What happens in Menopause ?

Over the next several weeks we will go over several facets of menopause. What is menopause and why do women go through it?

Life is change . We all go through stages in our lives, but those stages are a lot more marked in women. Menopause is defined as the cessation of menstrual cycles. Doctors like to define menopause after a woman was period-free for one year or longer. Average age of menopause in the United States is 51 years., but some women start menopause in their early 40’s and very few start menopause after age 51. Menopause before age 40 is not considered normal and needs to be investigated by a physician. In reality, menopause is a transition. Perimenopause begins approximately 4 years before the final period. It is when you start having more and more irregular periods and hormonal oscillation becomes more marked. We become aware of hot flashes. In the early menopausal transition, we start having more menstrual cycle irregularities. in late menopausal transition, cycle variability increases as ovarian function weans.

Factors that affect menopause:

Genetics: women that start menopause early tend to have family members that also have early menopause.

Ethnicity and race can also influence the age of menopause. In the US a study showed that Latin American women tended to have earlier menopause than Japanese American women for instance.

Smoking can accelerate menopause by 2 years! Another reason to avoid smoking, ladies! Other studies show that night shift work , history of diabetes type I and some genetic mutations can interestingly lead to earlier menopause.

During Early Transition ( into menopause) : periods extend over or decrease by 7 days or more. If you used to have periods every 29 days and for the past 3-4 months you are having periods every 50 days and you are over 40, you could be in this early transition phase.

During Late Transition phase, the cycles show more dramatic changes with skipped cycles, and cycles without ovulation. This lasts 1-3 years before the final period.

During early and late transition phases, our hormones are undergoing dramatic fluctuations and so hormonal testing may not be accurate at this stage. Not only are our pituitary hormones changing ( LH, FSH) but also our ovarian hormones ( inhibin B, estrogen, anti- Mullerian hormone (AMH) ) are decreasing while the ovaries continue to produce a small amount of testosterone even int he post menopausal years. In the ovary, the number of follicles that would have produced eggs decreases. Most women notice a gradual decrease in bleeding but some experience heavy or prolonged bleeding. Please consult your doctor if you have excessive bleeding as there are other causes of heavy bleeding that need to be ruled out. Then after about 4 years of pre menopause, the last period arrives and goes.

Everyone knows that hot flases are one of the symptoms of menopause. 80% of women experience hot flashes. Symptoms are usually mild and most women do not seek medical attention. Hot flashes are felt as a sensation of heat in mid chest area and face that rapidly spreads and if they occur at night, sweating may be the only evidence. Hot flashes usually last a few minutes, and may be followed by palpitations and more rarely- anxiety. They may happen once or twice a day to several times a day. They usually last 1-2 years but may last for much longer. Other symptoms include sleep disturbance and early onset of depression. Depression is relatively common and I suggest that you seek help for this if you cannot improve with self care alone. Sleep issues that become more frequent include sleep apnea and restless leg syndrome. Hot flashes are also more common at night and can wake you up in the middle of the night, leading to fragmented sleep and worsening depression. The decrease in estrogen also leads to vulvovaginal atrophy, now called Genitourinary Syndrome of the Menopause: reflects changes in genitourinary tract due to decreased estrogen levels and tend to happen in later stages of menopause. It can lead to sexual dysfunction but they respond well to estrogen applied vaginally. If this is a significant issue for you, please seek medical attention.

After menopause, we need to be aware of a few things:

Bone Loss: bone loss begins in the menopausal transition and continues throughout the post menopausal years. The best protection is to have good diet during and through puberty and early adult years. However you can help decrease bone loss even in post menopausal years with gentle exercise and continued healthy diet. Again, please seek medical advice for your personal case.

Cardiovascular disease: risk of cardiovascular disease increases after menopause, in part due to decrease in estrogen. It is important that we continue with self care and a balanced lifestyle and preventive medical visits.

Skin changes: collagen and elastin content of skin decreases with the declining levels of estrogen. Fine wrinkles as well as hyperpigmentation as well as fragmentation of the subcutaneous fat of our faces increase as we advance in age. Aging is very influenced by lifestyle, including sun exposure, smoking, alcohol intake, poor nutrition, poor sleep and toxic stress. We will definitely be talking about this topic more in later blogs.

One thing is for certain: we will all hopefully l go through menopause. We all know of the importance of taking care of our bodies and having adequate rest, some exercise and healthy diet. For me, I have not taken the best care of myself all the time and I suspect many women like me put their children and careers in ahead of their personal needs. We can see that the choices we make in life can affect our bodies and our beauty. It is never too late to improve our health and if you haven’t taken any steps yet, now is the time to start!

We are surrounded by toxins and more than ever we need to choose the products that surround us in our homes, our kitchens, the foods we eat and the personal care products carefully. A great website to subscribe to is http://www.ewg.org/skindeep from the Environmental Working Group, a non profit organization that researches products available in the market as to its safety of use. For cosmetics, the European Union ( Cosing database) has very thorough regulations on cosmetics and what is safe to be used in them. Regulation is very important to keep us consumers safe. In the United states, the FDA does not regulate cosmetics. but limits what is defined as a cosmetic. From the FDA website : “Under U.S. law, cosmetic products and ingredients do not need FDA approval before they go on the market. The one exception is color additives which must be approved for their intended use. Companies and individuals who market cosmetics have a legal responsibility to ensure the safety of their products.”

We are hearing more and more about eating healthy and avoiding processed foods and eating more veggies. I am not in favor of “diet” but I believe that cooking at home and eating home prepared foods is very important for our health. Our relationship to food changed since industrialization . In Western societies women are expected to work outside the home as much as ( often a lot more than ) men. It is convenient to get pre prepared foods or take out foods. Food is so accessible and easy to prepare that we tend to overeat. And overeat more indulgent foods. Our body needs fibers to develop a healthy microbiome. It is through eating a variety of different veggies that we obtain this healthy microbiome. Interestingly more and more research is showing that our microbiome influences our health including mental health. We will do several separate blogs on the microbiome as this is an exciting area of expanding knowledge!

Going to the market, getting our foods from as close to the source as possible, preparing our food and offering our loved ones ( or ourselves only) a labor of love is more nourishing than opening a pack and dunking it in the microwave. If we view food this way, we don’t need to diet. Diet feels like a punishment that we really don’t need. Learning about nutrition is an act of self love.

Even if we never slowed down, never took care of ourselves, it is not too late to start now.