Are You Mastering Menopause?

Menopause is not just a harmless transition out of the childbearing years. Menopause is actually the loss of vital hormones and a body-wide transition. If not properly treated, menopause can shorten a woman’s lifespan and healthspan because of the long-term effects on quality of life and wellbeing.

Changing the way that menopause is managed starts with changing the way that menopause is perceived. It is extremely important to understand what menopause truly is and how it impacts a woman’s health.

What is menopause?

Before understanding how to prioritize your health throughout menopause and beyond, its important to understand how and why menopause happens. As stated above, menopause marks the end of menstrual cycles. The average age for a woman to undergo menopause is 51, but it can happen throughout your 40s and 50s.

Menopause occurs over three different stages:

• Perimenopause: In the first stage of menopause, most women experience irregular period cycles. Some women might also experience some symptoms like hot flashes and chills. This typically happens around age 47.

• Menopause: Menopause marks the day you have your last menstrual period. But you will not be sure it has happened until 1 year has passed without a period.

• Postmenopause: The final stage occurs when you hit the year mark without a single period. This stage actually lasts the rest of a woman’s life.

Menopause can be spurred by several different circumstances:

• The natural decline of reproductive hormones: Your ovaries start producing less estrogen and progesterone when you enter your late 30s. Estrogen and progesterone are the hormones that regulate menstruation and fertility. The levels of these hormones will continue to decrease until the ovaries stop releasing eggs all together around age 50.

• The surgical removal of the ovaries: The hormones that regulate the menstrual cycle, estrogen and progesterone, are produced in the ovaries. When they are removed, menopause immediately occurs. Hot flashes and other symptoms of menopause occur and your period will stop. This abrupt loss of your sex hormones can wreak havoc on your body and likely cause severe menopausal symptoms. Surgery to remove the uterus doesn’t immediately cause menopause. While periods will cease, hormones will still be produced.

• Primary ovarian insufficiency: Premature menopause, menopause before the age of 40, occurs in about 1% of women due to primary ovarian insufficiency. Primary ovarian insufficiency occurs when the ovaries fail to produce normal levels of reproductive hormones. This can stem from genetic factors or an autoimmune disease.

Symptoms of menopause:

The most well-known symptoms of menopause include hot flashes and chills and are thought to arrive right before menopause. But symptoms of menopause can actually last through the months or years leading up to menopause. Some other symptoms of menopause include:

• Vaginal dryness

• Irregular period

• Hot flashes

• Chills

• Sleep problems

• Weight gain and slowed metabolism

• Thinning hair

• Dry skin

• Loss of breast fullness

• Night sweats

While researchers are unsure why certain women experience different symptoms of menopause at varying levels of severity, some connections between races and symptoms have been drawn. Symptoms of menopause actually differ between different races. Caucasian women have more muscle aches, irritability, and sleep difficulties. While African American women are more likely to experience hot flashes and night sweats. Chinese and Japanese women are less likely to have hot flashes and night sweats.

Hot flashes explained:

Hot flashes and night sweats are considered to be vasomotor symptoms, as they occur in response to the constriction or dilation of blood vessels. They are the most common type of menopausal symptom, 40-80% of women will have this kind of symptom throughout menopause. Hot flashes and other vasomotor symptoms also typically last longer than other symptoms, an average of 7 years. But some women experience hot flashes for upwards of 20 years.

There is no way to predict the onset of hot flashes, but there are some loose associations between some demographic factors and symptom prevalence. Demographics most likely to experience hot flashes include: smokers, lower-income, mood disorders, African Americans, less educated, and obese.

As described earlier, researchers are unsure why some women are more likely to experience symptoms more severely or for longer durations. Current hypotheses revolve around the brain. Some women seem to be “wired” to have hot flashes, while others are not. A hot flash is triggered by changes in circulating blood flow and a decrease in core body temperature. The vessels first dilate and then they constrict.

Hot flashes are more likely to occur with a decline in estrogen. Changes in the temperature regulation part of the brain, the body’s internal thermostat, is where hot flashes stem from.

Menopause throughout the body:

Another milestone marked by the onset of menopause is the accelerating risk of cardiovascular disease. In fact, frequent and severe hot flashes could potentially be a more accurate marker for cardiovascular disease than traditional risk factors like smoking or high blood pressure.

Research has pointed to the link between vasomotor symptoms of menopause and an increased risk of heart disease. Several studies have found that women who reported any vasomotor symptoms have “significantly poorer” vein and artery function and greater aortic calcification when compared to women with no vasomotor symptoms.

Menopause is also correlated with some cognitive symptoms like “brain fog” and forgetting words. Research has suggested that this is due to estrogen’s role in supporting verbal fluency and memory. When estrogen levels decline during menopause, this leads to some cognitive decline. Studies have found that women who experience premature or early menopause have a much higher rate of neurocognitive decline, dementia, and Parkinson’s.

Advancing age cannot explain memory decline around menopause, as women tend to experience a memory rebound after menopause ends. The connection between menopause, declining estrogen levels, and decreased cognitive function could also be the explanation behind 66% of Alzheimer’s patients being female.

Many women also experience sleep problems throughout the stages of menopause. The most common problem is an insomnia-type pattern, which throughout menopause means difficulty staying asleep. Over 50% of women going through menopause report some level of difficulty sleeping. An additional 25-30% of menopausal women report insomnia, which is defined as over 3 months of trouble staying or falling asleep that affects daytime functioning in response. Sleep apnea is also common during menopause.

The primary culprit behind sleep issues during menopause are vasomotor symptoms like hot flashes. Hot flashes can hit you any time of day, and when they occur at night, many women have difficulty falling back asleep and then feel lethargic or fatigued throughout the following day. Researchers also report that sleep disruption feeds into mood disturbance in women with falling estrogen levels during menopause.

Mastering menopause:

While there is nothing you can do to stop menopause, there are ways you can help mediate some of the symptoms.

Stress management:

Stress management is one of the primary ways to mitigate menopausal symptoms. Enacting mindful techniques, meditation, breathwork, yoga, and walking have all been proven to make a noticeable difference in symptoms. This is because, as estrogen and progesterone production levels decline in the ovaries, the body starts to rely on the adrenal glands. The adrenal glands sit on top of your kidneys and are also capable of producing sex hormones. While a woman is still fertile, this extra help isn’t needed, so the adrenal glands only produce a small amount. But in post-menopausal women, the adrenal glands produce nearly 80% of progesterone and estrogen.

The adrenal glands are also responsible for stress management and producing cortisol. Interestingly, cortisol, estrogen, and progesterone all require the same precursor- a hormone called pregnenolone. During times of stress, the majority of pregnenolone is being used to produce cortisol, and estrogen and progesterone production levels will decrease. But, if you can manage to lower stress levels, the adrenal gland can produce more estrogen and progesterone, thus minimizing menopause symptoms.

Avoid weight gain:

It’s also important to avoid gaining weight during menopause, which is a common symptom of menopausal women. Many women add pounds during menopause due to hormonal imbalances, aging, and lifestyle changes. But, gaining excess body fat during menopause can impact your menopause symptoms for the worse. Researchers have found that obese or overweight women have worse symptoms of hot flashes, night sweats, bladder issues, and muscle and joint pain than women of a healthy weight. In fact, the severity of these symptoms directly correlates to a rising BMI.

Researchers have also found that postmenopausal women who lost at least 10 pounds or 10% of their body weight were more likely to completely eliminate some menopausal symptoms like night sweats and hot flashes.

Exercise regularly:

Exercising regularly throughout menopause could help to alleviate symptoms and provide other beneficial health effects. Exercising during and after menopause has been found to offer many benefits such as:

• Preventing weight gain

• Reducing the risk of cancer

• Increasing bone strength

• Reduce the risk of other diseases like heart disease and diabetes.

• Boost overall mood

Keep in mind that strenuous exercise can trigger a cortisol response and thus decrease levels of estrogen and progesterone produced by the adrenal glands. So, during menopause, it is best to keep exercise light and not incredibly exhausting. Some examples of menopause friendly workouts include:

• Aerobic activities like brisk walking, jogging, swimming, water aerobics, or biking.

• Strength training like using weight machines, hand-held weights, or resistance tubing.

• Stretching will help to improve flexibility and keep your muscles lean and strong.

Try hormone replacement therapy:

With the help of your medical provider, hormone replacement therapy (HRT) could be a great way to prevent negative symptoms of menopause. Currently, due to the sensationalized findings of the 1993 Women’s Health Initiative study on HRT, many doctors are not prescribing it. To read more about the problems in the Women’s Health Initiative’s study, click here.

The true findings of many researchers after the 1993 study prove that HRT has been demonstrated to:

• Alleviate menopausal symptoms.

• Lower risk of death by 39% for women who started HRT before menopause.

• Improve sleep, muscle aches, and pains in menopausal women.

• Reduce the incidence of coronary heart disease by 50%, if started within 10 years of menopause.

• Help prevent osteoporosis and associated injuries.

• Decrease the risk of heart disease.

• Slow the progression of atherosclerotic plaques, which lead to heart attacks and cardiac death.

• Improve symptoms related to vaginal atrophy.

• Help alleviate depressive symptoms.

• Increase skin collagen content, thickness, elasticity, and hydration.

At The Johnson Center, we treat menopause not by simply treating the symptoms, but by treating the cause of menopause. Working with patients this way can slow down the process of aging and chronic diseases, increase energy, decrease weight, improve sleep, low sex drive, and overall feel better.

To learn more about the Johnson's Center's approach to menopause, click here to contact us! If you have any more questions about your path to optimal health, email our office at thejohnsoncenter@gmail.com or call 276-235-3205.

The Johnson Center for Health services patients in-person in our Blacksburg and Virginia Beach / Norfolk locations. We also offer telemedicine for residents of Virginia and North Carolina!