Menopause 101

According to the National Institute on Aging, the average age of menopause in the U.S. is 52 years old, but it can be difficult to know when you’re in the menopausal transition. We asked Dr. Nina Ali, director of the Menopause Center, what patients should know about this transition.

Question: What is menopause?
Answer: Menopause is a normal part of reproductive development and is marked by the cessation of menses. We define menopause as being one year without a period, which means our ovaries are no longer ovulating.

Q: Are there stages? If so, what are they?
A: We’re not machines with an on-off switch. There’s a transition that occurs over many years called perimenopause. Even within perimenopause, there’s an early perimenopause and a late perimenopause that is marked by often different patterns of periods and symptoms. There’s also early menopause, which is the first 5 to 10 years after your periods stop altogether, and there are certain symptoms associated with early menopause versus late postmenopause. Then we spend the rest of our lives in the postmenopause phase.

Q: What are some of the most common symptoms that women experience?
A: We’re learning a lot more about symptoms. Classically, the main symptom of menopause has been hot flashes. There are all kinds of references to women and how difficult a time we can have dealing with hot flashes.

So that’s certainly a part of it, but often before that even, many women will know something is going on because of the changes in the bleeding pattern. This could be periods getting a heavier or a little bit closer together and that tells us, “OK, the hormones are still being produced, but that balance is shifting a little bit.”

In that phase, even when periods are still fairly regular, women may start noticing early things like having sleep issues or mood-related symptoms, so feeling a little bit less able to cope with things that might not have been too bothersome before, feeling more anxious, feeling more easily irritable or experiencing depression.

Q: How do you know that it’s a symptom of menopause versus something else?
A: It’s not clear because there are so many things that could be hormone-related. Really, all the tissue in our body, whether it’s our hair, skin, muscle, bone, brain, nerves, they all have hormone receptors. So, there is the potential that a lot of things could be hormone-related, and we can’t say everything that starts happening at 48 is related to menopause. Sometimes, especially in perimenopause, when there are still hormonal ups and downs happening, if there’s a cyclic pattern to the symptoms, then they’re more likely to be part of that hormonal up and down fluctuation.

Also, the timing of when things come up can be a clue. If someone has had issues with insomnia for their life and that is still ongoing, then likely you know that’s not really mitigated by hormonal changes. But if that pattern has developed during the time that perimenopause occurs, that’s often another clue.

Q: Is there a reason some people have a harder time going through menopause versus others?
A: Yes, family history is very helpful to know. This is one of the areas where a lot of us, even though we know a lot of things about our family, might not know too much about this part of our family history. We’re also starting to understand better how much menopause symptoms are regulated by our central nervous system. We know that in different phases of life, certain women are more sensitive to those kinds of ups and downs. I would say someone, who for all their life has had symptoms of PMS or has had postpartum depression, these are women, who during perimenopause and menopause, have more sometimes pronounced mood issues and even vasomotor issues, like hot flashes and night sweats.

Q: Can menopause be treated? And if so, how is it commonly treated
A: Menopause is a normal phase of life and where treatment comes in is managing symptoms that impact our quality of life and ensuring good health and strength later in life, too. Those are the areas that we’re really looking to treat and not everybody is going to require that.

What we have learned based on trials and studies is that the late part of perimenopause and the early part of menopause are sort of the optimal time to start therapy. This time is when quality of life tends to be impacted the most, and there seems to be, for most women, very little risk and a lot of benefit to being on hormone therapy. Once you’e outside of that window, that risk-benefit ratio is no longer so much in your favor.

So even though not everyone needs to be on hormone therapy, they should know that this is an option and it’s effective and safe unless you have certain contraindications.

Q: When should a woman see a specialist for her menopause symptoms?
A: The important place to start is often with the team you already have. Most women have their established care with an OB-GYN, a primary care physician and maybe even have an endocrinologist. These are people who have some knowledge and background about what to expect and what the safe treatment options are. If it’s not going well or there are more complicating factors, then seek out a menopause specialist.

Q: Some people are experiencing menopause symptoms younger than previously thought. Is this common?
A: I think awareness has gone up a lot, so I think more people are recognizing, “Hey, this way that I’m feeling or how this is going, there might actually be an explanation that goes beyond me just being hyper vigilant.” However, we dismiss our symptoms sometimes. Also, there are cases or situations when women go through a surgical menopause, and those women absolutely need to be counseled and offered hormone therapy to prevent long-term health issues.

Q: What is one thing you wish more women knew about menopause?
A: Hormone therapy is a very effective and safe way to manage menopausal symptoms for women, but it remains underutilized. Before the Women’s Health Initiative, the use of hormone therapy was about one in four women and now it’s probably less than 10% of women. Likely even fewer than that are aware of the option that could be helpful for them.

By Anna Kiappes