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The Ups, Downs, Ins, and Outs of Menopause

Our mothers and grandmothers called it the change – the mysterious process during which females become unpredictably moody, irritable, short-tempered, and most of all, hot. We now refer to this time in our lives as perimenopause, and it can last from two to five years. These years can feel like decades to some, as the symptoms of menopause can be very uncomfortable as you transition from the childbearing years to menopause. Women find themselves standing in front of the open freezer door longer than necessary, and they begin dressing in layers. Turtlenecks are tucked away in the back of the closet. Many women cool their homes to frigid temperatures in an effort to combat the sudden flashes of heat that engulf them. 

The great news is that our periods stop, and there is no more need for birth control. The bad news is that most of us will have hot flashes and night sweats, and many females will have other unpleasant symptoms such as difficulty sleeping, cognitive issues, and vaginal dryness.

When does menopause occur?

Every female will experience menstrual irregularity as their ovaries gradually wind down and their periods stop. When periods are absent for a full year, the transition into menopause is complete. The average age when this happens is fifty-one; most women enter menopause between ages forty-five and fifty-five. Menopause that occurs before age forty is considered to be premature ovarian failure and is unusual.

There is a familial, or hereditary link to the timing of a woman’s menopause experience, particularly if her mother experienced menopause unusually early or unusually late. However, there are other factors such as smoking, underlying medical conditions, chemotherapy, and obesity that can affect the age at which menopause occurs.

For most females, hot flashes will subside within five to ten years after their last period. Other menopause-related issues, such as vaginal dryness, are likely to continue, which can lead to painful intercourse and vulvar/vaginal discomfort and urinary symptoms such as urinary frequency and urgency, and a greater likelihood of developing urinary tract infections.

Is there anything I can do about menopause?

Menopause is a natural process that occurs because of the decline in ovarian production of the female hormones estrogen and progesterone. The symptoms experienced by a majority of women are primarily due to the effects of low estrogen levels. These symptoms generally don’t adversely affect health, but significant quality-of-life issues can occur due to sleep disruption, difficulty concentrating, urinary symptoms, and painful intercourse. Women should be aware that a variety of options are available to help them navigate through the menopausal process more comfortably. These include over-the-counter herbal and other natural supplements, hormone replacement therapy, and other medications that help to treat vasomotor symptoms.

Vaginal dryness can be treated with topical vaginal treatments such as vaginal creams, tablets, rings, and suppositories. There is also a radiofrequency-based procedure that improves vaginal blood flow and elasticity, leading to improvement in vaginal dryness and sexual function.

Let your physician know if you’re suffering.

We encourage our patients not to suffer through menopause. Your physician should be well-versed in menopausal medicine and can offer solutions and approaches that are appropriate for you based on your medical history, lifestyle, and the severity of your symptoms. It may feel difficult to begin a dialogue with your physician about your concerns (especially concerning sexual function), but the only way to make your physician aware is to share problems you are experiencing so we can help. As you enter menopause, it is important to continue with regular exams so we can have these conversations with you, in addition to performing cancer screening tests and assessing your bone health through bone densitometry. Bottom line: Women of every age should feel comfortable discussing their health needs.

As gynecologists, we are your advocates for good health and optimal functioning during all stages of your life. Happily, as life expectancy increases, you can anticipate living many years past menopause. It’s our hope that these years will be an active, healthy, and fulfilling phase of your life. 

Ingrid Prosser, MD, sees patients at Virginia Physician for Women’s West Creek and Koger Center offices. When she’s not busy practicing medicine, Dr. Prosser loves to spend time with her two daughters Gabriella and Isabelle. They enjoy traveling, bicycling, and listening to music.
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