Managing Menopause
By taking care of yourself and becoming educated, you just might find that the “change of life” is a time to embrace

By Karin Mahony

Night sweats, hot flashes, sleep disturbance and mood swings. We’ve all heard horror stories about menopause, and some of us cringe at what’s waiting for us down the road.

An added blow to thinking about “the change” is that our society craves and lauds youth — primarily in its women. In the 1980s, Jane Fonda created a stir when she wore a bikini in “On Golden Pond” and Tina Turner shook things up by displaying her amazing legs in a miniskirt on stage. Both women looked incredible and certainly helped defy the myth that women over 40 weren’t sexy. More recently, L’Oréal’s choice of the lovely 60-something Diane Keaton as their new spokesmodel should be applauded. Perhaps it’s time for the rest of us to change our attitudes about the “change of life” too.

The change of life refers, of course, to menopause. Dr. Mary Stoffel, an obstetrician and gynecologist with Associated Physicians, clarifies, “Menopause is the complete decrease in ovarian function, and the absence of periods for a year.” The average age of women at menopause is 51.

Lucy*, an Oregon, Wis., resident, is 51 and hoping that her most recent period, three months ago, was truly her last. She’d been having irregular periods for several years, with the severe cramping she experienced when she was a young teenager. The inconsistency of her cycle was also bothering her. “Never knowing when my period would start was a real pain,” she says.

Lucy had some minor hot flashes before her last period, then started having four to five hot flashes a day, waking up with night sweats five times a night. Layering is her current fashion statement and she jokes that she’s getting exercise by taking layers off and putting them back on multiple times each day. To help curtail her hot flash symptoms, she’s tested out several herbal supplements, with some relief.

This transition time, when hormone levels are decreasing and many women experience irregular menstrual cycles as well as other symptoms, is called perimenopause. Just how long does perimenopause last? The media and the medical community differ in their perspective.

Stoffel feels the term perimenopause is used too broadly. “There are normal changes that occur with women in their 30s. Women in their mid-thirties tend to experience more pre-menstrual syndrome [PMS] because the ovaries have to work harder to stimulate aging eggs. Women are led to believe, however, that any variations after 30 are perimenopause, when it’s just normal life.”

Dr. Mary Haag, an obstetrician and gynecologist with Dean Health System, agrees. “PMS was a hot topic 15 years ago. Now, a lot of the symptoms of PMS are being grouped with perimenopause.”

For managing PMS symptoms, Haag recommends a healthy lifestyle. “As boring as it sounds, what has been found to be effective is healthy living: steady sugar levels, avoiding caffeine and alcohol, daily exercise and a multi-vitamin including B-complex vitamins.”

What about those menopausal symptoms? Stoffel reports that many women glide through menopause without great disruption to their lives. “About 40 percent of the women I see do not experience many symptoms; a few hot flashes, some wakening at night and night sweats, but they’re not problematic.”

Symptoms vary from woman to woman
Susan Benton, now 56, took menopause in stride. “For me, going through menopause wasn’t that difficult. I did have a lot of hot flashes, though, especially at night.” Drinking wine would make her too warm, so she cut back. “When my daughter Alyssa was in high school, we’d go to a concert and I’d feel I was burning up, so I would go someplace cool,” Benton remembers. She’s quick to add that she didn’t have headaches or mood swings. She knows women who had a more difficult time, so she considers herself lucky. “I didn’t take any hormones or do anything special except try to keep up my exercise routine.”

Stoffel does offer hormone replacement therapy (HRT) to her patients who are troubled by their symptoms and are interested in treating them. “One of the best things to do, if a woman is a good candidate, is to treat with a low-dose birth control pill. It’s a good way to provide some relief of symptoms and control irregular bleeding problems.”

If estrogen is used as a HRT treatment, that also helps protect women from developing osteoporosis. If women do not use any hormonal supplements, Stoffel recommends they get their first bone density scan around the onset of menopause, and urges them to watch their calcium and Vitamin D intake (Vitamin D helps the body absorb calcium), participate in weight-bearing exercise and actively manage their weight. Generally, this is a time for women to get their health under control. “Women are so worried about breast cancer,” Stoffel notes, “that they lose sight of what kills most women — heart disease.”

Haag moved to Madison several years ago from Chicago and she’s noticed that far fewer Wisconsin women go on estrogen. She’s frustrated with the bad press that the Women’s Health Initiative Study has given HRT and she doesn’t feel the media accurately reported the findings. “A lot of these women studied had been through menopause already, and had established heart conditions when placed on estrogen for the study. The study didn’t look at the subset of women who were on estrogen while transitioning through menopause.”

Lesser known symptoms
Lesser known menopausal symptoms are changes in bladder and sexual functioning. The bladder and urethra are somewhat estrogen dependent, so issues of incontinence may occur for some women after menopause. The vaginal wall thins after menopause and the vagina may be dryer, possibly making intercourse uncomfortable. Women who don’t want to use systemic estrogen, Haag explains, can use a local vaginal estrogen cream, which can help with both bladder and sexual functioning.

Stoffel notes that 20 percent of her patients don’t find relief from standard treatments. For these women, or for those requesting herbal or bioidentical hormones, she refers them to places such as Community Pharmacy or Green Earth Pharmacy, where they can find herbal remedies like black cohash (Remiferin), which can help provide relief of hot flash symptoms.

“Bioidentical hormones,” explains Marla Ahlgrimm, president of Madison Pharmacy Associates, “are hormones that come from plants and are identical to what your body naturally makes.” Her pharmacy specializes in women’s health, and takes its specialization seriously by testing a woman’s current hormone levels and then formulating supplements tailored to her needs.

Transitioning to next life phase can be wonderful
Barbara Reineke found that bioidentical hormones provided relief from the emotional instability of PMS and menopause that standard treatment didn’t help. She’s now 62 and is still using HRT. She works at Madison Pharmacy Associates as a nurse practitioner. She’s also a patient. “Once a year I have my hormone levels checked, and then my doctor makes an adjustment based on this,” she says.

There are emotional changes that occur during this period in a woman’s life, as well. Many women are experiencing menopause as they send their children out into the world, to college or work. Haag feels that the social support women find among friends and the understanding of their spouses is very important. But perhaps most important is the individual woman’s attitude. “I have some women,” Haag explains, “who truly blossom. They pack the kids off to college and they see that the caretaking phase of their life is coming to a close. They’ve been planning what they’re going to do with their new freedom and are excited. Others have a harder time.”

Karin Clark Edmiston, the director of the Center for Conceiving Health, agrees. “It’s the time to reinvent yourself, a time of deepening and self-discovery. However, women who don’t give themselves permission to focus on themselves can really get stuck.” Clark Edmiston runs support groups for women navigating this next life phase.

Clark Edmiston enjoys spotting women who have navigated this transition well. “When I see a woman in her 60s who has owned her power as a wise woman, versus society’s pigeonholing her as a ‘crone,’ she has a real aliveness and a joy that a woman in her 20s just doesn’t possess. It’s like these women know a secret. They’re often doing things that are really thrilling to them — gardening, painting, weaving — things they would not have predicted 15 years ago. You meet these women, and they don’t have to wear a red hat to express their new-found confidence.”

*Lucy preferred that her real name not be used.