Expert suggests a personalized approach to coping with symptoms and choosing treatment.
Menopause was once considered a one-size-fits-all journey.
Today, researchers know the transition from the reproductive to non-reproductive phase of life is complex and different for every woman.
“Even just two decades ago women were simply split into pre- and post-menopause categories, or they were divided into above age 50 and below age 50,” said Samar R. El Khoudary, associate professor of epidemiology at the University of Pittsburgh’s Graduate School of Public Health. “Now we know it’s not so simple. We know menopause is a process and there are a lot of variabilities that happen during that process.”
El Khoudary has researched how menopause affects the heart. That is important work because as a recent AHA Scientific Statement by Dr. El Khoudary noted, health problems during midlife increase risk for cardiovascular disease, the leading cause of death in women.
“Menopause is a period when multiple changes are happening simultaneously that contribute to heart health,” she said. “We hope that women who are young or at midlife realize the importance of preparing for menopause and use the time as a starting point to get as healthy as they can. For women already in menopause, it’s never too late to start making changes toward a healthier life.”
El Khoudary and the American Heart Association offer these other insights about menopause:
Make proactive health improvements before menopause.
Lowering disease risk factors before entering menopause is essential. “The importance is tremendous,” El Khoudary said. “If you start early, you can counteract some of the worse changes that occur during menopause.”
She suggests following the AHA’s Life’s Essential 8 to improve health through eating better, getting active, not smoking and monitoring key measures such as blood pressure and blood sugar.
In the years before menopause, women should seek preventive medical care; tackle mental or emotional health concerns; and monitor menstrual cycle length. These steps benefit women and allow them to notice any changes that may signal the start of menopause.
Menopause timing can vary.
Perimenopause is the first transition stage to menopause. It can start several years before menopause and is usually marked by menstrual irregularity.
Menopause is confirmed after 12 months without a menstrual bleed in otherwise healthy women but this timing can vary among women. There is no simple test to predict or confirm menopause, which occurs because the ovaries stop producing the hormones estrogen and progesterone. Some tests can be done to check hormone levels, but typically a woman’s medical and menstrual history are enough to determine if menopause is underway.
For most women, menopause happens naturally. For others, it occurs after chemotherapy, radiation or surgical hysterectomy, which includes removal of one or both ovaries. “
All women have different ways of experiencing menopause,” El Khoudary said. “Some women jump from one stage to another. Not all women experience the same change in their hormones, so not all women have the same symptoms.”
This is why searching for a timeline of exactly what will happen at each age doesn’t work for menopause. In general, most women enter natural menopause in their 40s to mid-50s. Several factors determine when menopause begins. These include genetics; age at first menstrual cycle; length of menstrual cycle; and socioeconomic disparities.
Physical activity and nutrition also may affect the timing of menopause. Women who drink less alcohol may start menopause later, and cigarette smokers may start menopause about a year earlier than non-smokers.
Menopause symptoms are unique for each woman in duration and severity.
In the past, symptoms of menopause may have been considered nothing more than a nuisance, El Khoudary said. Now, research has found many common menopausal symptoms are associated with increased risk of heart disease and other life-threatening problems. “
Women shouldn’t ignore these physical changes,” she said. “The more aware and alert women are to what’s happening in their own body, the more likely they will advocate for themselves and point out the changes to their health care provider.”
One of the most common symptoms of menopause is hot flashes, which is a sudden feeling of heat in the body usually accompanied with increased sweating. Other symptoms that some women may experience include sleeplessness, memory problems, vaginal dryness, anxiety and depression.“
Menopause seems to exaggerate the normal effects of aging. Physiological changes during menopause, such as increased abdominal fat and more body fat around the organs, are linked to higher risk of disease and cancer. These risks are even seen among women with healthier body mass index levels.
Menopause also increases the risk of metabolic syndrome, which is diagnosed when a person has three or more unhealthy conditions. These include abdominal obesity, high triglycerides, low HDL cholesterol (the good cholesterol), high blood pressure and/or high blood glucose levels (blood sugar).
Treatments may help relieve menopausal symptoms.
There are several ways to relieve menopausal symptoms. Treatment includes prescription remedies and lifestyle changes. A woman’s health care team will consider her age, medical history and symptoms when choosing the best treatment.
Medical treatment may include menopausal hormone therapy. The hormones can be administered in several ways, including a pill, cream or patch. Long-term use may increase risks of heart disease and breast cancer, but beginning hormones around the time menopause starts has shown benefits for some women, El Khoudary said.
Other benefits of hormone therapy – including a decreased risk of Type 2 diabetes and protection from bone loss – seem to outweigh the risks for most women in early menopause, according to some studies.
For women who can’t take hormones, low-dose antidepressants may decrease menopausal hot flashes and improve mood. Calcium and vitamin D supplements may also be needed to prevent or treat osteoporosis and strengthen bones, which tend to weaken during menopause.
Lifestyle changes may also help ease menopausal symptoms. Some of these include exercising, eating a nutritious diet, not smoking, reducing stress and maintaining a healthy body weight. There is little research on the long-term safety of other complementary approaches – such as taking over-the-counter dietary supplements. Women should discuss all supplements with their health care team because some have harmful side effects or interact with other prescription medicines.
Menopause doesn’t last forever.
Postmenopause includes all the years after menopause. Many U.S. women will spend up to 40% of their lives in this stage.
During this time, women may continue to experience menopausal symptoms, such as hot flashes. For some, the symptoms may continue for more than a decade, El Khoudary said.
Women in postmenopause no longer get a period and can’t get pregnant. Changing hormone levels during this stage may put women at risk for osteoporosis, heart disease and stroke.
El Khoudary hopes that research will continue to target these midlife health problems and lead to longer lives for women.
“When you view menopause you need to view it from multiple angles,” she said. “It’s a multifactoral process, and each stage requires a complex understanding. That’s why a collaborative relationship with healthcare providers is so important for women before, during and after menopause.”