Cathy Hamilton remembers her years leading up to menopause. She was hot all the time, sleeping horribly for the first time in her life and had brain fog at a degree that she wasn’t used to.

“I remember a conversation I had with my mom where I called her one day to ask her if she went through this. She said to me, ‘Oh, I don’t know. I was so busy with my five kids that I don’t think I even noticed.’ That absolutely drove me up the wall,” Hamilton said.

A lot of time and money is spent educating women on what to expect during pregnancy and other facets of reproductive health, but when it comes to menopause, you may feel as if you’re on your own to sort it out.

Fortunately, Hamilton, a local writer and Retirement Boot Camp leader at the Lawrence Public Library, was able to turn to her friends to discuss her experience. She said discussing it with other women brought her to a realization:

“The trick to these conversations is realizing that menopause is so different for everybody,” she said. “What you’re going through isn’t necessarily what your best friend is going through.”

Menopause is the stage in life where you stop having your menstrual cycle. It’s a normal biological process that marks the end of your reproductive years. For most women, it happens around age 50, but every woman’s body is different and runs on its own schedule.

“The age range for normal menopause is anywhere from 40 to 58, but chronological age can be a poor predictor of the beginning or end of menopause,” said Michele Bennett, a physician with Lawrence OB-GYN Specialists. “Natural, spontaneous menopause occurs around age 51 or 52 and isn’t brought on by medical treatment, but it can also be induced earlier through surgery, such as removing the ovaries, chemotherapy or pelvic radiation therapy.”

Signs of menopause

There are three phases of menopause: perimenopause, menopause and postmenopause. You might be entering the first stage — perimenopause — if you experience any or all of these symptoms:

• Irregular periods

• Vaginal dryness

• Changes in the skin, including acne or dryness

• Hot flashes

• Chills

• Night sweats

• Trouble sleeping

• Mood swings

• Cognitive changes, including brain fog, anxiety or depression

• Thinning hair on scalp

• Unwanted facial hair

• Weight gain

Some women have only a few mild symptoms. Others have severe symptoms that disrupt sleep and affect their day-to-day activities.

“You can line several women up and some in their early (or) mid-40s may have periods but also hot flashes. You might have a woman who is on (a hormonal IUD) who is experiencing no periods at all but wouldn’t know,” said Jan Morey, a nurse practitioner with Lawrence OB-GYN Specialists. “Family history and chronic health conditions also play a role.”

Natural menopause

Menopause that’s not caused by surgery or another medical condition is called natural menopause. This normal part of aging is a point in time where your ovaries stop releasing eggs and producing estrogen.

“Menopause represents the FMP — final menstrual period — and is confirmed by 12 consecutive months without having a menstrual cycle in women who have a uterus,” Bennett said. “For women who have had a hysterectomy, there are lab markers we can use to identify when they’ve entered the menopausal stage.”

Postmenopause

The phase of life after you’ve gone through menopause is called postmenopause. During this stage, many of the menopausal symptoms begin to ease, though some women continue to experience them for years to come.

If every woman’s experience is different, how are you supposed to know whether menopause has begun, or what stage you’re in? Morey said making an appointment to talk with your doctor is a good first step. She said providers will sit down for a conversation to talk about symptoms, overall health and options.

“I’ve also got patients whose partners or family members recommend they see us,” Morey said. “They’re kind of moody, always hot, have no libido, so we address those particular needs and determine the best course of treatment.”

“Partners are welcome to join in these conversations, if the patient is willing,” Morey added. “There can be a misunderstanding in what the partner understands about menopause because no one really talks about it. It helps them learn what’s really going on.”

What treatment options are available?

Because menopause is different for everyone, the treatment that’s the right fit for one patient’s symptoms might not be right for another. Clinicians will focus on treating symptoms that disrupt your life through either hormone replacement therapy (HRT) or nonhormonal treatments.

HRT is prescription medicine that helps to relieve your symptoms, including vasomotor symptoms like hot flashes and vaginal dryness. It works by replacing some of the hormones no longer made by your ovaries with artificial estrogen and progesterone. It can be taken as a pill, skin patch or as a topical cream.

Bennett said that a number of nonhormonal treatments have also been shown to help alleviate menopausal symptoms. These include:

• Avoiding triggers (alcohol, caffeine, hot drinks, spicy food)

• Maintaining a healthy body weight

• Getting a massage

• Meditation

• Not smoking

• Regular exercise

• Yoga

Some patients may take over-the-counter herbs or supplements instead of more conventional medications, but Bennett said it’s still important to exercise caution.

“These supplements are still medications,” she said. “While their active ingredients may be less concentrated than prescriptions, they can still have adverse effects and interactions. It’s important that you talk with your provider before starting anything new.”

Morey said no matter what road you decide to go down for your treatment, your provider will talk with you to help determine your best options.

“We want to be your partner and individualize it to what you want to do,” she said. “We’ll determine if medication is appropriate or make recommendations regarding nutrition, exercise or the like and then follow up to see what’s working and what isn’t. It’s just the beginning of a process that may take a couple of years, and we’ll make adjustments as needed.”

Mental health and menopause

Women in any stage of menopause may experience cognitive changes, including mild irritability, mood swings, becoming more emotional and issues with sleep or energy. Melissa Hoffman, a board-certified psychiatric mental health nurse practitioner with Lawrence OB-GYN Specialists and the LMH Health Women’s Center, said that if you experience big changes in your mental health, it might not be purely because of menopause — it might also be a mood disorder.

“Women who have a predisposed vulnerability to mood disorders related to normal reproductive changes, such as premenstrual dysphoric disorder (PMDD), are more vulnerable to mood changes during the reproductive changes in life,” she said.

Hoffman said this is particularly important if she’s working with a patient who had PMDD or had a profound mood impact when starting birth control. She lays the foundation to let them know they’re more at risk for a mood disorder during other reproductive health changes.

“It’s also important for women who have pre-existing chronic conditions like bipolar disorder to understand that reproductive life changes like menopause can exacerbate those mood disorders. Their perinatal disorder may be in remission, but they may be at greater risk during the perimenopausal period,” she said.

Hoffman understands that while society is becoming more comfortable discussing mental health issues, it can still feel taboo for some. Having these conversations with friends, family and health care providers can help to remove the stigma.

“Mental and physical health are very intertwined, so it’s important that your providers bring this up and talk about it. Know that these symptoms most definitely come with the menopausal stage in life,” Hoffman said. “I encourage women to consider these cognitive symptoms the same as any physical ailment or concern and bring it up.”

More information

It’s important to talk with your health care provider to get answers to your questions about menopause and other reproductive changes. Other reliable resources include books and podcasts, as well as resources available through the North American Menopause Society (NAMS) website at menopause.org.

“Menopause is notable, but it doesn’t have to take center stage or be a huge turning point,” Bennett said. “Women can optimize their health going into menopause by getting treatment for any underlying medical conditions, taking care of themselves through things like exercise, healthy foods, limiting alcohol intake, avoiding smoking/illicit drugs, getting regular dental exams, maintaining good sleep hygiene and talking to their doctors about new symptoms as they arise and adversely affect their quality of life.”

— Autumn Bishop is the marketing manager and content strategist at LMH Health, which is a major sponsor of the Journal-World’s Health section.