Menopause

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Mature Woman Experiencing Hot Flush From MenopauseIt’s something women know is coming. It’s something we often dread, because we’ve heard horror stories. But, knowing and understanding the process, symptoms and treatment for menopause makes it a bit less overwhelming and dreadful.

Dr. Eric Seward, a board certified obstetrician-gynecologist who practices in Santa Fe, N.M., recently sat down and answered some questions for Hope about menopause.

What is menopause?

Menopause is the time in a woman’s life when she transitions from regular ovulation to no longer ovulating. From around 12 years old to around 50 years old, eggs are produced nearly every month for the possibility of pregnancy. At the beginning of the process there are nearly 20,000 eggs.  Each cycle a handful of these eggs are used until there are none left.  The beginning of this process is called menarche, and the end is called menopause. Menopause itself is defined by the end of cycles and can be diagnosed by absence of periods for six to 12 months or more or blood tests.

What is perimenopause?

Toward the end of the reproductive years, women experience a change in their cycles and associated symptoms. We sometimes call this “perimenopause” or “climacteric,” and the process can oftentimes last for several years. Typically, this happens to women in their 40s and precedes menopause by a variable amount of time. Like all menstrual cycle issues, these things are quite variable from when they happen to how much one experiences.

What age does menopause start?

There is a large normal range for menopause from early 40s to mid-50s, and it’s determined by multifactorial things from genetics to behavior, stress and circumstance. Oftentimes women in the same family begin menopause around the same age, which could give you an idea for yourself. Otherwise, we typically expect menopause to happen on average around 50 or 51 and acknowledge a wide range.

What are the symptoms of menopause?

Like the range of menopause, symptoms are quite variable too. Nearly half of women have minimal and/or manageable symptoms, which may not cause much concern. The other half can vary from self-limited for a few months to years to a miserable alteration of lifestyle.  Symptoms may begin in perimenopause and may or may not be associated with changes in menses (heavy, light, irregular, etc.). Typical symptoms of menopause may include hot flashes, night sweats, mood issues (depression, irritability, anger, etc.), vaginal dryness, disinterest in sex, sleep disorders, short/medium term memory loss, skin and hair changes, and other associated problems. 

What causes hot flashes and night sweats?
Most of the symptoms are due to the loss of cyclic hormones (estrogens and progesterones, as well as drops in testosterone). The thermostat center in the hypothalamus portion of the brain goes haywire, particularly at night, and may leave people feeling hot or soaked very suddenly.  Sometimes these are outright and noticeable and sometimes they are subtle and effect only sleep patterns. More time is spent in lighter stage one and two sleep and this leads to fatigue, mood problems and other psychological and memory strains. Longer term, lack of estrogens can create skin and hair changes including vaginal dryness, bone loss, loss of general skin turgor and increased facial hair growth due to imbalance in estrogen and testosterone levels. 

What is the treatment for menopause?

Treatment can range based on symptoms. There is a growing sense that menopause is a normal function, but those of us on the front lines know there is a fine line between normal process and suffering. Since many women spend 30 to 50 percent of their lives post-menopause, this is a major issue for modern healthcare. When symptoms are minimal, management may not even be necessary. Many women don’t really manage menopause at all and live healthy, full lives with good long-term sex lives and vitality. Exercise is a major way to manage symptoms. Aerobic activity helps your brain peripherally control the thermostat malfunctions of early menopause, improving many of the symptoms. 

Other treatments may include localized treatments for specific issues such as local hormones for vaginal dryness or lubricants. They may also include alternate ways to strengthen bones such as bisphosphonates or other biologic agents. At any rate, these things should be discussed and followed closely by a knowledgeable medical provider considering all medicines have risks as well as benefits. 

What about hormone replacement therapy?

Hormones remain a mainstay in therapy as well. For those who need them they can be a wonderful improvement with regards to quality of life. For most women, they are relatively safe in the first years of menopause but with special consideration to general health and risk.  Estrogens are known to increase blood clotting and therefore have long-term risks for causing blood clotting disorders from DVT to stroke. These risks increase with age and other conditions and risk factors (family history, smoking, etc.). Also, some breast cancers are estrogen or progesterone receptor positive and hormone therapy can cause faster growth in these kinds of tumors. Hormones can be very helpful but must be monitored and reassessed at least yearly by a physician knowledgeable with them. Hormones can come in many forms, from pills to patches to creams to specially concocted “bioidentical” formulations and may include estrogen, progesterone, testosterone or some combination. Again, it is important that someone with sophisticated understanding of these hormones help guide the person in need of them.  Unopposed estrogens may cause uterine cancer and testosterone needs to be very carefully monitored if necessary.   

Eric Seward is a board certified Obstetrician-Gynecologist who grew up in Muncie, Ind. He earned a BS at Ball State University, an MD at Indiana University School of Medicine and completed a residency at Michigan State. He has a wide-ranging practice with a special interest in urogynecology and care and training for the female athlete. He currently practices in Santa Fe, N.M.  

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