What is Menopause?
Attitudes About Menopause
Common Concerns
Recognizing Menstrual Changes
Relieving Hot Flashes
Keeping Sex Satisfying
Keeping Bones Strong
Understanding Mood Changes
Hormone Replacement Therapy
General Recommendations for Health
More Resources

Most women go through menopause between the ages of 45 and 55, with the average age being around 51. Some women experience menopause earlier due to natural drop in hormones or surgical removal of the ovaries.

Signs of approaching menopause vary from woman to woman. The most common indicators, however, are irregular periods and/or hot flashes. A blood test can confirm whether or not menopause has begun.

Menopause has often been called the change of life and indeed, it is a time of physical, emotional and psychological change.

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Historically, menopause has often been regarded as a negative life experience. Doctors and others viewed the menopausal woman solely in terms of what she had lost: her youth and her ability to bear children. Many midlife problems were blamed on menopause.

With changes in women’s societal roles and an increase in life expectancy, menopause has come to take on a different meaning. As women’s roles continue to expand beyond childbearing, the end of fertility no longer symbolizes the end of their functional lives. And with the increase in longevity, women can expect to live a full 30 years or one half of their adult life after their periods have ended! For most, menopause hails mid-life and a new beginning, not the onset of old age.

Menopause and middle age can be an active and vibrant time for women, but myths and misinformation cause many to fear the changes occurring during menopause and in the years that follow. For some, the worst part of menopause is not knowing what to expect.

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Following are some of the most common concerns expressed by women going through menopause. Most of the changes mentioned are triggered by the natural drop in sex hormones. The effects do vary considerably from person to person.

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It is common for women to be alerted to menopause by changes in their typical menstrual patterns. Women may notice either that their periods are getting farther apart and lighter or that their periods become closer together and heavier. Eventually, periods will cease altogether. For pregnancy prevention, women are usually advised to use birth control for at least one year after the last menstrual period. If bleeding is extremely heavy or prolonged, or if it occurs after intercourse, consult your health care practitioner. It could be a warning sign of more serious problems.

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Most menopausal women experience at least occasional hot flashes. A hot flash is an intense feeling of heat in the face, upper body or entire body that generally lasts a few minutes. The feeling of warmth is often accompanied by a flush and sweating. Hot flashes can be uncomfortable, but they are not dangerous. Anything that affects body temperature can trigger a flash:

• A hot meal or drink
• Alcohol
• Emotional upset or excitement
• Hot weather
• A warm room
• A warm bed

Researchers do not fully understand why hot flashes occur; they seem to be related to sudden drops in estrogen, one of the sex hormones.

The best therapy for hot flashes is keeping cool. Dress in layered clothing that can be removed easily, keep the house cool, eat small, frequent meals, and go easy on hot beverages and alcohol. If you feel a flash coming on, stand in a cool breeze, use a fan, sip a glass of water or juice, or even imagine being in a cool, comfortable place.

If the flashes are very uncomfortable, you may want to consult your medical practitioner about possible treatments. Hormone replacement therapy has been shown to eliminate hot flashes in most women.

Hormone replacement therapy (HRT), involves taking synthetic estrogen and progestin to compensate for the body’s natural decrease during menopause. The hormones are usually taken orally, but sometimes they are injected, applied as a cream, or absorbed from a patch on the skin. The advantages and disadvantages of HRT are discussed later in this pamphlet.

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Postmenopausal women can have very fulfilling and satisfying sexual lives. Menopause marks the end of a woman’s ability to conceive a child, not her ability to give and receive physical love. Some women find that their sex drive increases after menopause. Many women, however, do experience some vaginal dryness and soreness during and after menopause; the vaginal walls become thinner and drier due to a drop in estrogen, and intercourse may feel uncomfortable or painful.

A lubricant such as K-Y jelly, which is available in most drug stores, can ease discomfort during intercourse. And regular sexual activity, including masturbation, sexual touching, and/or intercourse, actually helps to keep vaginal walls more elastic. Some couples increase their sexual fulfillment by including more massage and warm baths in their lovemaking. If vaginal discomfort persists, estrogen creams applied directly to the vagina or HRT may help.

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At the time of menopause, estrogen levels drop and bones may become more brittle and subject to breakage. As years pass, some women develop the characteristic dowager’s hump and about 25% will develop osteoporosis - a condition in which bones lose their strength and fracture easily. Women are more likely to develop osteoporosis if they drink a lot of coffee or alcohol, smoke, have a low-calcium diet, exercise infrequently, are underweight, are white, and/or have a family history of the condition.

To prevent osteoporosis, women should pay close attention to their calcium intake in their adult years. The U.S. Recommended Daily Allowance of calcium is 800 mg per day but most nutritionists believe that adult women should take in 1,000 - 1,500 mg daily to maximize bone strength. Since many people do not take in this much calcium from food alone, calcium supplements are often recommended for women over 35. While older women cannot usually add to their bone mass, they can lessen the rate of bone loss. Listed below are some foods that are good sources of calcium.

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Another important risk-reducer of osteoporosis is weight-bearing exercise such as walking. People who use their limbs and muscles vigorously develop thicker, stronger bones. HRT can also help to prevent osteoporosis, and may be recommended for women whose lifestyle or family history puts them at greater risk.

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Women’s emotional reactions to menopause are extremely varied.

"I felt relieved when my periods stopped. No more worry about birth control and painful cramps!"

"A few months after my last period it hit me—I wasn’t going to be able to have more children. I grieved for the loss."

"I don’t know why people make such a big deal about menopause; I had a few hot flashes and that was about it."

"I was pretty depressed during menopause, but looking back at it, I was also going through a difficult period in my marriage."

"Menopause and midlife felt like a new stage in my life. I had more time just for me - to relax, take a walk, read a book. It was nice."

Contrary to popular belief, menopausal women are not especially prone to depression. Some women are depressed during this time, but there is no clear evidence suggesting that this is directly linked to the natural drop in hormones. More likely, emotional upset is due to other important changes in women’s lives, such as taking care of an elderly parent or concern over adult children. If you are experiencing mood changes, it can help to talk about your feelings with a supportive family member, friend, therapist or support group.

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Studies have shown that estrogen eliminates many symptoms connected with menopause, such as vaginal dryness and hot flashes. But estrogen does have risks of uterine cancer. Today, most doctors prescribe a progestin (a synthetic form of the hormone progesterone) in addition to estrogen in an effort to minimize the risks.

Hormone replacement therapy, however, is not a cure-all; it cannot prevent wrinkles, cure psychological problems, or reverse the natural process of aging. Also, the positive effects will last only as long as the hormones are being taken.

Hormone replacement therapy is not for everyone. It is important to be informed of all the options. Consult with your health care practitioner to determine what is best for you. The following advantages and disadvantages of HRT should be considered:

Advantages:

• Elimination of hot flashes
• Elimination of vaginal soreness
• Reduced risk of osteoporosis
• Probable decreased risk of heart disease

Disadvantages:

• Possible growth of uterine fibroids
• Possible increased risk of breast cancer

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To help assure a healthily future, consider the following suggestions:

1. Exercise regularly.

Exercise has many benefits including:

• Strengthening heart and lungs
• Strengthening bones
• Assisting in weight control
• Reducing stress

Choose activities that you enjoy, and plan a regular time for them in your daily schedule, otherwise you probably won’t keep them up. Some suggestions for activities include: brisk walking, jogging, dancing, aerobics, bicycling, stationary bicycling, swimming, tennis, gardening or farm work, and cross-country skiing.

2. Eat a low fat, high fiber diet.

As women get older, they require only two-thirds the calories previously needed to maintain ideal body weight. The optimum diet is one that is high in whole grains, fruits, vegetables, and calcium-rich foods. Such a diet can supply plenty of nutrients without causing obesity or heart disease.

3. Cut down or eliminate:

• Caffeine. In large amounts, caffeine may contribute to high cholesterol heart disease, an increase in hot flashes, calcium loss, and osteoporosis.
• Smoking. Smoking clearly leads to a higher rate of lung cancer, heart disease and breathing problems. Also, smokers have earlier menopause, and more problems with brittle bones due to calcium loss.
• Alcohol. There are several negative aspects of alcohol use during and after menopause. Alcohol may trigger hot flashes. Also, people who drink large amounts of alcohol are more vulnerable to osteoporosis because they generally get less calcium in their diets and have trouble absorbing the calcium into their systems.

4. Have regular exams.

Women approaching menopause continue to benefit from yearly exams that include a check of blood pressure, heart and lungs, breasts, abdomen, along with pelvic and rectal exam. Yearly mammograms and monthly breast self-exams are also very important for early detection of breast cancer.

Take the time to choose a health care practitioner with a positive attitude toward women’s health, menopause, and self-care measures, and a sincere interest in the questions and concerns of patients.

5. Be good to yourself.

You deserve it! Often, people get so involved in their busy schedules that they don’t leave time to unwind, reflect, and reenergize. Set aside some time every day to do something relaxing and fun. Reducing stress can promote physical as well as emotional health. Also, consider developing a new interest or getting more involved in community activities. This is an excellent way of keeping busy and staying connected to the world around you.

Menopause is a normal, natural part of a woman’s life cycle. Margaret Mead, a famous anthropologist, referred to this vital and new time as one of post-menopausal zest (or PMZ)! Knowing and understanding the changes that usually accompany menopause can help a woman to feel positive about this transition and look to the future with a renewed sense of confidence, excitement, and strength.

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Planned Parenthood Federation of America

A Friend Indeed

• Canadian newsletter with understandable and reliable information about menopausal transition
• Includes a list of other links

North American Menopause Society

• Excellent answers to frequently asked questions

Power Surge

• A virtual community for women in Meno-Morphosis
• A commercial site with good information and links to other sites

The National Women's Health Information Center  (NWHIC)