Hormones. We experience their sometimes witching effects from the start of puberty, through pregnancy and the postpartum period, to the mother of all hormonal changes, menopause.
The technical definition of menopause is 12 months without a menstrual period. Once you’ve reached this retrospective milestone, you’re considered to be “menopausal”. Anticlimactic, I know. So what about all of the time in between normal menstrual cycles, through the on-again-off-again, light-then-heavy-then-light, to the final destination of menopause? It is called the transition (known medically as perimenopause, close but not quite there). Although the menopausal transition begins on average at age of 47, the onset is quite variable. Generally, women over age 45 with irregular menstrual cycles, hot flashes, mood changes, vaginal dryness, new-onset depression, and/or sleep disturbances are most likely to be in the menopausal transition. These symptoms are related to the hormonal changes due your imminently failing ovaries. Had a hysterectomy? Chances are you probably still have your ovaries. While you may be spared the inconvenience of unusual pattern menstrual bleeding, you are still just as likely to experience the other symptoms. The perimenopausal period lasts, on average, four years. The good news? It does eventually end. Most women are menopausal by 51.4 years.
Virtually all women experience menstrual irregularity and hormonal fluctuations during the menopausal transition (they call it “the change” for a reason). Up to 80 percent of women develop hot flashes, the hallmark and most common menopausal symptom. They usually occur several times per day, but can range from one or two each day to as many as one per hour throughout the day and night. Hot flashes are particularly common at night (i.e. night sweats). They carry on (and on) for four to five years in most women. However, some women have hot flashes that persist for many years, with nine percent reporting persistent symptoms after age 70 years. Despite their prevalence and persistence, only 20 to 30 percent of women seek medical attention for treatment for their hot flashes. That leaves almost half of you suffering silently (or maybe not-so-silently).
And who wouldn’t be aching for a broom ride with wicked, intense hot flashes day and night, interrupting sleep and life? Before you blame it all on the miserable, chronic perspiring know that you could be suffering from depression. A number of reports indicate that there is a significant increased risk of new onset depression in women during the menopausal transition. In a within-woman eight-year study, a diagnosis of depression was 2.5 times more likely to occur in the menopausal transition as compared to the same woman when she was premenopausal. Think you could be feeling the pangs of depression? Consider taking a depression screen and talk with you provider.
Ready to seek treatment? There are more options than just hormone replacement therapy. Antidepressant medications are recommended as one of the first line treatments for hot flashes in women (sounds like two birds with one stone). Venlafaxine (Effexor), citalopram (Celexa), and escitalopram (Lexapro) were developed to treat depression, but studies show that they are also effective for hot flashes. Paroxetine (Paxil) is successfully used for hot flashes, but should be avoided if you are taking tamoxifen for breast cancer. Sertraline (Zoloft) while effective for depression, is not helpful for treating hot flashes. If you already have a history of depression, it could worsen during the transition to menopause. Prepare yourself. Know the signs and symptoms, and ask for help when you need it.
More interested in “natural” remedies before trying prescription medication? Plant-derived estrogens (phytoestrogens) are found in many foods, including soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Isoflavone supplements, are also phytoestrogen and can be found over the counter. However, there is no convincing evidence that phytoestrogens help to reduce hot flashes or night sweats (or depression). Many postmenopausal women use black cohosh for hot flashes as an herbal remedy, but clinical trials have not shown it to be effective either. And caution, many supplements are not regulated by the FDA.
Menopause is a natural part of our aging process [unfortunately]. Some discomfort is to be expected, but treatment options are available for unbearable symptoms affecting your quality of life. Talk with your provider, particularly if you are experiencing symptoms of depression. In the meantime, there’s always the holistic, low risk, life-style changes of a healthy diet and exercise. Learn more about menopause at ACOG’s award winning website, “Pause”.