Menopause: What to Expect

women-menopauseMenopause is a time of incredible physical and emotional change that, though challenging, can be the beginning of a very rewarding period in a woman’s life.

On average, most American women have their last menstrual period at age 51, according to the National Institute on Aging. But menopause can start as early as age 40 or as late as age 60.

The gradual slowing of ovarian function that marks the end of a woman’s childbearing years can cause unwelcome physical symptoms, including hot flashes and night sweats, but it also provides a golden opportunity to guard against such major health risks as heart disease and osteoporosis.

Although all women go through the same basic changes, no two women experience them in exactly the same way. By knowing what to expect, you can take steps to ease symptoms and prevent future health problems.

Menstrual Changes

During your childbearing years, your menstrual cycle is controlled by the production of two hormones made by the ovaries — estrogen and progesterone. First, the ovaries release estrogen, a hormone that causes the lining of the uterus to thicken in preparation for pregnancy. The ovaries then release a mature egg in a process called ovulation, which causes progesterone levels to increase. If you do not become pregnant, estrogen and progesterone levels begin to decrease, triggering menstruation, or the shedding of the uterine lining.

In your mid-40s, you begin a transitional phase called perimenopause, a time marked by changing hormone levels and menstrual cycles.

During perimenopause, the ovaries produce less estrogen. Some months, there may not be enough estrogen to thicken the uterine lining. Ovulation may not occur, and you may skip a period. The number of days between periods may increase or decrease, periods may become shorter or longer, and menstrual bleeding may become heavier or lighter.

Although major changes in menstruation are normal during this time, contact your doctor if you experience bleeding between periods or after sex, or if bleeding is heavier or lasts longer than usual.

Menopause is defined as the absence of a menstrual period for at least one year. Only then are you free of the risk of pregnancy.

Hot Flashes

As you approach menopause, you may experience hot flashes, one of the most common and uncomfortable symptoms of this transition. A hot flash is a sudden feeling of heat that rushes to the upper body and face. The skin may redden and you may break out in a sweat. Chills may follow.

Hot flashes can last from a few seconds to several minutes or longer. They can occur several times a day or a few times a month, and can happen at any time of day or night. Some women experience them for months or years; others don’t get them at all. Those that occur during sleep, called night sweats, may wake you and leave you tired and sluggish the next day.

Although hot flashes are a nuisance, they are not harmful. The following tips may help you cope:

  • Dress in light layers, preferably breathable cottons.
  • Exercise regularly.
  • Avoid spicy foods.
  • Stay out of the heat.
  • Use a fan.
  • Sleep in light clothing and avoid using heavy bedding.
  • Keep a damp cloth nearby to cool yourself, especially if you experience hot flashes at night.

Sleep Problems

In addition to night sweats, many perimenopausal women have trouble falling asleep or wake up much earlier than usual. Such sleep problems can prevent you from getting enough rapid eye movement, or REM, sleep, which permits dreaming and is key to feeling rested. When normal sleep rhythms are broken, it can affect your moods, your health and your ability to cope with ongoing changes.

If you have trouble falling or staying asleep, try these tips:

  • Stay on a schedule. Go to bed and wake up at the same time every day.
  • Eat regular meals at regular times. Avoid late meals.
  • Limit caffeine consumption to the morning or early afternoon. Caffeine stays in the bloodstream for up to six hours and can interfere with sleep.
  • Avoid nightcaps. Alcohol may make you feel drowsy, but it also affects your sleep patterns.
  • Exercise regularly. In general, people who are fit tend to sleep better.

Sexual Changes

As estrogen levels decrease, the vaginal lining becomes thinner, drier and less elastic. When this happens, some women experience vaginal burning or itching, and it may take longer for the vagina to become moist during sex. This vaginal dryness can cause pain during intercourse.

You’ll likely notice changes in your libido, too, because sexual arousal takes longer as women age. In fact, lack of interest is the most common sexual concern reported by menopausal women.

But don’t fret. You can enjoy an active sex life after menopause. If you are experiencing unpleasant sexual changes, try these tips:

  • Use a water-soluble lubricant to help moisten the vagina.
  • Talk with your partner about what you are feeling and what excites you. It may help to spend more time on foreplay or to try new positions.
  • If intercourse is uncomfortable, remember that sex also includes such activities as kissing, fondling, oral sex and mutual masturbation.

Bone Changes

For the first part of our lives, our bones grow faster than they are replaced. From birth until age 30, new bones grow at a faster pace than old bone is broken down, thus becoming larger and denser. After age 30, the process reverses and bones break down faster than they are made. A small amount of bone loss after age 35 is normal, but in the first four to eight years after menopause, decreased estrogen levels cause bone loss to accelerate.

Too much bone loss can increase the risk of osteoporosis, a condition that causes bones to become thin and weak, resulting in breaks or even disability. Signs of osteoporosis include back pain or tenderness, curving of the upper back and height loss. When spinal bones weaken and collapse under the weight of the upper body, they can cause a pronounced curve or hump in the back.

To prevent bone loss and reduce the risk of osteoporosis, try these tips:

  • Consume plenty of calcium. Women younger than 50 need 1,000 mg of calcium a day; women 50 years and older need 1,200 mg of calcium a day. Milk, yogurt, cheese and other dairy products are good sources. It may also help to take a calcium supplement.
  • Don’t skimp on vitamin D, a vital nutrient that helps the body absorb calcium. Your body makes vitamin D when exposed to sunlight, but its ability to do this decreases with age. The best sources are fatty fish, such as salmon and tuna, eggs and fortified dairy products.
  • Exercise daily. Just as muscles get stronger with regular exercise, so do bones. Active women have higher bone density than inactive women. Weight-bearing exercise — such as brisk walking, hiking, stair climbing, tennis, running and weightlifting — done three to four times a week can strengthen bones and slow bone loss.
  • Postmenopausal women 65 years and older should have bone mineral density tests. Your doctor may make specific recommendations based on these results and other risk factors.

Cardiovascular Disease

The risk of cardiovascular disease also increases during midlife. In fact, cardiovascular disease is the number one killer of women in the United States, accounting for more than 33 percent of female deaths — about 450,000 — each year.

Women who have not yet reached menopause are at lower risk because the estrogen they produce protects against heart attacks and stroke. However, less estrogen production means less protection, so these risks increase after menopause.

To reduce your risk, follow these guidelines:

  • Do not smoke.
  • Eat a low-fat diet with plenty of fruits, vegetables, whole grains and lean proteins.
  • Exercise daily. Heart disease is twice as likely to strike inactive people than people who exercise regularly. Aerobic activities, including brisk walking, running or swimming, are recommended to strengthen your heart and lungs.

Emotional Changes

Last, but certainly not least, you’re probably not “going crazy,” as many women fear. Changing hormones can significantly affect a woman’s emotions, leading to mood swings, depression, memory lapses and poor concentration. Not all women experience these symptoms, but those who do often find it difficult to cope because they typically occur when life’s pressures are greatest — when raising teenage children, caring for aging parents and managing career responsibilities.

The best way to get through it is to reach out for help. Talking with others can be reassuring, and you may find that friends are facing the same fears and stresses. Counseling and support groups exist for everything from grief and divorce to career changes. Exercising regularly, controlling stress and getting more sleep can help. Antidepressants can help even out moods.

If you are bothered by unsteady emotions, talk to your health care provider.

Hormone Therapy

Hormone replacement therapy can help ease perimenopausal symptoms. But there are risks, many related to a woman’s health and family history. Studies have linked long-term use to an increased risk of heart attacks, strokes, blood clots and breast cancer. If you are considering hormone therapy, it is important to learn as much as you can and discuss your options with your health care provider.

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