We all know that menopause is the time of life when the ovaries stop making estrogen, which causes menstruation (periods) and reproduction to both come to an end. What ELSE does menopause do to you? How does it all work? Today, we sit down with Dr. Amy Heeringa, certified North American Menopause Society Practitioner, and our resident expert in all things menopause.
So, let’s say you’re in your forties and you know menopause is coming, what should you know?
The transition through menopause (not unlike other phases of life) varies widely person-to-person. Even the age when you start menopause, like the onset of menses (first period) earlier in life, or when menstruation returns after giving birth, is different for each person. The average age to start menopause is 51, but it can start much earlier or not come until the late 50s. If it occurs before age of 40, it is considered ovarian insufficiency. The timing of menopause somewhat correlates to family history, or when your relatives went through menopause, and also your general health and other conditions. If you’re wondering if you’re nearing menopause, come in for exam and possible laboratory evaluation.
Menopausal symptoms also range. Some women have very difficult times and others sail through it.
A quote I like to use is:
“Menopause is like white water rafting. Some women go straight
down the river, some bounce of each bank and all the rocks.”
It’s important to remember that if you are postmenopausal (meaning you haven’t had vaginal bleeding for a full 12 months) and then you start to bleed, you need to make an appointment to be seen right away, as this could indicate a serious health condition or even cancer.
What are the common issues women share about their menopause experience?
The most common experiences are vaginal dryness, hot flashes, mood changes, weight instability, sleep disturbances, irregular bleeding, libido (sex drive) changes, and discomfort with intercourse. Unfortunately, many of these complaints are embarrassing to patients, so they are often reluctant to bring them up with their providers. We don’t want you to feel embarrassed or isolated. These are extremely common, and manageable! We’re working hard to make these topics less taboo, so women feel empowered to discuss them, and we can better help. Also, any irregular bleeding or discomfort with intercourse, although common around the time of menopause, needs to be evaluated and ruled out as something more concerning (like uterine cancer). When in doubt, make an appointment and come see me. You are not alone.
Mood changes: Because of all the hormonal changes related to menopause, it is also a very common time for mood changes, and often patients don’t know where to go for help with this. A GYN experienced in menopause is a great place to start. The good news is, if we choose to use pharmacological agents to help, there are those that can improve mood AND vasomotor symptoms (hot flashes, vaginal dryness, etc).
The decline of libido is a very real issue that can significantly impact your life and your relationship, and it’s one of the most common concerns patient have. Again, unfortunately, patients are often embarrassed to bring it up with their primary care providers, so it may go unrecognized and unmanaged. Come see us! Low libido is common and complex, and often multifactorial, in women. It’s frustrating that there are 26 FDA drugs approved for male sexual dysfunction and 1 for female….(and it’s for premenopausal women and comes with lots of restrictions). This reflects how complex this issue is, so we need to approach it from multiple angles. The first thing we always do is rule out physical conditions that might be contributing to vaginal dryness or vaginal/vulvar pain, with a thorough conversation and exam in the office, then we discuss possible solutions. You’re not alone! So many women are having these hard conversations every day with their providers, and are glad they did!
Do you recommend any specific vaginal lubricants for postmenopausal women?
Lubricant will become a part of your sex life, if it isn’t already, and that’s OK! There are great products on the market. We have samples in the office for you to try!
Are there any simple things people can do that might help with their menopause symptoms?
Traditional teaching tells us to dress in layers so you can remove clothes during hot flashes, avoid hot, caffeinated beverages, and get regular sleep and exercise. These are a great place to start, but sometimes women need more than lifestyle modifications to get good control of their symptoms.
Do you recommend hormone replacement therapy to your postmenopausal patients?
There are a broad range of treatments for menopause symptom control, including hormonal and non-hormonal options. The need for and use of hormones varies by how severe the menopause symptoms are, and the patient’s personal, medical, and family history. It is a very individualized approach, and safety and quality of life are the priorities. We always extensively discuss the risks and benefits of all treatment options before beginning any treatment, and follow closely during treatment.
Where would you recommend people look for more information about menopause?
North American Menopause Society is a great resource, with tons of helpful info. There you can also find providers who specialize in menopause, like myself. Also, there is a lot of handy information on menopause at the American College of Obstetrics and Gynecology’s site.
Thanks so much for talking menopause with us today, Dr. Heeringa!