The truth about menopause: What to expect and how to support your well-being

When it comes to menopause, you probably have a lot of questions: How long will it last? Does it mean my sex life is over? Is it safe to consider hormone therapy?

While half the world’s population becomes menopausal, it’s a phase of life that’s often shrouded in myth and misinformation — and what you hear from your friends or relatives may or may not apply to your particular situation.

“One of the most important things I tell patients is that your experience with menopause isn’t going to be like anyone else’s,” says Terry Silvestrin, ARNP, a board-certified nurse practitioner and certified menopause clinician at MultiCare Health System. “You may breeze right into menopause or you may have symptoms that interfere with your daily life. If that’s you, there’s no need to tough it out or suffer. There are options that can bring relief and help you feel like yourself again.”

What happens during menopause

Hot flashes and night sweats are symptoms commonly associated with menopause, but this transition can bring other unwelcome symptoms, too: mood swings, insomnia, fatigue, forgetfulness, brain fog, decreased libido (sexual desire), weight gain and more. In the U.S., the average age for menopause is 51, but troublesome symptoms may appear years before — a time of life known as perimenopause.

“During perimenopause, which typically begins when a woman is in her 40s, the ovaries are starting to shut down,” says Catherine Hunter, DO, a board-certified physician who specializes in the care of menopausal patients. “The ovaries no longer produce hormones like estrogen in a predictable pattern. These spikes and drops in hormone levels mean that some days you may feel OK and others you may not.”

The first sign of perimenopause women often notice is changes in their menstrual cycle — periods may get heavier, lighter or more irregular.

“There are options for dealing with super frequent or super heavy periods, and typically that’s with some kind of birth control, like an intrauterine device (IUD),” says Leanne Zilar, CNM, ARNP, a certified-nurse midwife and nurse practitioner at MultiCare Rockwood Clinic. “However, prolonged irregular or heavy periods can also be a sign of a health condition, such as uterine fibroids or uterine cancer, so it’s important to talk to your provider if you’re experiencing this.”

The transition to menopause is often defined as the absence of a period for 12 consecutive months. However, if you have an IUD or have had your uterus surgically removed, then your menstrual cycle will not indicate whether you are menopausal. When women enter menopause, it means their ovaries are no longer functioning — they have stopped releasing eggs and producing most estrogen and other hormones. Women then enter postmenopause and remain in that phase for the rest of their lives.

“Thanks to our longevity, women can spend about one-third of their life in some stage of menopause,” says Silvestrin. “It’s important to understand what this means for your body — physically, emotionally and mentally — so you can make informed decisions about how to manage changes and symptoms as they come.”

Living well in menopause  

According to the National Menopause Foundation, 62 percent of women report that menopause symptoms interfere with their quality of life, but many women find it difficult to get their needs adequately met. Below we talk about options for symptom relief as well as ways to support your overall health and well-being.

Know your risk for health conditions. The presence — or absence — of estrogen in our bodies affects more than just fertility. This hormone plays an important role in women’s overall health, regulating cholesterol, protecting the heart and blood vessels, and supporting healthy bones, among other benefits. As a result, when women enter menopause, their risk of some health conditions — such as heart disease and osteoporosis — goes up. This is one of the many reasons it’s important to eat a nutritious, heart-healthy diet and maintain an active lifestyle during this phase of your life.

Learn the facts about hormone therapy. Hormone therapy refers to medications that contain hormones such as estrogen. It was the standard approach for treating menopause symptoms for many years until 2002, when a study suggested hormone therapy increased the risk of breast cancer and heart disease. We know now that there were flaws in how the study was set up and interpreted, and that hormone therapy is in fact beneficial for most women.

“A whole generation of women has unfortunately gotten the wrong message about hormone therapy and they’ve suffered as a result,” says Dr. Hunter. “There’s zero data to support that hormone therapy increases the risk of breast cancer. When women go on hormones early in menopause, it can relieve hot flashes, night sweats, brain fog and other symptoms. It can also help protect against osteoporosis, heart disease and other long-term risks associated with menopause.

“We should approach menopause the same way we approach medical conditions like hypothyroidism —if someone has it, we give them thyroid medication. Giving estrogen to women in menopause is no different. It’s really important for women to have the correct information about hormone therapy so they can make a decision they’re comfortable with.”

Consider vaginal estrogen to support your sexual and urologic health. It probably comes as no surprise that estrogen is key for maintaining healthy tissue in the vagina, bladder and urethra — the tube that urine passes through on its way out of the body. Declining estrogen levels during menopause can affect desire for sexual intimacy and contribute to uncomfortable urinary symptoms.

“Without estrogen, the vagina becomes dry and loses its elasticity, which can make sex painful, and the tissue in the urethra can shrink, making it easier for women to get bladder infections,” Zilar says.

Vaginal estrogen is a treatment option that can relieve discomfort during sex as well as symptoms associated with the bladder and urinary tract. This treatment delivers a small amount of estrogen to the vaginal tissue, either through a topical cream or a ring inserted inside the vagina.

“Vaginal estrogen is often overlooked as a treatment option, but it’s something that women can use for the rest of their lives without any increased risk to their health,” Zilar says.

Talk to a provider about other treatment options. If you aren’t a good candidate for hormone therapy or don’t want to pursue hormone therapy, there are other options to consider, including medications, herbal remedies, acupuncture or lifestyle changes, depending on your symptoms.

“With menopause, you can’t just throw a quick fix at someone and call it good. It’s important to consider each patient as a whole person, listen to what their experience has been and chart a course forward based on their priorities,” says Silvestrin.

Visit a provider who specializes in menopause. If you are experiencing troubling symptoms or have questions about changes associated with menopause, consider making an appointment with someone who specializes in this area of medicine.

At MultiCare, you can schedule a virtual video appointment with one of our menopause specialists. Those who live in the Spokane area can also visit the OB/GYN & Midwifery Center at MultiCare Rockwood Clinic.

Learn more about menopause by visiting the North American Menopause Society.