Adjusting Your Attitude About Menopause
Baby boomers are handling menopause differently from earlier generations, according to Sheryl Kingsberg, Ph.D., assistant professor of reproductive biology and psychiatry at Case Western Reserve University.
"Life expectancy for women now is over 82 years," Dr. Kingsberg says. That means a third of a woman's life may be lived after menopause. More women are talking about menopause, and more is being written about it than ever before.
In the past, premenopausal women held divergent notions about menopause and aging. Some believed it was a natural transition that should be managed by natural means; others considered menopause a medical condition requiring treatment.
"Menopause is not a disease," says Dr. Kingsberg. "It is a normal event; a passage from one stage of life to another."
A doctor's evaluation
Perimenopause -- the time around menopause -- usually begins when a woman is in her 40s. Each woman's experience can be very different, however.
Although most changes occurring during perimenopause will not continue far beyond menopause and will stop without treatment, it is important to seek a medical evaluation. Hot flashes and other changes can be a sign of disease or can be caused by other conditions such as a thyroid disorder. Any changes should always be reported to your health care provider.
The most reliable test for menopause measures the blood level of the follicle-stimulating hormone (FSH), which is produced by the pituitary gland. This hormone stimulates the ovaries to secrete estrogen. As the ovaries age and production of estrogen declines, the pituitary gland tries to stimulate greater estrogen production by releasing more FSH into the blood. When a woman's FSH rises to a constant level in the blood of 30 to 40mIU/mL or higher, it is generally accepted that she has reached menopause.
Many women go through natural menopause with minimal discomfort. Those who do experience discomforts may reduce them by making lifestyle changes. These include stopping smoking; exercising; modifying alcohol intake; eating a healthy diet, and practicing safe sex. For those who need additional help with symptoms, hormone therapy (HT) is an option. The decision on whether to use HT should be made by a woman and her health care provider.
Variety of symptoms
Studies have consistently shown that only two symptoms -- hot flashes/vasomotor symptoms and vaginal dryness -- are definitely related to menopause. Dr. Kingsberg says she is careful to listen and help a patient assess symptoms so that an effective treatment can be found.
"A woman might be having problems with insomnia, and when we really listen to what is going on, the insomnia is caused by hot flashes happening every hour," Dr. Kingsberg says. "The resulting sleep deprivation could be creating issues like irritability, fatigue or whatever. It's not always cut and dry. We have to weed out what is causing what and not just try to simplify things by attributing them all to menopause."
Some women's fluctuating hormonal levels may put them at increased risk for depression, especially if they have a history of depression, Dr. Kingsberg says.
When bleeding becomes abnormal
In the perimenopausal years, menstrual periods become lighter and farther apart. Irregular periods are common and normal during perimenopause. You shouldn't assume that all changes are cause by menopause, however. Other conditions may be the cause.
Talk to your health care provider if the following conditions appear:
Periods are very heavy, gushing or accompanied by clots.
Periods last more than seven days.
Intervals are shorter than 21 days from the start of the last period.
Spotting or bleeding happens between menstrual periods.
Bleeding occurs after intercourse.