You may be lucky enough to have a good doctor -- one who takes menopause seriously, respects that your feelings and the symptoms going on in your body are real, and cares enough to listen and try to help you feel better.
Or, you may not. Sadly, when it comes to menopause, many doctors have outdated information and perceptions, or they simply don't have the time for the careful diagnosis and trial-and-error process it takes to treat menopause symptoms accurately and safely.
So, chances are, when it comes to navigating the inhospitable terrain of menopause, you'll be largely on your own. That means you need to familiarize yourself with how this enormous change of life actually happens, and what to expect. We talked to a range of women going through menopause, and here's what we learned about what to do to make it through healthy and happy.
Problem: Your doctor won't take your menopause symptoms seriously
Has either of these happened to you?
- Your doctor listens to your list of symptoms, says it sounds like PMS or "period moodiness," and offers you a prescription for an antidepressant.
- Your doctor listens to your list of symptoms, says the only approach is hormone replacement, and offers you a prescription for hormone replacement therapy (HRT).
If so, it's a red flag that your doctor isn't doing all he or she should to help you.
Solution: You're going to have to push harder to get quality help from your doctor. Don't get us wrong: Both antidepressants and hormones are reasonable approaches to some menopause-related problems. But neither should be an automatic first-line solution, and neither should be given without making sure they're the right approach.
So before you zip over to the drugstore with a prescription, make sure you and your doctor have had a thorough discussion about your symptoms, the best dosage, and what you can expect the drug to accomplish, as well as a full rundown of the side effects and risks. And if you find you consistently leave your doctor's office feeling that no one really listened to you, or that you don't know what to do next to feel better, it's time to get a new doctor. Really.
Problem: You're not sure if you're in menopause
Menopause itself isn't medically diagnosed until you've gone one year without having a period. So the phrase in menopause is sort of useless, because it's the period leading up to that, called perimenopause, when most women experience the really crazy physical and emotional changes. And the years afterward, when hormone production has pretty much shut down, bring their own health issues and problems.
Solution: Start by looking closely at your own symptoms. Don't be too certain that being a particular age automatically means you're in menopause: Perimenopause/menopause can start when you're in your late 20s -- usually induced by a medical condition, but not always -- or as late as the late 50s. But the majority of women start to notice a series of incremental changes and symptoms, increasing in severity, between ages 40 and 50.
If your periods are changing, you're becoming uncharacteristically moody, and you're starting to have night sweats or hot flashes, then you're probably in perimenopause. Notice we say changing, not stopping. This is where some of the greatest confusion lies. Your periods might actually become heavier or occur closer together. They might be the same but you might notice more bloating, moodiness, and new symptoms, such as breast pain or a flu-like achiness. You might have spotting between periods or skip periods altogether, like you did when you were a teenager. In fact, some experts counsel us to think of menopause as a second adolescence -- it's that big a life change.
If you're like most women, though, you can skip the only actual diagnostic tool available, a menopause blood test. It's unlikely to tell you much. The test is quite reliable for women who have gone at least a year without a period and for women experiencing premature ovarian failure (a medical disorder), but it's basically useless for women in the midst of perimenopause. The test measures hormone levels, but during perimenopause the hormone levels fluctuate wildly. The blood test only checks where your body is on a particular day, and it could show something completely different a week or even a day later.
So when your doctor says your hormone levels are fine, take that with five grains of salt. Better yet, don't even have the blood test. Common sense tells you that if you're between 35 and 55; your periods are getting squirrely; you're constantly adding and removing layers; and you find yourself inexplicably cranky, weepy, and just plain mean, you're almost certainly menopausal. Then go with that and get help.
Problem: You're having hot flashes and night sweats
One thing you need to know right away: They're not exactly the same thing, though they're related. Some women really do have one without the other, and that's normal. The explanation for this strange symptom is that when your body's natural hormone regulation system is overtaxed, it gets confused and sends out a signal to dispel heat. Your blood vessels dilate, your heart rate increases, your sweat glands open, and voilà -- that rush of heat and flushing we're all too familiar with.
Solution: Understand that your body's mixing up its signals and overreacting. You can often prevent the reaction by avoiding the triggers that set off the hot flashes and night sweats. Here's a list of hot-flash triggers you may not know about:
- Spicy food and hot sauce
- Acidic foods, such as tomatoes
- Tobacco and marijuana
- Hot tubs and saunas
- Intense aerobic exercise
- Stress and intense anxiety
Two other things that can make a big difference: losing weight and quitting smoking. Both smoking and extra pounds increase the incidence of hot flashes and night sweats enormously. Also, women who struggle with anxiety are five times more likely to suffer from hot flashes, so antianxiety remedies can help.
Experts recommend a few simple habits anyone can use to cope with hot flashes. Keep a glass of water by the bed; drinking water can cool down night sweats. Dress in layers, learn to recognize the sign of an impending hot flash (it feels like a surge of adrenaline), and react by dressing down. Make sure you're getting adequate calcium, magnesium, and vitamin D, which not only prevent osteoporosis but reduce hot flashes.
If nothing works and your hot flashes are so bad they're interfering with daily activities or preventing you from sleeping, you may need to consider hormone therapy.
Problem: Your mood swings are out of control
As one 49-year-old woman recently put it, "Is it normal to be a complete witch for two weeks out of every month?" Well, um, yes.
Solution: Just because your mood swings are a normal part of menopause doesn't mean you -- or your family and friends -- have to just stand by and take it. First off, start marking on the calendar which days of the month you're a complete hellion. Is it the week right before your period? Two weeks before? Or both? Then analyze the emotion -- or emotions -- you're experiencing. Is it anxiety? Depression? Anger? Are you oversensitive, feeling hurt all the time; or overreactive, freaking out over everything in sight?
The reason for compiling all this data: Mood-altering medications come in many varieties, and it's not a one-size-fits-all situation, though far too many doctors treat it that way. If your primary emotion is anxiety, even paranoia, a short-acting benzodiazepine like lorazepam (brand name: Ativan) may be much more effective and have fewer unwanted side effects than an SSRI (selective serotonin reuptake inhibitor), like Prozac or Zoloft.
If your mood problems come primarily in the form of irritability and anger, an antidepressant might help, but making time for regular yoga or dance classes or a strenuous walk can do just as much to relieve stress and that horrible sense of feeling overwhelmed. And if middle-of-the-night, mind-racing insomnia is your main symptom, then taking an herbal supplement such as valerian or chamomile might get you back to sleep without the need to be on a drug full time. (Several midlife women we talked to keep a simple chewable homeopathic remedy called Calms Forté in their nightstand drawer for such moments.)
It's not that antidepressants are bad per se, but going on one can cause additional issues, such as loss of libido. So if you can take care of your symptoms without a systemic solution, there's less chance of complications. If you do go on an antidepressant, many women swear by citalopram (brand name: Celexa); in fact, a recent study found that citalopram was the most effective SSRI, and even more effective for women than for men. Research at Massachusetts General Hospital showed a surprising additional benefit: Celexa reduced women's hot flashes by 50 percent. Another tip: Start with the lowest possible dosage your doctor thinks might be effective and work up from there. With citalopram, for example, studies have shown just 20 milligrams to be as effective -- and to have fewer side effects -- than the more common starting dose of 30 milligrams.
Problem: You can't fall asleep, can't stay asleep, or sleep poorly
Many women in their forties and fifties complain that getting a good night's sleep is a thing of the past. They mourn the loss of deep, restful sleep and struggle to cope with the fatigue, grumpiness, and inability to concentrate that are the natural results of sleeping poorly or not enough. Most wisely try to avoid sleeping pills, or take them guiltily, not knowing what else to do. So what does work?
Solution: The first and easiest fixes you can make to help you sleep are in the arena known as "sleep hygiene," which simply means all the factors surrounding getting to and staying sleep:
- Keep your bedroom cool and breezy; open the window or run a fan in summer.
- Use layers of covers, just as you do with clothes. Make sure your bed has a couple of top layers you can throw off and put back on easily, without crossing the room or turning on a light.
- Speaking of light, get rid of as much of it as possible. Use blackout shades, tape over the lights on alarm clocks and smoke alarms, turn electronic devices to the wall.
- Create a schedule that works for you. If you have to be up at 6:30 a.m. on weekdays, be in bed by 10:30 p.m. If you prefer to stay up later and sleep till 8 a.m., do so -- but try to be consistent. And yes, unfortunately, sleep scheduling works best if you stick to it even on weekends.
- Set aside the last hour before bed for restful, relaxing activities. If possible, exclude computer work; studies show that the bright light of the computer screen affects your circadian rhythm, the internal clock that regulates sleep.
- Keep your bedroom work- and computer free, so that daytime stresses don't intrude.
- Tire your muscles with at least half an hour of exercise a day, but not within two hours of bedtime.
- If bathroom trips are waking you in the middle of the night, don't drink liquids after 8 p.m.
- Don't drink tea, coffee, or caffeinated cola within six hours of bedtime.
- Avoid alcohol in the evenings; it may make you feel relaxed, but it causes middle-of-the-night insomnia.
- If you're still not sleeping well, try taking a small dose (.3 to 1 milligram; this means cutting 3 milligram pills into thirds) of melatonin about an hour before bedtime.
More and more doctors are prescribing Ambien and Lunesta as sleep aids for women who complain of menopausal insomnia. However, research shows mixed results on the effectiveness of these drugs, and they can cause psychological if not physical dependency. Here's the problem: Both are recommended for short-term use, if you're in a situation where stress and other factors are making sleep difficult. But since menopause-related sleep issues typically persist for years, you want a long-term solution, and sleeping pills are not a good idea for the long haul. Yet once you start taking sleeping pills, it can be more difficult to sleep when you try to stop taking them -- so you're setting yourself up for future sleep problems. With that in mind, first try everything else on the list above, before resorting to sleeping pills.
Problem: Sex is no longer fun
Does going through perimenopause or menopause mean your sex life is over?
Absolutely not. Here's an area where there's lots of help available, and many women actually find that postmenopausal sex is a whole new, exciting (and birth-control free!) world to explore.
Solution: To enjoy sex again, you'll likely have to make some changes:
- Use lots of lubrication, natural and otherwise. Invest in one of the great new lubricants specifically for midlife women; you won't be sorry. Also avoid rushing to intercourse; giving things a bit more time to develop is extremely helpful.
- Minimize pain with different positions. Many women find deep penetration more painful as they age; use this fact to give yourself -- and your partner -- permission to experiment with new positions.
- Eliminate or change antidepressants. Many have loss of libido as a side effect; if you're on one that does, ask your doctor about changing drugs or taking a break to see if things improve.
- Keep in mind that this particular symptom tends to be temporary. When monthly-period hormone production stops, many women feel their libido plunge. But with time, the adrenal glands take over, producing both male and female hormones, often bringing back libido -- and then some.
- Combat loss of libido with male hormones. Yes, this is a last-ditch approach, but many women find it worthwhile if sex has gone completely off their radar. Both testosterone and androgen therapy have been found to help; discuss the pros and cons with your doctor.
Problem: Nothing has worked, and you want to avoid hormone replacement therapy
People tend to talk about HRT as a black-and-white, either-or question, but it's a bit more complicated than that. The two key hormones, estrogen and progesterone, can be taken orally or as creams or patches. And you can take one or both, and in different dosages. Then there's the hot topic of bioidentical hormones, given enormous attention by Oprah and other gurus. So you have a lot to consider.
Solution: At the point you're considering hormones, make sure you have a really good doctor and have a thorough discussion. The two risks you want to discuss in depth: cancer -- breast, ovarian, and other types -- and heart disease. If your family history puts you at risk for breast or ovarian cancer, most experts would say HRT is out for you. It would up your risk, and you don't want to take that chance. If you have any risk factors for stroke, HRT is similarly inadvisable, as HRT can increase your stroke risk by as much as 60 percent.
However, even here there are major differences based on estrogen-only versus combination therapy, and bioidentical therapy versus synthetic hormones. So every case has to be considered individually; talk to your doctor and make sure that, whatever choice you make, your health is closely monitored.