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Menopause 101
Why do girls have a class in 5th or 6th grade about going through puberty, yet women in their 30s don’t have a class about going through menopause? I ponder this question almost every day while talking with my patients, since menopause is equally, if not more, life-changing for women.
The Women’s Health Initiative study, published over 20 years ago, was meant to positively transform women’s experience with menopause. Unfortunately, the study was flawed, and instead the results caused a generation of women to be lost without solutions for their menopausal symptoms.
Decreased libido, hot flashes, night sweats, irritability, anxiety, fatigue, weight gain, irregular bleeding, vaginal dryness, painful intercourse, vulvar skin sensitivity, joint pain, hair loss, and sometimes a feeling of being generally unwell are all symptoms that women may experience in perimenopause, and that may continue through menopausal life.
These symptoms start when a woman’s ovaries reduce the amounts of hormones that they produce, especially estrogen, progesterone, and testosterone. The reduction in hormone production is not at a constant rate. Often, levels of hormones increase and decrease throughout the perimenopausal time, which can start for some women in their 30s. Once other medical problems are ruled out, perimenopause can be diagnosed. When these hormones reach their lowest levels, evidenced by having one year of missed periods, menopause is diagnosed.
Unfortunately, there isn’t a lab test that can diagnose perimenopause. The reference ranges for hormonal lab tests are strictly to diagnose, or rule out, menopause. In addition, a lab test will not tell which balance of hormones is best or when symptoms will appear or disappear. Success with treatment is based on a woman’s report of improvement rather than lab values.
When treating perimenopause and menopause, individualized treatment, including shared decision making, is a creative process between a woman and her physician. There are many products, such as patches, pills, and creams, with hormonal and non-hormonal options among them. Each is associated with benefits and risks. A woman’s symptoms, as well as her medical history and family history, will all play a role in what type of treatment to start.
Since menopausal symptoms can change over time, the types and doses of hormones or other medications used may need to be altered to help each unique woman. Some symptoms may not improve even with treatment. Finally, if women do not have difficulty with menopausal symptoms, then they do not need treatment at all.
In short, menopause is complicated and quite different from woman to woman. For that reason, if you are experiencing bothersome menopausal symptoms, I recommend that you have a conversation with your ob/gyn physician to discuss what options may be best for you.
Book an appointment with one of our ob/gyn physicians online or by calling (239) 432-5858 to find relief from your menopausal systems.