrogen and/or progesterone, or sometimes low-dose birth control pills until your reach menopause) may also help with hot flashes, but this approach should be discussed in detail with your provider to assess the risks and benefits of these many options.
Vaginal Dryness During Menopause
Vaginal dryness (and even overall skin dryness) is an uncomfortable symptom of menopause caused by reduced estrogen in your body. Reduced estrogen leads to lost tissue elasticity, less lubrication, and thinner skin and vaginal tissues. These symptoms may make sexual activity less enjoyable, or even painful.
How can I treat vaginal dryness?
Vaginal dryness can be treated with non-hormonal options such as over-the-counter lubricants or even small amounts of olive or mineral oil. However, this may not be enough with the additional thinning of vaginal tissues. Prescription vaginal estrogen creams, tablets and a slow-release ring can provide localized support of these tissues with minimal hormone exposure risk. There are also prescription oral tablets (Osphena and Intrarosa) which may be useful in some situations.
Will treating vaginal dryness improve my sex drive?
Treating vaginal dryness and pain could improve your sex drive by making it less uncomfortable. But it’s important to note that other factors impact your sex drive, too:
- With the approach of menopause, your ovaries may also produce less testosterone along with less estrogen
- Lack of sleep can make all things seem less inviting and affect your sex drive
- Fatigue, excessive distraction, stress, depression or mood swings may affect your sex drive
If menopause is affecting your sex drive, be sure to maintain open communication with your partner. Make sure they know that the changes to your sex drive are not personal, that they are a normal part of this life transition. Look for additional ways to create intimacy together and to show your partner that you care for them.
Weight Gain During Menopause
It’s no secret that your metabolism slows as you get older, for both men and women. You don’t need as many calories at age 55 as you did at age 30. But even if you are eating the right amounts and types of food, you may notice that you’re carrying weight in different places after menopause. Your breasts may also change, becoming more fatty and less fibrous.
Is “menopause belly” a real thing?
After menopause, many women notice that their weight is redistributed. They may weigh the same, but their clothes no longer fit the way they used to. For some women, their body begins holding more fat around the middle area (but this also happens to men as they age!)
Can I lose weight after menopause?
Yes, you can! However, losing weight after menopause may take more work because your basal metabolic rate is slower as you age. Your basal metabolic rate (BMR) is the number of calories your body burns in order to function without any added exercise. As you age, that number goes down. This is why you can’t eat the same amount of food without gaining weight that you ate in your twenties and thirties.
The solution: move more and eat wisely.
Make every calorie count by selecting nutrient-dense foods. Balance the amount of fats, carbohydrates and proteins you eat. Consider working with a nutritionist to build a meal plan that you’ll enjoy and be able to realistically follow. Simple adjustments in habits can turn into lifelong results!
Adding more movement to your day is beneficial in many ways:
- Exercise improves your mental health and mood
- Weight-bearing exercises help prevent osteoporosis
- Regular exercise helps you sleep better at night
- Movement keeps you flexible and helps you feel less achy
- Regular movement maintains coordination and strength, and helps prevent falls as you age (and fractures!)
Add movement to your day by:
- Using a sit-to-stand desk
- Walking 20 minutes a day
- Taking the stairs rather than the elevator
- Setting a timer to remind yourself to take a break from sitting at your desk
What are the best exercises to do after menopause?
Aerobic exercises (like jogging, swimming, dancing) are good for your cardiovascular health, and may burn off some calories, but sometimes don’t have as much influence on weight loss as hoped. Instead, focus on weight training. Create a likable and safe routine that you can follow consistently.
Weight training is especially important for women for many reasons:
- Weight training builds muscle, which increases your BMR and helps improve your metabolism
- Weight training can help prevent osteoporosis by improving bone density
- Upper body weight training helps maintain your spine
- Stronger muscles can reduce your risk of falling
If you are a member of a gym, ask a trainer to show you some basic lifts with weights. Ask them to help you use the correct form so you avoid injury and work the right muscles.
If you don’t enjoy being in a gym, you can still get in a good workout from home using just your body weight. Do an internet search for “at-home bodyweight exercises” or try some of these:
- Sit to stand—try not to use your hands to push yourself off a chair. To make it more challenging, hold a heavy item close to your chest as you get better at standing up, and then sit back down
- Wall pushups—Stand a couple feet away from the wall, lean toward it, and push away. It’s the same motion as a traditional pushup but places less stress on your wrists and shoulders. As these get easier, try pushups from your knees. Then, progress to doing pushups on your toes.
- Glute Bridge—Lie on your back with your feet planted on the floor. Lift your hips up toward the ceiling. Pause, then slowly lower your hips back down. Repeat this motion several times.
Trouble Sleeping During Menopause
Hot flashes, achy joints, increase urge to urinate….They all add up to some women having poorer sleep! Difficulty falling asleep (and especially staying asleep) is very common for women who are going through the menopausal transition.
How can I sleep better during menopause?
- Get daily exercise
- Keep your room cool (65 degrees or lower)
- Wear cool, wicking or light cotton pajamas at night
- Use cooling sheets
- Sleep with a pillow that has a place for a cold pack
- Limit screen time an hour before bed
- Avoid alcohol right before bed
- Consider a temporary sleep medication if these measure don’t work and lack of sleep is interfering with your ability to function during the day
Brain fog, body aches and bathroom breaks
Some women experience a sensation of “brain fog” and short-term memory difficulties while they are going through the menopausal transition. It can be harder to multi-task and harder to find the right words. And some mornings, they just wake up feeling achy and stiff at times. Not only that, but they find themselves having to hurry to the bathroom more often, or having to urinate more during the night. While these are also variable in occurrence, it may surprise you that these are also menopausal symptoms.
You have estrogen receptors all over your body, including your brain and your cartilage, and even the tissue around your bladder. When your estrogen drops, all tissues that are estrogen-sensitive may be affected.
Is hormone placement therapy my only option?
Hormone replacement therapy (HRT) can be used safely for many women without increasing their long-term risks of breast cancer or cardiovascular disease if started shortly after menopause begins. Transitional hormone replacement therapy can be used for up to 5 and possibly 10 years without significant lifetime risk increase, but this should always be individualized based on a woman’s personal and family medical history and risks. This can help reduce symptoms such as hot flashes, poor sleep, mood swings and vaginal tissue irritation. If you are more in the pre- or peri-menopausal phase, low-dose birth control pills may be a better option for a few years until you are closer to true menopause.
As for achy joints, some women report that glucosamine/chondroitin helps relieve the achy feeling, although you should be careful taking this if you are on certain medications (check with your pharmacist.). Regular movement and stretching also helps, and aerobic exercise can help improve mood and mental clarity.
Treat the menopause symptoms that bother you the most.
If you’ve been reading our articles for awhile, you’ll notice that we don’t give “one-size-fits-all” advice. That’s because every woman’s body and situation are different. There are trends, of course, but the way you experience perimenopause and menopause is different from how your best friend may have experienced it.
Determine with your doctor which symptoms are most disruptive to you. Together, you can form a plan that could include hormonal or non-hormonal treatments.
Whatever you decide to do, keep this in mind:
1) Recognize that your metabolism is changing. Make the food that you eat count.
2) Move daily. Add weight training and weight-bearing exercises to strengthen your muscles and bones.
3) Communicate with your partner and those close to you so that they better understand what you are experiencing.
4) Communicate with your OBGYN provider. Let them know if you experience lots of spotting between periods, frequent periods (more often than every three weeks), prolonged heavy bleeding, dizziness, chest pain or any neurologic symptoms as these are not necessarily “typical” menopausal symptoms.
At Madison Women’s Health, we’re here for you in all stages of life!
Dr. Mary Stoffel has been providing healthcare to women in Madison since 1990 and is a founding partner of Madison Women’s Health. Committed to the highest quality of care in all aspects of women’s health, she envisioned a practice devoted to personalized medicine grounded in communication and trust.
