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Let’s face it: Menopause sounds challenging. Nobody wants hot flashes or any of the other unpleasant side effects you may hear about. And the worst part is not knowing what to expect.
To get answers to some common questions about menopause, we talked to Denise M. Millstine, M.D., a specialist in women’s health and integrative medicine at Mayo Clinic.
Every menopause experience is unique
“Everybody’s experience is individual,” says Dr. Millstine. “Not everyone is going to have difficulties with menopause — a lot of women go through menopause without symptoms. Some women will feel great, other women will have debilitating symptoms, and there’s everything in between.
“For years, women going through menopause were dismissed as just being uncomfortable,” she says. “And women, being who we are, put our heads down and toughed it out. Now, many healthcare professionals have learned that, first of all, toughing it out is unnecessary because we have treatments that work. Second, toughing it out potentially leads to adverse health consequences.”
How long does the menopause transition take?
“One of the confusing components is that menopausal symptoms can last for years,” explains Dr. Millstine. “We used to think symptoms lasted a few months, and then women were fine.”
“But the average time that women have symptoms of menopause is a little over seven years — so it’s a long time,” she shares.
What are some common menopause symptoms?
According to Dr. Millstine, “There are common themes. Many women have hot flashes. They may have weight changes, they can have mood and cognitive changes, they could have depression and they even might have rage. They might have sexual dysfunction or changes in vaginal health. All of these things can happen during the menopause transition.”
If you have menopause symptoms, talk with your healthcare team about treatments that could help you. There are often options available.
Hot flashes and night sweats
Research suggests that hot flashes occur when decreased estrogen levels cause the body’s thermostat (regulated in part by the hypothalamus) to become more sensitive and less predictable. When the hypothalamus is triggered, it starts a chain of events — a hot flash.
“What’s becoming apparent is that your number of hot flashes impacts your overall outcomes, particularly in brain health,” Dr. Millstine adds. “If you’re having hot flashes, it’s really important that you actually discuss and consider treatment.”
Cognitive issues
Often, women in perimenopause have problems with concentration or short-term memory — causing them to worry about early Alzheimer’s and dementia. However, the onset of these conditions isn’t usually the cause.
Dr. Millstine says that many things can cause cognitive issues during menopause.
“Whether or not the change in hormones actually causes some cognitive changes is debatable, but many women have symptoms that are distracting,” she explains. “It’s really a question of understanding why the brain fog is happening and seeing if we can address it.”
She continues, “For example, if you wake up with several hot flashes every night, that impacts your ability to get quality sleep, which contributes to feeling less sharp. So managing those overnight hot flashes might be the secret to helping you be clearer during the day.”
Mood disorders
“One of the big mistakes by medical professionals is that women with mood changes during the menopause transition are diagnosed with a mood disorder, such as depression or anxiety” says Dr. Millstine. “It may also be that the mood changes are related to the changes in hormone levels.”
She says, “Maybe the treatment is mental health therapy or medications. However, it also could be that addressing your hormones might be what is needed. Or it might be a combination.”
Menopausal rage
“A lot of women who go through menopause have what we call menopausal rage — they’re suddenly angry, and they don’t know why,” Dr. Millstine explains. “They say, ‘Why am I snapping? Why am I so irritable?’
“It can be pretty distressing because culturally, we don’t expect women to act like that,” she says. “If you’re finding yourself flying off the handle, it could be perimenopause or menopause, so consider addressing that with your healthcare team.
Vaginal health changes
“Sexual health is important,” says Dr. Millstine. “If you’re having any pain, dysfunction or even less pleasure than you had before, see somebody to get help.”
Irregular bleeding
“If you are having irregular bleeding and it’s becoming heavy, disruptive and painful, you have options,” Dr. Millstine suggests. “For example, you could get an IUD, even if you’re not using it for contraception, to lower that flow.”
What are tips for surviving menopause symptoms?
Beyond getting exercise, eating well and staying social, here are a few ideas to try.
Consider mind-body therapies
“I work in integrative medicine, and there are a lot of mind-body approaches that are effective for managing menopause,” Dr. Millstine says.
She recommends exploring therapies such as:
- Cognitive behavioral therapy, in person or online.
- Hypnotherapy, which has been shown to reduce hot flashes.
- Nonhormonal medications or supplements prescribed by a medical professional.
Advocate for a menopause-friendly workplace
Dr. Millstine notes that, “Menopause certainly has economic impacts because women who have debilitating menopausal symptoms are often impacted in terms of their professional lives.”
Ask about creating menopause-friendly environments in your workplace, including:
- Education, awareness and open dialogue about menopause.
- Rest areas where people can take short breaks during hot flashes.
- Remote work or flexible work hours, especially for people who have menopause-related sleep issues.
- Accommodations with dress code requirements to allow for temperature regulation.
Menopause shouldn’t stop you from doing your best work or living your best life. Talk with a health professional if you need help managing menopause symptoms.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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