illustration by niky motekallem
Girls generally start learning about puberty and the changes in store for them and their bodies in elementary school, often years before menstruation occurs. Many expectant mothers start researching the ins and outs of pregnancy and postpartum issues before they ever conceive. Menopause, on the other hand, seems to sneak up on many otherwise thorough and well-prepared women, leaving them flushed, sleepless, moody…and perplexed.
Dr. Stephanie Faubion, director of the Mayo Clinic’s Office of Women’s Health in Rochester and medical editor of The Menopause Solution, sees many women who come to her complaining of problems sleeping, irregular periods, or memory and concentration issues, worried that there’s something seriously wrong with them. “Women are not expecting this,” says Faubion. “I have patients coming to the Mayo Clinic to figure out what’s wrong with them, and they’re just in perimenopause [the several years leading up to menopause, during which hormone production becomes irregular and less predictable]. They ask, ‘Why didn’t someone tell me?’”
As with puberty and pregnancy, understanding what is happening to your body—and what you can do about it—reduces the stress of coping with the accompanying changes. Like those other hormonal transitions, experiences and symptoms of menopause vary from woman to woman. A minority of menopausal women will not experience noticeable or disruptive symptoms, while the majority will experience some combination of hot flashes, night sweats, weight gain, fatigue, sleep disturbances, mood changes, and changes in sexual function, to varying degrees.
These symptoms only last, on average, around seven years, and sometimes more than a decade. Ouch.
The good news is that we know more today than ever before about how to ease the symptoms of menopause. “Menopause is not a disease,” says Dr. Debra G. Bell, an integrative medicine specialist at the Penny George Institute for Health and Healing in Minneapolis. “But if a woman is experiencing significant symptoms, that should not be overlooked. We can treat those things.” That’s welcome news for the more than two million women who enter menopause every year, particularly since increasing life expectancies mean that women are now living a third of their lives beyond menopause. “The average life expectancy for a woman in the early 20th century was 50,” says Faubion. “This is a brave new world. Women didn’t used to live for 40 years after menopause, and we’re still trying to figure out what that means.”
Hormone replacement therapy has long been one of the go-to treatments for menopausal symptoms. The first oral formulation of estrogen was marketed in 1942, and since then millions of menopausal women have used evolving forms of hormone therapy to treat their symptoms. But a great cautionary flag was raised with the 2002 release of the Women’s Health Initiative (WHI) study results, which indicated that the use of the commercial hormone replacement therapy popular in the 1990s (specifically, a drug called Prempro, a combination of conjugated equine estrogen synthesized from pregnant mares’ urine and synthetic progestin) was correlated with an increased risk of heart attack, stroke, blood clots, and invasive breast cancer. The findings sent shock waves through the medical community, and many of the women who had been using hormone therapy abandoned it.
The study, which tracked more than 160,000 postmenopausal women between the ages of 50–79, has since been the target of criticism and reevaluation, as it has become clear that its results in older menopausal women were generalized—without scientific basis—to younger menopausal women as well. (The average age for women in the study was 63—well beyond the average age of menopause onset.) It also only tested a single commercially available hormone combination that was popular at the time (Prempro), at a single, orally delivered dose.
“The WHI investigators were well-meaning, but the study had some unintended consequences, and we’re still trying to make up for that,” explains Faubion. “A generation of women missed the opportunity to take hormone therapy who needed it, and we missed training a generation of medical practitioners, who learned something incorrect.” Today, most experts agree that the benefits of hormone therapy outweigh the risks for women in their 50s who are within 10 years of their last period and are experiencing bothersome symptoms of menopause.
Hormone therapy options available today also go well beyond the oral synthetic hormone formulation featured in the WHI study. Transdermal estrogen can be delivered via skin creams or patches (possibly mitigating certain risks by bypassing the digestive tract and the liver), and low-dose local vaginal estrogen therapy can be used to relieve vaginal dryness. And some women prefer to use “bioidentical” hormones derived from plants, which became more widely available in the early 2000s in the wake of the WHI study and are identical in molecular structure to the hormones naturally produced in a woman’s body.
There’s also good old-fashioned griping to ease the stress and discomfort of menopause symptoms. Bell leads a six-week “shared medical visit” at the Penny George Institute for groups of up to 10 menopausal women, offering them the chance to connect and receive support from women experiencing similar symptoms, as well as learn about holistic approaches to treatment, including herbs and supplements, meditation, nutrition, Chinese medicine, and aromatherapy. “It tends to be very affirming for the women who participate,” says Bell. “Despite their varied backgrounds, there’s a connectedness and appreciation that enhances their ability to manage their menopause.”
While Bell advocates for the benefits of hormone therapy to mitigate symptoms of menopause, she also sees plenty of women who have enough success using alternative, non-pharmaceutical methods that they don’t need to consider it. Limiting the consumption of processed foods, sweets, caffeine, and alcohol, for instance, can reduce the severity of hot flashes in some women, as can stress-reduction techniques, exercise, and herbs such as black cohosh (a member of the buttercup family).
Both Bell and Faubion stress that, while menopausal symptoms can be a challenge, the transition into post-menopause can be a liberating and joyful time of life. “Many people in our culture approach aging with dread,” says Bell. “But I like to talk about the aspect of wisdom and benefits of experience that come with it. In the same way there’s a monumental shift that happens with puberty and pregnancy, menopause can be a very positive shift in life that comes with a sense of wisdom and a new stage.”
“It’s a time you can step back and reinvent and reassess,” says Faubion. “Think of all the women who became famous after 50—Julia Child, Mother Teresa, Georgia O’Keeffe. If you want to go take an art class, if you’re unhappy in your job, if there’s something you’ve always wanted to do, now’s the time. The rules have changed; it’s a major milestone and a chance to go after the life you really want.”