Living With: Menopause

Menopause occurs after a woman has her last menstrual cycle. Both menopause and the time preceding it cause significant physical changes in a woman’s body. Women can decrease the undesirable effects of menopause by taking medication, undergoing therapy, and making behavioral changes.

Symptoms

Most women experience menopause between the ages of 48 and 55. Perimenopause can occur four to five years before the onset of menopause. During perimenopause, the woman may have irregular periods but begins to have other symptoms of menopause. Common menopause symptoms include:

• Night sweats
• Cold feet and hands
• Moodiness
• Increased fat around the abdomen
• Hot flashes
• Dizziness or headaches
• Vaginal dryness
• Insomnia
• Memory loss
• Weight gain

While menopause is part of the natural progression of aging, certain health situations can cause menopause to occur more quickly. The risk factors for early menopause are:

• Low weight
• Never giving birth
• Hypothyroidism
• Adrenal glands that do not produce adequate hormones
• Ovarian failure that occurs before age 40
• Chemotherapy or radiation
• Smoking

Major Depression

Menopause can trigger a severe mood disorder known as major depression. Women who have had depressive episodes previously, especially if the episodes were caused by childbirth or menstruation, are at a higher risk of developing major depression during menopause or perimenopause. To diagnose the problem, doctors use blood tests to determine the level of function of the ovaries and thyroid glands. The doctor concerned will also enquire about other possible symptoms and life stressors.

Doctors diagnose women as having major depression if they are depressed for most of the day for at least two weeks. Women who are no longer interested in activities they once enjoyed may also be diagnosed with major depression. Some women experience both of these primary symptoms. Major depression can also cause these secondary symptoms:

• Fatigue
• Restlessness
• Feelings of worthlessness or guilt
• Thoughts of suicide or death
• Trouble sleeping
• Oversleeping
• Trouble concentrating

The severity of the symptoms affects how doctors treat major depression. Doctors may prescribe hormone therapy, antidepressants, and psychotherapy to women with severe symptoms. Women with less severe depression symptoms might only use hormone therapy or antidepressants in conjunction with psychotherapy. Women who have fully transitioned into menopause may respond better to antidepressants than to hormone therapy. Those who begin to take antidepressants should expect to wait one to two months before feeling an improvement. Hormone therapy patients can expect a response in two to four weeks.

Hormone Therapy

Hormone therapy was once prescribed to most women who started menopause as a way to reduce common menopausal symptoms and prevent future health risks. Most women took hormone replacement therapy, which was a combination of supplemental progesterone and estrogen. Women who no longer had a uterus were prescribed estrogen replacement therapy, which used only supplemental estrogen. Taking only estrogen increases the risk of uterine cancer.

Hormone therapy may have more risks than benefits, however. Women in their early 60s who took hormone replacement therapy for several years showed an increased risk of blood clots, heart disease, breast cancer, and stroke. Hormone therapy for younger women, if it is taken for a shorter period of time, may yield worthwhile benefits without such substantial risks.

Hormone therapy can also be used to treat depression caused by menopause. For women who are in perimenopause, hormone therapy and psychotherapy may be the only elements needed for successful treatment. Women who never had a depressive episode before they entered menopause are also likely to respond positively to hormone therapy. However, some doctors recommend adding an antidepressant to the treatment plan if the depression is severe or the patient has had depression in the past.

Health Risks of Menopause

Women who have started menopause have an increased risk of developing some diseases, cancers, and other conditions. Menopause increases the risk of:

• Heart disease
• Osteoporosis
• Macular degeneration
• Colon cancer
• Glaucoma

Women should discuss these increased risks with their doctors. If a woman has other risk factors for these conditions, cancers, or diseases, her doctor may choose to monitor her more closely.

Adjusting to Menopause

A woman should make an appointment with her gynecologist when she enters perimenopause. After seeking her doctor’s advice, she should consider whether or not to begin hormone therapy. Many women wait until menopause symptoms are severe before trying hormones.

Women entering menopause should also be aware of the signs of depression. Even women who do not experience depression can be affected by possible upheaval during this period in their lives. Empty nest syndrome and other challenges of middle age, which often occur during menopause, can also cause unpleasant emotions. Menopause can trigger negative feelings about the body and self-identity. While these feelings are common, they may merit therapy.

Woman entering menopause should consider continuing or starting a regular exercise program. Women who are active experience fewer and milder symptoms of menopause. Exercise may also prevent postmenopausal weight gain. Weight-bearing exercise can also help keep bones strong. In fact, research suggests that exercise is more effective than hormone therapy in maintaining a desirable body fat ratio.

Menopausal women may also experience urinary stress incontinence. This is caused by muscle atrophy in the pelvic floor muscles caused by shifts in estrogen levels. Regularly completing Kegel exercises can help prevent further muscle atrophy and stop the condition from progressing.

Sex can become difficult for menopausal women. Vaginal dryness and tenderness is common, and these symptoms may reduce women’s interest in sex. Women should also be aware that their sex organs, including their outer genitals, will shrink. Due to hormone changes, menopausal women may have less interest in sex. All of these conditions can be treated and should be discussed with a doctor.

Supporting Someone with Menopause

Menopause can be a stressful time for any woman, but support from friends and family can make the transition easier. Some women believe that depression is a natural by-product of menopause; family members should encourage them to seek treatment rather than enduring their symptoms. Family members can also help menopausal women maintain healthy lifestyles by offering to exercise with them or keeping unhealthy foods out of the home.

Many changes that occur with menopause are caused by middle age and are not necessarily directly caused by hormonal changes. Family members should be sensitive to women’s feelings about these changes. Children can make a special effort to regularly talk to mothers experiencing empty nest syndrome. Spouses should also be aware that hormonal changes can impact their wives’ responses to sex, but clear communication and seeking help from a doctor as necessary can keep a physical relationship in good health.

For more on the topic of Living with Menopause, we’ve included the following expert consensus documents as reference materials:

• Depression During the Transition to Menopause: A Guide for Patients and Families

View Resources

• Princeton – information about menopause and hormone therapy
• UNL.edu – Menopause: Adaptation or Epiphenomenon?
• Rochester – general information about menopause
• CBS – why menopause?
• Cedars-Sinai – more information about menopause