Menopause

Menopause is a transition period from fertility to infertility. During the process, an individual’s menstrual periods stop, and they ultimately become unable to get pregnant or give birth. Menopause typically occurs in middle-aged cisgender women, although transgender men and nonbinary individuals may also experience symptoms. (Since most research focuses exclusively on cisgender women, this article will discuss the data using mostly female nouns.)

Menopause is a normal part of aging, and the symptoms are typically not dangerous. However, some women may mourn the loss of their fertility. Others may become frustrated with symptoms such as insomnia or mood swings. When menopause causes emotional distress, a compassionate therapist can offer support.

Stages of Menopause

According to the National Institute on Aging, the full menopausal transition lasts an average of 7 years. However, every woman experiences menopause differently. Some individuals take up to 14 years to finish the process.

The menopausal transition occurs in three stages: perimenopause, menopause, and postmenopause.

Perimenopause is when a woman’s fertility typically starts to decline. Her ovaries gradually stop producing the hormones estrogen and progesterone, which control the menstrual cycle. A woman may start having irregular periods, then stop having periods at all.

Menopause officially begins 12 months after a woman’s final period. Most women reach menopause between the ages of 45 and 55.

Postmenopause describes a woman’s entire life after reaching menopause. Due to the lack of estrogen, women in this phase are at increased risk of heart disease and osteoporosis.

Sometimes the entire transition process is referred to as menopause. However, it is only once a woman reaches the second stage that she is truly infertile.

Symptoms of Menopause

As a women’s estrogen levels decrease, her body will begin to change. Some symptoms, such as hot flashes, appear early in the transition and are generally temporary. Others, such as thinning bones, typically persist after menopause.

Common physical symptoms of menopause include:

• Hot flashes. Most women in menopause (70%) experience periods of sudden heat in their bodies. A hot flash can last anywhere between 30 seconds and 10 minutes. When hot flashes are strong enough to wake a person up, they are called night sweats.
• Reduced bone density. This can make women more vulnerable to fractures.
• Metabolism. Some women gain weight more easily during this time and have a harder time shedding pounds.
• Vaginal dryness. This can cause discomfort during sex.
• Incontinence. During menopause, the lining of the urethra thins, and it can be harder to hold urine in one’s bladder. Some women find themselves needing to visit the restroom much more often. Others may leak small amounts of urine when they sneeze or laugh.

Common mental health symptoms of menopause include:

• Insomnia. Some women have trouble falling or staying asleep, especially if night sweats regularly wake them up.
• Changes in Libido. Shifting hormones can cause women to become very interested or very uninterested in sex. Vaginal pain and fatigue can also affect one’s interest in sex.
• Mood Swings. During perimenopause, it is common for women to swing between high and low moods. Some researchers believe this is due to shifting hormone levels, while others connect it to sleep disturbances. (Clinical research shows that menopause in itself isn’t a risk factor for depression, but it can cause women with pre-existing depression to have a recurrent episode.)
• Memory Issues. Some women report difficulties with attention and memory during perimenopause. However, experts disagree whether these issues are related to hormone changes or are simply universal signs of aging. Research suggests some memory issues may be caused by co-occurring depression.

Most women (60%) experience only mild menopausal symptoms. One in five report no symptoms at all. The remaining 20% have moderate to severe symptoms that may require treatment.

Premature Menopause

When a woman reaches menopause before age 40, she is said to have premature menopause. Women who reach menopause early will spend more years with low estrogen, putting them at higher risk for osteoporosis or heart disease. A case of premature menopause can be natural or induced.

Around 1% of women experience natural premature menopause. The causes for premature menopause are poorly understood, though some believe there is a genetic influence. Premature menopause often causes the same symptoms as regular menopause.

Induced menopause occurs due to a medical procedure. Women who have their ovaries removed always go immediately into menopause. Chemotherapy can also cause premature menopause, but it isn’t guaranteed. Women who go through induced menopause may have more intense symptoms that require treatment. (Trans men who go through induced menopause can reduce symptoms through testosterone therapy.)

Women who experience menopausal symptoms before the age of 40 may wish to get evaluated by a doctor. A medical professional can run blood tests to check a person’s levels of estradiol and follicle-stimulating hormone. You may also need to get your thyroid checked, as hypothyroidism can cause symptoms resembling menopause.

Remedies for Physical Menopause Symptoms

Menopause generally does not require treatment. However, when symptoms affect one’s quality of life, it may help to visit a medical professional.

Hormone replacement therapy is a common treatment for hot flashes and other symptoms. A doctor will typically prescribe estrogen therapy on a short-term basis at the lowest effective dose. Long-term hormone therapy is typically not recommended, as it can increase one’s risk of breast cancer.

Some people claim that estrogen-rich foods like soybeans can stabilize hormone levels. However, there is currently not enough evidence to back up this claim. Studies have conflicting conclusions on red clover, while soy products are widely considered to be ineffective.

There are some lifestyle changes which have been shown to help with physical menopause symptoms. These include:

• Avoid caffeine, alcohol, and spicy foods. These can all trigger hot flashes. If you drink caffeine or alcohol shortly before bed, they may contribute to sleep disturbances.
• Practice pelvic floor exercises. These can strengthen the muscles around one’s urethra. A stronger pelvic floor can increase bladder control and help prevent leakages.
• Try yoga. Research is mixed, but some studies do suggest yoga can help with hot flashes. It can also reduce stress and promote relaxation.
• Use lubricants. If vaginal dryness has caused sex to be painful, a person can use over-the-counter lubricants to make intercourse easier.

Therapy for Menopause

Menopause can be emotionally challenging for some women. Fertility and youth are a source of identity for some people, and the end of fertility can be painful. Additionally, menopause can sometimes lead to an increase in body hair, weight gain, and wrinkling, any of which can lead to body image issues.

Many women are reluctant to talk about menopause symptoms with their friends or family due to embarrassment or shame. Psychotherapy can be a means to get confidential support in a stigma-free environment. Common goals of therapy include:

• Decreasing the stress that comes from this life transition.
• Exploring grief around the loss of fertility, especially if the person wishes they had more children than they currently do.
• Rebuilding self-esteem; learning to combat cultural stereotypes around aging and beauty.
• Treating sleep issues and/or co-occurring depression.

In some cases, a woman’s changes in libido or vaginal pain levels can affect intimacy in a relationship. Couples counseling can help partners navigate differences in sex drive in a healthy and respectful manner. There is no shame in seeking help.

References:

1. Depression & menopause. (n.d.). The North American Menopause Society. Retrieved from https://www.menopause.org/for-women/menopauseflashes/mental-health-at-menopause/depression-menopause
2. (n.d.). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401
3. (n.d.). Virtual Medical Centre. Retrieved from https://www.myvmc.com/diseases/menopause
4. Obedin-Maliver, J. (2016). Pelvic pain and persistent menses in transgender men. Center of Excellence for Transgender Health. Retrieved from http://transhealth.ucsf.edu/trans?page=guidelines-pain-transmen
5. Perimenopause & premature menopause FAQS. (n.d.). The North American Menopause Society. Retrieved from http://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/perimenopause-premature-menopause-faqs
6. Weber, M., & Mapstone, M. (2009). Memory complaints and memory performance in the menopausal transition. Menopaus, 16(4), 694-700. Retrieved from https://journals.lww.com/menopausejournal/Abstract/2009/16040/Memory_complaints_and_memory_performance_in_the.17.aspx
7. What are the signs and symptoms of menopause? (2017, June 26). National Institute on Aging. Retrieved from https://www.nia.nih.gov/health/what-are-signs-and-symptoms-menopause
8. What is menopause? (2017, June 27). National Institute on Aging. Retrieved from https://www.nia.nih.gov/health/what-menopause

Last Updated: 04-12-2019