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  • Alan Frischer, MD, MPH

Menopause

Menopause: you don’t know whether to laugh or cry, so sometimes you do both! It is the permanent end of menstruation and fertility, officially beginning 12 months after the last menstrual period. It’s a natural biological process, and certainly not a medical disease. Nonetheless, it may take a significant physical and emotional toll. I have told my patients that almost any symptom is possible as a result of the chemical and hormonal changes that occur in their body at this time.


This transition most often happens between the age of 45 and 55, and typically lasts about seven years. The actual duration is affected by several things, including one’s age at which it starts, race, ethnicity, and lifestyle factors (like smoking). The months or years leading up to it are known as perimenopause; note that pregnancy is still possible during perimenopause.


Signs and symptoms of menopause and perimenopause can range from extremely mild, to severe and disruptive. They may include:

  • Irregular cycles which may be shorter, longer, or heavier, or skipped altogether.

  • Hot flashes, which can last for years. These are described as a sudden feeling of heat in the upper body. The face and neck can become flushed. Red blotches may appear on the chest, back and arms, accompanied by heavy sweating followed by cold shivers. They range in severity, and last between 30 seconds to 10 minutes. They can occur several times an hour, or once or twice per week.

  • Night sweats and other menopausal symptoms leading to insomnia (both trouble falling asleep, as well as waking too early).

  • Vaginal dryness, which can make sexual intercourse uncomfortable.

  • Incontinence, the sudden urge to urinate, or the leaking of urine when exercising, sneezing, or laughing. (Lower estrogen levels can cause pelvic muscles to weaken, leading to some loss of bladder control.)

  • Changes in feelings about sex, ranging from loss of interest to feeling freer and sexier due to pregnancy being less likely. (Of course, the risk of contracting an STD continues to make protection important.)

  • Moodiness and irritability may be more common. Causes may include changing hormones, family stress, growing children, aging parents, or fatigue.

  • Other body changes, related to menopause and aging, may include a widening waist, loss of muscle tone, thinner and more fragile skin, loss of breast fullness, stiff and achy muscles and joints, hair loss, and palpitations.


Your doctor will usually make the diagnosis by taking a simple health history. If you are the appropriate age, menstrual cycles have stopped, and some symptoms are present, the diagnosis will likely be menopause. Blood tests, looking for increased levels of follicle-stimulating hormone (FSH) and decreased levels of estrogen (estradiol), can be ordered to confirm it. (Occasionally, other conditions can have symptoms that mimic menopause, such as hypothyroidism.) Menopause can also be triggered by a hysterectomy, or by surgical removal of the ovaries. Unless hormones are taken, the symptoms of menopause will begin immediately after those surgeries.


Due to hormones and other changes, post-menopausal women may become more vulnerable to heart disease and osteoporosis, vaginal atrophy, and some mental health issues. Should the symptoms of menopause be treated? The answer must take into account a number of issues, including any family history of cancer and heart disease, the severity of symptoms, and one’s individual medical history. Data from well-controlled studies on hormone replacement therapy (HRT) show that it can carry significant risks. Today, HRT is used only for those with the most severe symptoms.


Other treatments for menopausal symptoms include:

  • For hot flashes, many use botanical products that naturally contain or act like estrogen. These include soybeans, chickpeas, other legumes, whole grains, some fruits and vegetables; and herbs, such as black cohosh. Research is limited. Low dose antidepressants have provided some relief, as well as Neurontin, a seizure drug that is also used for chronic pain.

  • To help prevent osteoporosis, foods and supplements that are rich in calcium and vitamin D are recommended. Moderate exposure to sunlight also helps the body produce vitamin D. An active lifestyle, including regular weight-bearing exercise, helps to stop bone loss. Medication includes bisphosphonates such as Fosamax, as well as a newer class of medications, selective estrogen receptor modulators (SERMs), such as Evista. Note that it is also important to limit alcohol consumption, in order to reduce the risk of falls, and to avoid smoking, which prevents calcium absorption, leading to lower bone density and weaker bones.

  • To reduce the risk of heart disease, follow a heart-healthy lifestyle: not smoking, limiting consumption of saturated fat and cholesterol, salt, and alcohol; maintaining a healthy weight; and being physically active. Medications may be helpful for the control of high blood pressure, high blood cholesterol, or diabetes.


Menopause can be a complex physical and emotional process. I urge you to discuss it with your loved ones and with your physician.


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