When most of my patients ask me about menopause they want to know if they are "in it" or not, very few ask about the purpose of "the change." Most women feel that they just need to accept it, but acceptance is difficult when dealing with what often seems such a mystery.
The generally accepted definition of menopause is the first day of the first year of no menstruation for a woman of appropriate age (average age 51-52). This is imprecise as any woman may ovulate and menstruate remote from her "day of menopause," prompting a warning to not throw away supplies for at least 2 to 3 years. What most women call menopause is a time of transition from cycling sex hormones to very low levels of hormones due to ovarian (or gonadal) decline.
In menopause what to expect is a very tough question as each woman experiences the "change" so uniquely. Ultimately, the reason is that the ovaries are programmed to retire--a process that begins before we are born. In fact, the design is so purposeful, that it must have an evolutionary benefit. The logical emerging theory is that because our species has such a long dependency period for our young, one of the sexes must have programmed gonadal retirement so not as to reproduce with "one foot in the grave." The obvious choice of which sex has this timed end-to-fertility is the same that bears the fruit--the woman. The surprising aside is that the female brain doesn't give up on the retiring ovary, kicking out the signals even more strongly, to try and re-ignite the extinguishing gonad as it declines.
Many of the side effects of menopause can be traced to what is referred to as "estrogen withdrawal," due to the fact that as estrogen production is reduced, the brain craves more estrogen. Certain side effects (such as hot flashes) are very similar to those seen with drug withdrawal. While not all women experience hot flashes after ovarian decline, about half do, and most women have at least one symptom that relates to a withdrawal syndrome. Others have no symptoms at all. 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. A very few women will have them forever.
Another dilemma is that men do not have a clear planned gonadal decline. Sperm production occurs in the testicle to some degree until death, but a woman "spends" her limited amount of eggs. Just like an hourglass turning over, the eggs decline steadily from before birth, and only a relative few are "rescued" by puberty to generate the menstrual cycle and the hormonal rhythms that ensue. In fact just 300 to 500 eggs out of an initial 10 million or so are ovulated in a lifetime. The millions of others degenerate through what is called apoptosis: programmed cell death. When the last egg is "spent," the reproductive function of the ovary is finished (remember, not dead--just "retired"), but the ovary still provides a source of hormonal vitality beyond this time, prompting what many women may experience as "post-menopausal zest."
An inconvenient truth is that most of the physical signs of beauty and attractiveness for women are related to estrogen levels. Even a young woman's curvy, low waist-to-hip ratio is enhanced by estrogen, and withdrawn to some degree by menopause. This is not to mention the estrogenic support of collagen content, scalp hair volume, skin quality, sleep quality, and verbal memory, to name a few. There is much that can be done, but the best approach is to start with understanding.
Menopause is not a disease, but it can put women out of sync with some of the estrogen-enhanced physicality, behaviors and appearances on which they have come to rely. It can also put women out of sync with the men in their lives, who may be affected by a subtle, or not so subtle change in relationship dynamic. Sexual synchronicity is not Mother Nature's prime concern. As far as She is concerned, it's all about reproduction; love is for intellectuals, which can interfere with the former. In the meantime, reproduction has risks, especially to the female. It would follow that Mother Nature may consider ovarian retirement a gift, in other words, "Congratulations, you are off-duty. Now you may rely on your true, unadulterated personae to guide your passions--go forth and be free." Not all women feel this way, but it is very liberating for those who do.
In the meantime, lifestyle strategies can help redirect "the change" to meet the individual needs of any woman. Even the least symptomatic woman needs to know that her bone density may decline, as does her body's collagen, and that her metabolism will slow, especially carbohydrate metabolism. Increasing exercise, keeping dietary plant protein high (a good source of phyto, or plant estrogens), 1500mg of calcium a day in divided doses (through food or supplements), adequate vitamin D (at least 1000 IU a day), and a good intake of Omega 3 fatty acids.*
Some women choose hormone replacement therapy, and others try over the counter herbal supplements 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 for those that seek guidance from an expert.
The bottom line is that menopause is normal, as is puberty. And as with puberty, the "change" can be famously unsettling...or beautifully smooth. This is a time to stay informed, and stay healthy. Your doctor can help, but it should not be "add-on" to your annual exam. Make a special appointment to meet with him or her, and be prepared to follow up. There are many choices, and the key is to understand--menopause and your options.
* For more information on supplements click here