As a Director of the Harvard Vanguard Menopause Consultation Service, I have the privilege of spending one day a week talking to women about their menopause transitions. Over the years several themes have emerged, and as the Editor of Changes, I would like to share my professional take on these issues with you.
Perimenopause The years preceding menopause—technically, the final menstrual period—are referred to as perimenopause. The definition of perimenopause has varied,
and there is controversy about when it starts. But if you are in your 40s, your periods are totally unpredictable, and your hot flashes come and go, then you know something is happening—even if your doctor tells you you’re too young
for perimenopause.
The illustration (at right) shows what is happening to your hormone levels at various life stages. The first row represents the years of regular periods. While there are ups and downs, there is a consistency that provides some comfort. The middle row illustrates why you may feel out of control during perimenopause. On any given day, your hormones could be anywhere. And you will write your own menopausal script.
The illustration also shows why birth control pills (BCPs), which turn off a woman’s ovaries, are one of the best treatments for perimenopausal symptoms. BCPs even out hormones and make periods regular. The good news about perimenopause is that it is finite. And the hormonal stability of menopause (see the third row) is—believe it or not—something to look forward to.
Weight GainMidlife women often have trouble just maintaining their weight; losing weight is an even bigger challenge. For example, one study showed that women gain an average of seven pounds and two to three inches in the waist over six years of the menopause transition. To some extent, this may be inevitable. Consider what happens to girls when they go through puberty: They gain weight and change shape. No one expects anything different. Similarly, as you navigate perimeno-pause, you will either have to eat less or exercise more, just to maintain your
weight. Meanwhile, your fat may re-distribute, no matter what you do. If you’re in your 40s, it’s time to put some mental energy into planning a calorie-reducing, energy-increasing strategy that can be part of your life for the next 30 to 40 years. And realize that not gaining weight in this life stage is an accomplishment!
Risks of HormonesIn the 50-plus years that estrogen has been used to treat women in menopause, many claims have been made about both its positive and negative effects. The well-known, large-scale study, the Women’s Health Initiative (WHI), was designed to answer one question: Should all women be given estrogen to prevent heart disease, their number one killer? The answer was a resounding “no.” Participants who used estrogen plus progestin had more heart disease, more strokes and more breast cancer than women who took sugar pills (placebos). But that doesn’t mean no one should ever take hormones.
The part of the WHI study involving women who had had hysterectomies showed some interesting results. The participants using estrogen alone had more strokes than the women on placebos, but they had no more heart attacks and slightly fewer incidents of breast cancer.
Another, sometimes overlooked, point is that the average age of the women in the study was 63, and most of the women had been beyond menopause for 10 years or more. Many experts think starting hormones in a perimenopausal or newly postmenopausal woman is very different from starting them in a woman who has not had periods for a decade or more.
Additionally, only one dose and one kind of hormone was studied in the WHI. We don’t know whether the results are applicable to other kinds or doses of hormones. Varied delivery routes (i.e., by mouth versus topically) may also make a difference. There is a great deal we don’t know about hormones and their harms and benefits. If you think you might benefit from hormone therapy, you should talk to a knowledgeable clinician about your individual symptoms, health-risk factors and personal philosophy. Then you can make your own decision about hormone therapy. (For more information, see www.whi.org.)
Keeping Sex Enjoyable Advice columnist Ann Landers once said, “The most important sex organ is the brain,” and discussions about waning libido and sexual function should start there. Depression and stress, both of which can be common in midlife women, may have a dampening effect on your sex drive, but there are other reasons for a dwindling libido.
- It is a time when partnerships can unravel. Hidden or outward anger toward a lover is not a turn-on.
- Some medications, especially antidepressants, can dampen sex drives, the strength of orgasms or the ability to orgasm at all.
- The decreasing levels of estrogen lead to vaginal aging and can make sex uncomfortable or painful. Lubricants may help. Only vaginal estrogens treat this condition.
- Partner function can be an issue in the decreased sexuality seen in some midlife women. You may not have a partner or your partner may have lost the interest in or ability to have sex.
But many of these negatives can be overcome. You will benefit from taking care of yourself, talking with your partner and seeking a clinician you feel comfortable with, to explore sexual issues. You can be sexually active well into your postmenopausal years, and it may even be better than ever.
A Final Reminder Menopause has many meanings. It is a physical milestone that reminds us that time is marching on. This stage presents an opportunity to look around with awareness and take stock of where you are and where you might go. And needless to say, not having periods is not that bad! |
