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When most women start thinking about menopause, they want to know if they are “in it” or not, when will it be over, what to expect, and how to cope with it in the meantime. If you’re in or approaching that time of life, this information may help.

The definition of menopause is the first day after one year without menstruation for a woman of appropriate age (average age 51-52). However, most women and clinicians refer to “menopause” as a time of transition from regularly cycling sex hormones to very low levels of hormones.

What you can expect in menopause is very difficult to predict, since each woman experiences the “change” so uniquely. The “why” is that women’s ovaries are programmed to retire—a process that begins before we are born. We’re programmed to stop having children later in life. Many of the side effects of menopause are due to what is referred to as “estrogen withdrawal,” because, as our estrogen levels decrease as we approach menopause, the brain continues to crave more estrogen. While not all women experience hot flashes, about half do, and most women have at least one bothersome symptom that relates to a withdrawal syndrome (anxiety, palpitations, insomnia, mood swings, sweats, etc.) that may not be brief. There is essentially no test to determine how long such symptoms will last, but the range of duration for hot flashes—the most common problem—is 6 months to 3 years.

While men have a gradually decreasing but always regenerating supply of sperm, women have a finite number of eggs, which either implant for pregnancy, shed in menstrual periods, or die before those processes. When the last egg is “spent,” the reproductive function of the ovary is finished, but the ovary still provides a source of hormonal vitality beyond this time, prompting what some women may experience as “post-menopausal zest.” Menopause is not a disease, but it can put women out of sync with some of the estrogen-enhanced features, behaviors, and appearances on which they have come to rely. On the other hand, menopause offers a certain freedom as well, as if Mother Nature is saying, “Congratulations, you are off-duty. Now you may rely on your true, unadulterated personae to guide your passions—go forth and be free of hormones and periods.”

In the meantime, lifestyle strategies can help you weather the less desirable parts of menopause. Even if you’re lucky to have an “easy” menopause free of most symptoms, you should be aware that your bone density and collagen will decline and your metabolism will slow, especially carbohydrate metabolism. These changes can weaken your body and make it easy to gain weight. Making some lifestyle changes can help combat this. Strategies include:

  • Increasing exercise, at least 200 minutes a week
  • Lessening carbohydrates in the diet
  • Increasing intake of dietary plant protein (a good source of phyto, or plant, estrogens)
  • 1500 mg of calcium a day in divided amounts (preferably through food)
  • Taking adequate vitamin D (at least 1000-1200 IU a day)
  • Taking Omega 3 fatty acid supplements (fish or flaxseed oils, 1000 to 3000mg a day)
  • Some women choose hormone replacement therapy, and others try over-the-counter herbal supplements (such as Estroven) or non-hormonal medications for symptom relief
  • Some women may need help with changes in libido, or painful intercourse
  • Some battle depression and may need therapy or specific medication
  • Meditative practices can be extremely helpful, especially with guidance from an expert

The bottom line is that menopause is normal, just as puberty is normal. As with puberty, the “change” can be famously unsettling…or beautifully smooth. This is a time to stay informed and stay healthy. Women First can help. Make a special appointment outside of your annual exam to meet with your Care Team about your concerns about menopause, and be prepared to follow up. You have many choices to help you get through this time of life positively, and the key is to understand menopause and your options.

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