For many women, menopause is a dreaded process, especially since we usually only hear about the bad parts. Menopause is a fact of life for all women, like it or not. No matter who you are or where you’re from, if you’re a woman then at one point in your life you’ll have to deal with the menopause symptoms.
It helps to view menopause as a natural part of the aging process — not a medical illness or problematic condition, as some think of it. When it comes to finding relief from menopause symptoms, the hardest part is often the emotional and physical side effects it brings along. Transitioning through menopause can mean dealing with unwelcome symptoms, such as weight gain, low energy, low sex drive and changes in your mood.
One of the most common ways to ease the sometimes-hard-to-deal-with side effects of menopause is to use hormone replacement therapy drugs. This generally involves taking estrogen and/or progestin replacement drugs or using hormonal creams. However, the risk to a woman’s health from taking hormone replacement drugs has become a serious concern. The good news is this: While the side effects of going through menopause can range from bothersome to debilitating, there are ways to handle it naturally without increasing your risk for certain diseases.
No. 1 on the list? Exercise. That’s because transitioning into menopause can be a risky time for women, given the fact they are more likely to develop certain metabolic-related diseases during this transition. But women do have a lot of control in reducing the risk. A new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism in October 2018 found that midlife women transitioning to menopause may be able to lower their risk of developing heart disease and type 2 diabetes by focusing on exercise and eating a lower calorie diet.
“Previous studies have largely focused on cardiovascular disease and type 2 diabetes in postmenopausal women. This study is unique because it focuses on an earlier stage in women’s lives, the menopausal transition in midlife, to potentially prevent such diseases from occurring,” says lead study author Jennifer S. Lee, MD, PhD, associate professor of medicine at the Stanford Medical Center.
What Is Menopause?
Let’s take a look at exactly what menopause is all about — and what it’s not.
The Women’s Health Research Institute at Northwestern University explains that there are three stages of menopause:
- Perimenopause (before menopause)
- Postmenopause (after menopause)
Unlike what many think (or how it might feel), menopause doesn’t last forever, and your body does become accustomed to the new changes with time. How long it takes depends on each individual woman, her own body and her state of overall health.
Menopause is the permanent end of a woman’s menstrual cycle and therefore her years of fertility. Technically, menopause is considered to start one year following a woman’s last period (meaning she’s been experiencing “amenorrhea,” or no menstrual cycle, for one year). This means that 12 months after your very last period, you’re officially “in” menopause and likely already starting to experience some common menopause symptoms. This time period signifies the end of reproductive ovarian functioning and a transition through various hormonal changes.
Menopause symptoms usually first appear around the age of 35, when your ovaries get smaller and stop producing the hormones estrogen and progesterone that control the menstrual cycle.
What Causes Menopause Symptoms?
Menopause involves many natural changes to a woman’s entire reproductive system, including her internal organs, external genitalia, breast tissue (which is capable of secreting hormones), and various reproductive and non-reproductive hormones. Around the time of your mid-30s, your ovaries start to produce less estrogen and progesterone, and therefore fertility starts to decline.
The hormones primarily involved in a woman’s reproductive system, and therefore menopause, include:
- Gonadotropin-releasing hormone (GnRH)
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Estrogen (three types including estrone, estridiol and estrioll)
Prior to menopause during the reproductive years, estradiol is the major form of estrogen, which is released primarily from the ovaries. After menopause, estrone becomes the most abundant type of estrogen produced, which is mostly released from a woman’s fat cells and adrenal glands. Estrogen works by attaching to receptors on cells within tissues, including those in the uterus and the breasts, and also the kidneys, heart, blood vessels and other tissues to a lesser degree.
There is isn’t one sole cause of menopause since it’s a very complex process. However, the most significant changes taking place in a woman’s body during this transition are that there’s increasing loss of ovarian follicles (called follicular atresia) and therefore a decreasing amount of estrogen being produced. Mature follicles secrete estrogen, so as the rate of follicular loss keeps accelerating, less estrogen is produced. Estrogen levels start to drop six to 12 months before menopause (during perimenopause) and continue throughout the process.
Another thing to keep in mind is that every adult, whether going through menopause or not, experiences some signs of aging. As Harvard Medical School puts it, “It is often hard to say which changes are a direct result of a drop in hormone levels and which are natural consequences of aging. Some of the symptoms overlap or have a cascade effect.”
Common Menopause Symptoms
The rate at which various reproductive hormones adjust during menopause varies widely from woman to woman, so symptoms of menopause can be very different for each person and also very unpredictable. Hormones tend not to drop in a fast, linear fashion — rather they can spike back up at times, which helps explain why a woman’s period might still come and go during the transition through menopause.
What’s feared the most during menopause is not missing the monthly menstrual periods, but facing the side effects caused from a decrease in reproductive hormones in the body. The decrease of estrogen particularly seems to impact the hypothalamus, a part of the brain that’s often refereed to as “the thermostat of the body,” as it regulates body temperature, sleep patterns, sex hormones, moods and appetite.
What kinds of menopause symptoms can you expect to experience? Again, this depends on your unique hormonal makeup. Studies have found that menopause symptoms range considerably in terms of how long they last and how intense they can become, because even women of the same age can have hormone levels that are very different at any given time.
Some of the most common menopause symptoms include:
- Irregular periods: This is especially common during perimenopause, when periods tend to occur every two to four months on average. Periods can come and go, plus get heavier or lighter at times.
- Hot flashes and night sweats: John Hopkin’s University reports that about 75 percent of all menopausal women experience hot flashes (sudden, brief, periodic increases in body temperature), 80 percent of which occur for 2 years or less. Around 15 percent of menopausal women report having “severe hot flashes” caused by hormonal changes that affect hypothalamus, which controls body temperature.
- Mood swings: These can include increased irritability, anxiety or depressive symptoms.
- Vaginal dryness: The vagina technically shortens and loses elasticity (called vaginal atrophy). Vaginal thinness and dryness can come along with higher susceptibility to urinary tract infections caused by vaginal fluid loss/less lubrication to move bacteria out.
- Increased abdominal fat and weight gain: Due to a slowed metabolism.
- Insomnia and changes in sleep quality
- Thinning hair and dry skin
- Changes in urination: Due to changes in vaginal tissue some women experience frequent, sudden, strong urges to urinate, or might have trouble controlling urination.
- Breasts becoming smaller: As the breasts no longer are stimulated by estrogen, they tend to become smaller, less dense, have more fatty tissue and lose some of their volume (becoming “saggier”).
- Decreased sex drive: Blood flow is reduced to the genital area, the labia becomes smaller and the muscle tissue of the clitoris starts to shrink.
- Changes in the uterus, ovaries and cervix: Although you likely can’t feel this taking place, the ovaries and uterus shrink in size, and muscles in the uterus become harder (fibrotic). The cervix also gets smaller and narrower.
- Higher risk for other diseases and complications: Studies show that following menopause a woman’s risk for heart and blood vessel (cardiovascular) diseases, as well as osteoporosis, increases. This is due to a decline in estrogen levels, which changes fat accumulation and also contributes to loss of bone density, weak bones and increased risk of fractures.
In addition to the common symptoms listed above, the end of a woman’s period and fertility can often signify an emotional change in her life. Moving from a young, life-giving, fertile woman to an older woman can sometimes wreak havoc on the woman psychologically and emotionally. However, that’s only the case if you let it be this way. If you work on understanding menopause, welcome and embrace it, and use appropriate therapies that don’t put your health at risk to deal with menopause symptoms, then this might even be one of the best, most-meaningful times of your life.
How long does menopause last?
Most women transition through these changes for five to 10 years. For most, it’s closer to about five years, but symptoms might come and go for other women for much longer. What’s one piece of good news associated with menopause? A woman’s life expectancy in the Western world is growing, and older women are now estimated to live to 79.7– 84.3 years on average (a significant increase from about 50 years ago). About two thirds of the total U.S. population is expected to survive to age 85 or longer! This means taking care of yourself during and following menopause has never been more important.