Interviews of 61 women between ages 38 and 60 found that some reported experiencing symptoms of menopause as early as their late 30s or early 40s. These included irregular and heavy bleeding, missed periods, hot flashes and mood swings. A common frustration expressed by these women was that their symptoms, which are typical of perimenopause, tended to be dismissed by their physicians who considered them “too young” to be having menopause-related symptoms.
Increasingly, researchers are finding that there is a poor correlation between chronological age and menopause. Rather than focusing on menopause as a marker at a set point in time, it might help women to think of menopause as a life stage.
Culturally, menopause is tied to aging; yet menopause occurs in the middle years. So for women–more than for men–there is a very real distinction between reproductive aging and physical aging. Although reproductive systems decline, all of a woman’s other biological systems remain healthy and dynamic for decades.
Studies of women going through the menopausal years show that, despite the often-troubling symptoms they report, most see menopause as a normal life stage with physiological changes and not as an illness.
Perimenopause, the period leading up to menopause, can range from 2 to 10 years. During this period, hormone levels can vary dramatically, then decline sharply in the years after menopause. It is the abrupt withdrawal of estrogen and other hormones that triggers hot flashes and many of the other bothersome physical symptoms that develop at this time.
In the recent past, the answer to hot flashes, night sweats, vaginal dryness, bone loss and other common physical symptoms was simple: hormone replacement therapy (HRT.) For the majority of women, it provided relief from hot flashes and the sleep disturbances that so often accompanied them. And physicians felt HRT offered an extra benefit–protecting women’s hearts in the years when heart disease in women begins to rise. But in 2002, with publication of the results of the Women’s Health Initiative, women and their doctors learned that taking estrogen and progestin increased the risk of heart attack, stroke, blood clots and invasive breast cancer. Many women abruptly stopped hormone therapy, preferring to either live with the annoying effects of menopause or seek other treatments.
A very recent study found that since 2002, the year many women quit using HRT, there has been a remarkable decline in breast cancer rates, notably the forms of breast cancer that are hormone sensitive.
Hot flashes, a common complaint in the years both before and after menopause, pose a frustrating challenge for those who want to avoid HRT. Eating a diet high in soy or taking black cohosh supplements may provide relief for some women, but results from controlled trials have been mixed, and reported benefits do not compare with HRT.
Hot flashes can occur many times a day for peri- and postmenopausal women and often frequently at night. Nighttime hot flashes create sleep disturbances and may prevent women from getting the deep sleep they need.
Dressing in layers and having a small fan available at home and at work can help provide some quick relief for hot flashes. Studies have shown some benefit from two cognitive-behavioral interventions: relaxation training and paced respiration, a form of slow, deep breathing.
Vaginal dryness and urinary symptoms are common complaints when estrogen levels fall. Topical estrogen creams and rings that can be inserted vaginally can help provide relief and maintain tissue health.
Menopause is a life passage that closes some doors for women but opens others. Although reproductive systems are ending their life cycle, other body systems remain dynamic and capable of powering women through this next life phase, which represents a third of a woman’s lifespan. With children leaving home for college or work, this can be a time to explore new interests and challenges.
Kerri Musselman, PharmD—Rev. 5/19/2010 TNK
