For ten years, my mother blamed everything on menopause. Hot flashes, forgetfulness, mood swings, sleepless nights of course. But somehow any problem we encountered from 1994-2004 was directly related to varying degrees of ovarian failure.
If her car ran out of gas, somehow menopause would get the blame. If she got lost while driving, she would pull over, cry a bit, and then laugh out loud at her mistake and say, “Leave me alone, I’m in menopause.” If she got caught up on a simple math problem, she’d give it a brief, weak effort and then tell someone else to do the calculation. After all, she was in menopause. Admittedly, she was never good with directions or math, but now she had a solid reason.
When she finally had her ovaries removed for ovarian cancer, we threw a little party bidding adieu to source of a decade of frustration. We thought for sure, the old mom would be back. After 5 years of chemo side-effects, we would have taken back to quirks that accompanied menopause in a heartbeat.
But for the woman going through it, menopause is a frustrating and oftentimes confusing period. Menopause is a natural part of the life cycle that every woman will go through. Translated, menopause literally means the cessation of menses, secondary to ovarian shut-down.
The ovaries are the source of estrogen and progesterone that set the rhythm of the menstrual cycle. The hormones are the signals that build up the uterine lining to prepare for pregnancy, release an egg from the the ovary, and shed the uterine lining if fertilization does not occur. The ovaries are in chemical communication with the pituitary, thyroid and adrenals.
As ovarian function starts to wane, usually beginning after age 40, women may experience changes in their cycle. Menses may become irregular, lighter or shorter. The withdrawal from a normal hormonal cycle may cause unpredictable mood swings, hot or cold intolerance, fatigue or insomnia. Some women experience drying of the vaginal mucosa as a result of disappearing estrogen. Loss of breast fullness, slowed metabolism and therefore weight gain, thinned hair, insomnia are also common symptoms of fluctuating hormonal balance.
Many women come to me desperate for help controlling the difficult symptoms of menopause. Testing the hormone levels in the blood can sometimes let us know if the ￼ovaries are shutting down. But usually you can diagnose perimenopause (the period leading up to the cessation of menses) based on symptoms alone. As I say, we can always do bloodwork, but if it walks like a menopausal duck and talks like a menopausal duck, guess what?
While the severity of symptoms can fluctuate throughout the course of perimenopause, many women choose to be proactive in controlling their symptoms. Regular exercise and a balanced diet are crucial is preparing your body for the endocrine disruption that comes with menopause. Nutritional supplements may be required depending on other conditions and risks such as osteopenia/osteoporosis or low bone density. In addition to adopting an active lifestyle and healthy diet, getting enough sleep and reducing stress, there are several treatment options - herbal remedies, traditional hormone replacement and bioidentical hormone replacement.
On the conservative end of the menopause treatment spectrum are the natural remedies that have been used for millions of years. For example, black cohosh, red clover, kava and evening primrose oil are widely used as natural treatments for hot flashes. Although it is not used to treat hot flashes, ginseng is another herbal remedy that is used primarily for mood swings, insomnia and energy. Scientific studies reveal mixed results, although anecdotally, I have found that many women rely on their effects to get them through menopause.
Each of these may have safety concerns in patients with certain medical problems such as liver or blood disorders. As an aside, I encounter many patients who taken herbal medicines, remedies, over-the-counters without knowledge of their potential side effects or contraindications. Many herbals interact with other medications making the other medications less effective or more toxic. You should always know why you’re taking a supplement and if there are any serious potential risks. Just because it’s natural doesn’t mean it’s completely safe. (Cocaine, heroin and tobacco are natural too)! It is crucial that you notify your doctors of any herbal, homeopathic or over-the-counter medicines/remedies you are considering taking.
Traditional hormone replacement therapy consists of birth control pills, which control the symptoms of perimenopause by supplementing your body with a cyclic dose of synthetic hormones. It can also be used for pregnancy prevention and symptoms of postmenopausal hormone loss. The estrogen and/or progesterone that you receive through a pack of birth control pills mimics the body’s natural menstrual cycle and therefore replaces the hormones that your body is no longer making regularly. The right product at the right dose can likely relieve most or all of the typical symptoms of menopause. HRT may have added benefits of protecting against colon cancer, osteoporosis, dementia and heart disease. However, It is well-known that any woman taking hormone replacement therapy for menopause or for birth control is at increased risk of blood clotting and therefore CANNOT and should not smoke. And possibly most controversial is the concern that taking exogenous hormones may confer an increased risk of breast or endometrial cancer. Your individual risk can be assessed with your doctor so that you can determine if HRT is right for you.
Somewhere in the middle of the menopause-treatment-spectrum is bioidentical hormone replacement therapy, also known as BHRT. Unlike traditional HRT, BHRT consists of plant-derived compounds that are chemically identical to the hormones that our body produces naturally. Therefore, the body is unable to distinguish these exogenous hormones from our own. Theoretically then there should be no increased risk of unwanted side effects. Also, as opposed to a standard pre-determined dosage, BHRT is a cocktail of hormones, usually estrogen, progesterone (which is micronized for better absorption) and testosterone, which is measured and tailored to fit the individually for whom it is being prescribed. Essentially, it’s natural, customizable hormone replacement. But again, just because it’s “natural” doesn’t mean it is safe. Although bioidentical hormones are widely prescribed, large controlled research studies are needed to quantify their effectiveness and safety. Again, discuss your risk and treatment options with your doctor as no one prescription fits all.
Whether you choose to treat menopause or not, it’s something all women will go through, a natural part of the life cycle that is not an illness or condition but a transient state of being. When assessing a woman’s reproductive cycle we can usually look at her mother and older sisters as a guide. Many women will mimic their female relatives with respect to age of onset, duration and severity of symptoms.
So lucky for me, I have a decade’s worth of wacky and wildly variable symptoms that begin somewhere around age 40. At that rate, I’ll be back in action in the year 2030. Which reminds me that keeping a sense of humor will certainly ease the transition.
Check out The Menopause Bill of Rights, written by Eva Moon and published on The Huffington Post on 8/30/2013.