Signs and Symptoms of Menopause: How to Cope

 Julia M. Stauble, MS, APRN, MSCP with patient
Julia M. Stauble, MS, APRN, MSCP with a patient

“Women don’t need to suffer during menopause,” says Julia M. Stauble, MS, APRN, MSCP who works in Obstetrics & Gynecology at Dartmouth Hitchcock Clinics Nashua.

Stauble recently received certification from The Menopause Society, an independent, evidence-based resource seeking to improve women’s health and healthcare experiences during and after the menopause transition.

She says thinking about treating the signs and symptoms of menopause is changing, and women should talk to their provider to learn more about how to manage this sometimes challenging stage of life.

What is menopause?

'Thriving After 40: A Unique Look at Menopause: Don’t Suffer in Silence"

What: A free discussion about menopause

When: Thursday, December 12

Time: 5:30 to 8 pm

Where: Dartmouth Health Medical Center, Auditorium H

To Register: Email Katelyn.M.Danner@hitchcock.org

Menopause is the permanent ending of menstruation, usually between the ages of 45 and 55.

According to the nonprofit The Menopause Society, this phase of a woman’s life brings sudden and often unexpected changes that can impact her physical and mental health.

If this transition into a woman’s non-reproductive years does not happen because of any type of medical treatment, surgery or event, the process is gradual and happens in three stages:

  1. Perimenopause, transition to menopause
  2. Menopause, when a woman has not had a menstrual cycle for 12 consecutive months and stops producing reproductive hormones, estrogen and progesterone
  3. The post-menopausal stage, the period after the 12 months of menopause.

In total, this entire period can last for as long as one-third of a woman’s life.

Signs and symptoms of menopause

Menopause can be destabilizing.

The effects of menopause are unique to each woman. Signs and symptoms of this transition, explained in this short but informative video, may include but are not limited to:

  • Hot flashes, night sweats, skin flushing, heart palpitations, dizziness, tingling, joint and muscle aches, breast tenderness, dry skin or eyes, parched mouth, a pressing need to urinate, mood swings, irritability, depression, anxiety, forgetfulness, difficulty sleeping, decreased interest in and pain during sexual intercourse, hair loss or hair thinning and vaginal dryness.

In addition to the above symptoms, menopause has longer-term health risks that may be associated with aging. These include:

  • An increase in cholesterol levels
  • A greater risk of heart disease and stroke
  • Bone density loss that may lead to osteoporosis.

The apprehension is not surprising

Recent studies suggest that women often feel anxious and unprepared going into this often-overlooked phase that can significantly impact their personal and professional lives.

Changing recommendations have not helped provide clarity on how to manage its signs and symptoms.

In the 1960s, many women got hormone replacement therapy (HRT) to counter the drop in hormone production and its effects. But about three decades ago, a major women’s health study challenged the safety and thinking around HRT.

The study led to a big drop in the number of postmenopausal women pursuing hormonal treatment.

“It changed how we handle menopause,” says Stauble. “And many women were already reluctant to talk about this phase of their life. This stigmatized treatment even more.”

Hormone therapy is recommended again

This past year, another seismic shift occurred. A follow-up by the Women’s Health Initiative (WHI) determined that the reaction to the women’s health study was overblown, particularly for younger menopausal women.

The review found that the benefits of hormone therapy likely outweighed the risks of treatment when used in early menopause to relieve vasomotor symptoms that include hot flashes, night sweats and sleep disturbances.

As a result, some women are again eligible for FDA-approved therapy that provides hormones lost during the menopause transition, primarily through estrogen and progestogens.

Is hormone therapy right for you?

Stauble cautions that while studies have shown that different types of hormone treatments can help address certain health challenges, risks and benefits vary depending on age and other biological factors.

For example, women who have had a hysterectomy may be treated with estrogen but those with a uterus should also have progesterone or progestin (progesterone-like medication) in their treatment to prevent the uterus lining from thickening, which can lead to uterine cancer. 

Healthcare providers also may stop or not begin hormone therapy for women ten years out from menopause due to the increase in cardiac risk, which can come with age and is the leading cause of death for women.

But even when it comes to cardiac risks, findings can be confusing. Recently, a study based on WHI data suggested that estrogen-based hormone therapy actually has a favorable long-term effect on the risk of heart disease.

“Again, women really need to talk to their providers to determine the risks and benefits of hormone therapy and figure out if it is right for them,” Stauble says.

Alternative treatments for women

If hormone therapy is not right for you, other treatments are available, but Stauble again cautions that these also need to be carefully managed and developed in consultation with a qualified provider.

In particular, she warns women to stay away from going online without a prescription to buy compounded hormones, such as bioidentical estradiol products that are not FDA-approved.

That said, there are FDA-approved synthetic options that are shown to be effective and safe.

For postmenopausal women, some providers may prescribe selective estrogen receptor modulators,(SERMs), which help prevent and treat breast cancer and osteoporosis; prevent invasive breast cancer; slow vaginal atrophy and bone loss; and provide relief from hot flashes.

Topical and non-hormone treatment options also exist, including medication, supplements and lifestyle and diet modifications

One of these treatment options is local estrogen. It does not have the same risks as oral forms and can help with vaginal dryness and discomfort during intercourse, which can also benefit from pelvic floor physical therapy.

Eat right

A healthy diet is also important, particularly when it comes to lowering your risk for health problems such as heart disease and osteoporosis that can develop as women age.

Getting your vitamin D and calcium, managing cholesterol levels, eating fruit and vegetables, limiting or avoiding alcohol, and not smoking are shown to have a positive impact on long-term health.

There are also foods with nutrients that have estrogen-like properties. These nutrients are called phytoestrogens and can be found in soybeans, chickpeas, lentils, flaxseed, beans, grains and other foods.

And if you’re not getting what you need through food, supplements—like calcium with vitamin D to fight bone loss—may be helpful. When appropriate, providers may also recommend magnesium supplements to combat sleeplessness and other ailments.

Maintain your physical and mental health

When it comes to lifestyle, Stauble says that being active and integrating resistance training into your workout regime is good for your bone health.

For optimum benefit, women should establish a consistent workout regimen beginning during perimenopause or before, she says.

Education and support groups, classes and workshops, such as those offered by Dartmouth Health Women’s Health Resource Center, are also available and can help you learn more about menopause while reminding you that you are not alone.

And if you are struggling with your mental health, be sure to seek out help.

Life in the post-menopausal stage

“Menopause may be a big change, but by no means should it stop you from enjoying an active and fulfilled life,” says Stauble.

So talk to your healthcare provider to determine the best way for you to manage the signs and symptoms of this stage of your life.