Welcome, Agenda readers, to our menopause tutorial and survival guide. Permit me first to apologize for being a male (not needing to experience menopause) and thank you ladies for all the wonderful things you do to keep us males intact. Now with that said, let us equip you as best we can with the tools you will need to combat pre- and post-menopause.

Menopause is actually Mother Nature’s unique way of extending the time and quality of a woman’s life. Yes, you read that right. This is the natural transition point in a woman’s life between the age of 40-60 (age 51 on average) in which fertility halts due to the cessation of ovarian function. From an evolutionary standpoint, women were designed with menopause in order to increase a woman’s survival rate in later years. Remember that at the dawn of mankind, life expectancy was incredibly short compared to today’s standard, living only to the ages of 15-30 on average. In prehistoric times only 1.5% of humans lived past 40 and the rarest to age 50, hence the time window menopause has evolved into. Mother Nature actually intended to help, not complicate a woman’s life, as the older a woman is when she conceives the higher the risk of complications and death to mother and child. From a strictly basic evolutionary standpoint, men were designed to spend their time spreading their seed while women were designed to find the best seed/provider worthy of their egg. Since men’s role in the whole life creation process is so minimal, evolution designed a safety mechanism to increase birth survival of mother and child while favouring strong healthy future generations. Mother Nature sought to give women 1/3 of their lives without the strong natural urge to produce life. Wasn’t that nice of her? The word menopause itself translates literally as “end of monthly cycle,” stemming from the Greek word pausis (cessation) and mensis (mouth) and was intended for positive reasons, as bothersome as it may seem. The key marker of menopause is amenorrhea (absence of menstruation) for one year. The base of it all is the cessation of key hormones (estradiol & progesterone) by the ovaries. These hormones make reproduction possible and control sexual behavior, hence the drop in sex drive around this stage. Estrogen does continue through other tissues in the body but without steady estradiol levels for balance, chaos begins. The key words are hormone imbalance, causing the dramatic fluctuations in symptoms women experience. Now let us travel through the various terminology of stages and culminate with some solutions for relief from it all shall we?

Premature Menopause:

Premature menopause is more commonly referred to as premature ovarian failure (POF) and is not considered an effect of aging. POF is incredibly rare, affecting only 1% of women by age 40 and 0.1% by age 30, so don’t lose any sleep worrying. The following are the most common triggers:

Early Menopause Triggers:

• Smoking cigarettes (quickens menopause onset significantly)
• Significant unhealthy excess body fat
• Significant illness (i.e., thyroid or autoimmune disorder, diabetes)
• Chemotherapy
• Radiation
• Chronic long term stress (i.e., financial strain)
• Hysterectomy (uterus removal)—patients on average reach menopause 3.7 years earlier
• Oophorectomy (ovary removal)—patients will enter immediate surgical menopause unless at least one proper functioning ovary exist

Perimenopause (Premenopause):

The word perimenopause literally means “around menopause” and is the more common reference for the transition time leading up to menopause. One of the more obvious signs is irregular periods until it has been 12 months since the last sign of menstrual blood. Signs can begin as early as age 35 but on average begin around age 41. Symptoms can last a few years and up to 10+ years before menopause arrives fully, and this is not uncommon but varies per individual. The most infamous of symptoms are the “hot flashes” due to a woman’s internal thermostat being thrown off by unbalanced hormone levels. Although hot flashes are not considered harmful, they are definitely a nuisance as women will profess. Hot flashes can be controlled through a few methods. Hormone replacement therapy (HRT) prescribed by a physician or over-the-counter plant estrogen methods are the most common. As hot flashes are the body’s attempt at reaching a balanced temperature, dressing in light fabrics along with drinking plenty of ice water and a cool environment will go a long way. The following are common symptoms that women may run across, transitioning from peri- to post-menopause but they are not necessarily expected to undergo each symptom.

• Mood swings
• Irregular periods
• Migraines
• Rapid heartbeat
• Decreased fertility
• Vaginal dryness, itching and possible bleeding
• Hot flashes
• Increased abdominal fat
• Thinning hair
• Decreased libido & difficulty reaching orgasm
• Tingling or itching of skin
• Loss of breast fullness
• Back, joint, and muscle pain
• Urgency of urination
• Insomnia
• Fatigue (aided dramatically by even 30 minutes of brisk walking, or greater to raise serotonin levels)
• Memory problems
• Depression

Depression is common for many reasons.  Children are off living their own lives, leaving an “empty nest.”  Many events at this stage in life move perimenopausal women from middle age into a new, older life bracket, triggering a flood of new emotions. These new life events, combined with a hormonally transitioning body, can make for a very emotionally and physically difficult time. Melatonin supplementation has shown in research to aid depression, insomnia, fertility and menstruation problems through significant thyroid support and raising gonadotropin. There is no avoiding menopause, unfortunately, but there is relief every step of the way if you are proactive about your comfort and well-being.

Menopause or Post-menopause

Menopause or post-menopause itself is marked officially at 12 months since last sign of menstrual blood and ovaries become dormant. Note that during the few years just before this point it is very difficult and rare to become pregnant, but there is still a marginal chance. High follicle-stimulating-hormone (FSH) levels are an indicator typically measured by a physician to confirm this stage along with common hormone fluctuations that can last a few to seven years in post-stage before the body stabilizes. Symptom discomfort varies greatly as some women might not be bothered by most symptoms at all while others suffer extreme discomfort until full stabilization.  There should be no blood at this point; and if there is even a slight sign of spotting, be sure to see a physician to rule out endometrial cancer.

Treatment & Relief

There is nothing wrong with a woman at this stage, so menopause should not be seen and treated as a negative disease. Natural or not, this stage is still full of uncomfortable symptoms that can be helped dramatically today with the following resources:

• Hormone Therapy (HT) – Estrogen therapy by far remains the most effective option for combating menopausal hot flashes. Make note though that women using HT and those not using HT still reported fatigue as the most common complaint, so consider the last item on this list.
• Conjugated Equine Estrogens – Although this therapy is still used, it has also been shown to raise the risk of breast cancer and heart disease; so do your research first with your physician.
• Low-dose Antidepressants – Help mood along with aiding in hot flash relief
• Gabapentin (Neurontin) – Commonly used to treat seizures but has also shown to significantly reduce hot flashes.
• Phytoestrogens – Natural estrogen-rich plants are popular, but science has yet to prove them effective enough simply because estrogen amounts are not high enough for adequate relief. Although this is the most natural relief, it is the least consistent but will vary per individual.
• Vaginal Estrogen – To relieve vaginal dryness, intercourse discomfort, and some urinary symptoms.
• Vaginal Lubricants – Common over-the-counter lubricants (Astroglide, K-Y) give quick, simple relief for vaginal dryness.
• Bisphosphonates – These are commonly used by physicians to prevent or treat osteoporosis, effectively reducing bone loss and risk of fracture.
• Selective Estrogen Receptor Modulators (SERMs) – Another common bone density aid in post-menopausal women with significantly fewer risks than estrogen.
• Yoga & Exercise – This will help immensely in far more ways than all others mentioned, as even 30 minutes of moderate intensity exercise will work miracles. Known to trigger the body’s natural aids for relieving hot flashes, reducing cardiovascular disease, stress, diabetes, osteoporosis, insomnia, cholesterol, aiding posture, mood elevation, and weight loss along with infinitely more.

References:

1)     Ringa, V. .(2000). Menopause and treatments. Quality of life research 9(6): 695-707

2)     Bellipanni G, DI Marzo F, Blasi F, et al. Effects of melatonin in perimenopausal and menopausal women: our personal experience. 2005. Ann N Y Acad Sci 1057:393-402. DOI: 10.1196/annals.1356.030 PMID 16399909.

3)     Davis SR, Dinatale I, Rivera-Woll L, Davison SR. Postmenopausal hormone therapy: from monkey glands to transdermal patches. J Endocrinol. 2005 May;185(2):207-22