Q:  What is menopause, and what are the different stages?
A: Menopause is often referred to as the “change of life”.  It is a natural phase in a woman’s life. The dictionary defines menopause as “the time in a woman’s life when menstruation diminishes and ceases, usually between the ages of 45 and 50.” And it is identified as not having a period for one year.  Perimenopause (peri is Latin for “around or near”) is the time prior to the cessation of menstruation when you experience hormonal changes and you are still having periods. Many doctors now refer to perimenopause as the menopausal transition.  Menopause is official after you have not had a period for 12 months.  And postmenopause is the time after menopause when the symptoms of estrogen absence appear. Going through the menopausal transition is the reverse of puberty.

Q:  When does perimenopause begin?
A: A woman can start to experience emotional and physical changes in her late thirties.

Q:  What are the symptoms of menopause?
A: Every woman experiences different symptoms during menopause, but these are the most common:  hot flashes, weight gain, mood swings, night sweats, heart palpitations, changes in your period, migraine headaches, bladder changes, vision changes, joint aches, breast tenderness, memory loss, fuzzy thinking, sleep problems, loss of libido, dry vagina during sex, hair changes (not just from pulling it our during this transition), and to make matters worse, aging skin. So, if you are experiencing one or many of these “changes” you may be perimenopausal, menopausal, postmenopausal or having symptoms from surgical menopause (hysterectomy).

Q:  What causes these changes?
A: On an average, women have approximately 400 periods in a lifetime, all governed by her hormones.  During your childbearing years, the pituitary gland located in the brain releases follicle-stimulating hormone (FSH) to the ovaries, which causes eggs to grow inside the ovarian follicles. The hormones estrogen and progesterone are released to help prepare the lining in the uterus for the possible implantation of a fertilized egg in the first half of a cycle.  Next, mid-cycle, the pituitary gland sends a surge of luteinizing hormone (LH) after a dominant follicle reaches it full size.  The LH causes the dominant follicle to burst and the egg is released from the ovary (ovulation).  The egg travels to the fallopian tubes awaiting fertilization by a sperm, which needs to be received within 12-24 hours.  Hormones play an important part of our bodies.  So at the beginning of perimenopause you gradually start to produce less estrogen and progesterone.  After menopause the estrogen levels are one-tenth the levels during your childbearing years and progesterone levels are almost non-existent.

Q:  What tests are available to determine if you are menopausal?
A: There are a few tests to determine what stage of menopause you are in.  Your doctor can give you a FSH blood test (follicle stimulating hormone), hormone blood test or you can take a Salivary Hormone test.

Q: Can you get pregnant during menopause?
A: Yes. Until a woman has gone 12 months without a period, she can still get pregnant.

Q: How can you treat menopause?
A: You can choose to “hang-in there” doing nothing until it is over (possibly years), try alternative methods, or seek medical attention to consider hormone replacement therapy (HRT). If you choose to take hormones there are five modes of delivery:
• Oral (tablet)
• Transdermal (skin patch or cream/gel)
• Implant (pellet inserted under the skin)
• Injection
• Vaginally (cream or tablets)

Q: Can HRT treat or prevent osteoporosis?
A: The definition of osteoporosis is a decrease in bone mass and bone density and an increased risk and/or incidence of fracture. When estrogen levels fall, the bones can become thin or brittle.  HRT is therefore used to maintain bone density and thereby reducing the risk of fractures in post-menopausal women or younger women without ovaries.

Q: Why does your sex drive decline during menopause?
A: There are a number of reasons your sex drive may decline during menopause.  First, you are going through physical changes and not feeling good.  When you are exhausted from lack of sleep caused by night sweats, there is no question that sex is the last thing on your mind.  Second, as your hormone levels change you can be irritable and cranky, so how could you possibly be in the mood for ‘love’. And speaking of hormones, as your estrogen decreases you will notice a difference in vaginal lubrication, vaginal tissue and decrease in overall sexual desire. Third, psychologically going through menopause can cause depression, it can force us to look at our purpose in life, question if we are happy and search for our focus not defined by having children.  Fourth, you may be experiencing “social” pressure.  Youthful advertising drives our society, so aging and going through menopause can be dramatic. So, the four factors that may cause or contribute to sexual dysfunction are physical, hormonal, psychological, and social.

If after careful consideration, you discover hormones (or lack of them) appear to be the reason
for your loss of libido, the following guidelines may apply:
• Estrogen is needed for proper response of vaginal tissue such as lubrication and clitoral engorgement.
• Testosterone may contribute to increased desire. However, in order for testosterone to work
  properly, the body needs estrogen first.
• You can also treat a dry vagina with a water based K-Y Jelly or AstroGlide.
• And communicate with your partner to decrease the anxiety you may be experiencing
  during this transition.

Q: How do you treat hot flashes?
A: If you feel flushed, an overall feeling of warmth and perspiration you may be having a hot flash. Hot flashes are associated with fluctuating hormone levels.  Not all women experience hot flashes, but if you do, there are a few options to make your transition easier. You can choose hormone replacement therapy (HRT) either synthetic or natural, natural herbal remedies, or to do nothing. If you choose to live through them without the support of hormone replacement therapy, you can dress in layers knowing that when you get a hot flash you can “peel down” until your hot flash passes.  Wearing natural fibers, such as cottons in the summer or wools in the winter make it more comfortable during the actual hot flash.

Q: Why do menopausal women gain weight so fast and have a hard time getting it off during menopause?
A: Weight gain is another early menopausal symptom, and often the hardest to live with. I wish I could say all weight gain could be blamed on menopause, that would just make the experience a little easier to live with. But only some weight can be blamed on our ever-changing hormones. Many of us over the years have less time to exercise and eat properly, and menopause is unforgiving.  You will find it is harder to get back in shape, loose weight and firm up muscles.  You are not alone in feeling frustrated.  As a result, it is necessary to make healthy life choices regarding diet and exercise.  This weight gain is a wake up call.  The hard truth is that during your menopause experience it is and will continue to be more difficult to lose weight.  As you gather information and make hormonal, eating and exercise choices, you will start seeing results in your weight loss.

Email the Menopausal Bride if you have a question about menopause: Bride@TheMenopausalBride.com