Women go through two major hormonal changes in life: puberty and menopause. Both changes are important times to talk to someone to help navigate the ins and outs of a changing body. During menopause in particular, women start to experience major hormonal changes, including decreases in the production of estrogen and progesterone. There are many myths and misconceptions about the process of menopause (and perimenopause, which comes before it), but there are also ways of making sure patients are comfortable as their bodies experience this time of change.
Dr. Chris Morris, a gynecologist at Tryon Medical Partners, provides guidance on what to expect when your body starts to experience the change of menopause.
“In your late 40s and early 50s, you’re setting the course for how you’re going to feel over the next decades of your life. Focusing on making sure you are prepared now will return dividends in the decades to come,” says Dr. Morris.
1. Many symptoms often associated with menopause typically arise before the official start of menopause, during a period called perimenopause.
Hot flashes, sleep disturbances and mood swings are all symptoms typically assumed to indicate that menopause has started. However, as Dr. Morris notes, many women will experience these symptoms before the official onset of menopause (defined as one year without a menstrual cycle). The transition into menopause varies by person, and many begin to experience changes years before the actual menopause. Many women will experience changes in the menstrual cycle, while others begin to experience hot flashes, night sweats, brain fog, or other physical symptoms. Dr. Morris also flags that lab testing does not diagnose menopause, and that hormone levels can vary widely, even on a day-to-day basis. Instead, you should have discussions with your health care provider about any changes in your menstrual cycle and other symptoms to determine the best course of action for your health.
Just as each women had a unique journey through puberty, no two women will experience the menopause transition in the same way. At the time of perimenopause, Dr. Morris says that he starts to talk with his patients about how their hormonal function is changing. “I like to give them a guide for expectations. There is high variability of symptoms between women, and no two peoples’ menopause journey is the same.”
2. There are many health benefits to hormone therapy; treatment can provide both short-term relief of symptoms, as well as long-term health benefits.
Hormone therapy involves the taking of medications that contain hormones (typically estrogen) to replace hormonal loss during menopause. While menopausal hormone therapy (MHT) has received mixed reviews in popular media, Dr. Morris states that these articles often overstate risks while disregarding health benefits. He emphasizes that fears about hormone therapy are often resolved when women have the opportunity to have an open discussion about the risks and benefits, and he finds that many fears are based on myths or information that is factually incorrect. He stresses that there are many options available to address perimenopausal symptoms, and that hormone therapy can have short and long-term benefits, including a reduction in the risk of bone fractures in post-menopausal women.
“Patients often think that they are making a lifetime decision, but hormone therapy can be used over a short-term period to address severe symptoms, and current hormone therapy used this way carries very little health risk,” says Dr. Morris
3. In addition to hormone therapy, there are also alternatives that you can take directed at controlling the symptoms of menopause.
While many medications were not originally created to treat the symptoms of menopause, Dr. Morris notes there are many off-label uses of common medications that can help ease symptoms. A number of SSRIs, typically used to treat anxiety and depression, can help reduce hot flashes. These include Paxil and Effexor. Neurontin, an anti-seizure medication, and clonidine, an antihypertensive, can help reduce symptoms for those not taking estrogen.
Additionally, while there are many over-the-counter supplements marketed toward women with symptoms of menopause, Dr. Morris says that most of these fail to address symptoms and have failed to proven beneficial when studied. While these supplements are unlikely to be dangerous, very few have been rigorously studied.
Dr. Morris also suggests acupuncture, mindfulness and improved sleep hygiene to address symptoms and flare-ups. While these methods are not well-studied, they are safe and may provide benefit on an individual basis.
4. While menopause can cause some disruption to sexual function and intimacy, there are many ways to improve these changes and maintain a healthy sex life.
Changes in sexual function can occur at any point during the menopause transition, but many women may not experience vaginal dryness or discomfort until later in the process. The decline of estrogen production can cause immense changes to the tissue in the lower bladder and vagina, leading to painful intercourse and urinary tract infections. These changes, along with changes in libido, can result in loss of sexual function which may be devastating for some women. Dr. Morris emphasizes that women should find a provider that is both comfortable and knowledgeable about these changes and how to manage them. Options such as topical vaginal estrogen or DHEA suppositories can restore full function. Additionally pelvic floor physical therapy can be helpful in improving muscle tone and sexual function.
“Intimacy doesn’t have to be something that becomes a chore,” says Dr. Morris. “Sex should be a healthy and wonderful part of patients’ lives well beyond menopause.”
5. Your doctor has your back as you establish a plan of care for menopause.
While the transition to menopause can seem daunting, working with your doctor to establish a good plan of care both before, during and after the change can allow you to live a happy and comfortable life well beyond your menopausal years. If you are starting to experience symptoms or have questions about this hormonal change, reach out to a Tryon gynecologist like Dr. Morris today to set up time to establish a plan for care.