If your mother lived long enough, she went through menopause.
The same is true for your sister, your wife, and your daughter.
And yet we don’t much talk about it, and many of us know very little about it. Since October 18 is World Menopause Day, let’s pause to collect a few facts and bust a few myths.
DEFINITION
Menopause is a transitional process that typically starts in a woman’s 40s. Over the course of several years, estrogen levels decline; menstrual periods become irregular; symptoms like hot flashes and vaginal dryness appear; and eventually periods stop altogether. When a woman hasn’t had a period in a year, she’s considered menopausal.
A few notes:
~ The typical symptoms of menopause are real: low libido, painful intercourse, difficulty climaxing, hot flashes, night sweats, brain fog, insomnia, bladder leaks. That said, other conditions can result in these symptoms as well. Just as patients and doctors shouldn’t ignore menopause, they shouldn’t blame everything on it, either.
~ Since a main driver of menopausal symptoms is the decline in a woman’s hormones, hormone replacement therapy (HRT) is valuable for most women. Despite some scare headlines back in 2002, we’ve known for years that such treatment is safe for most women—including many with a family or personal history of breast cancer.
~ HRT has benefits beyond the reduction of menopausal symptoms. It also protects users from osteoporosis, cardiovascular disease, and dementia. If a woman is on the fence about HRT, she should consider the reduction of these substantial health risks.
~ For HRT to provide maximum protection, a woman should start it about two or three years BEFORE menopause, during the transition called perimenopause. This will help balance the upcoming early drop in hormone levels. But it’s never too late to start. Of course, consult your health care provider.
~ Reminder: there’s more to sex than having something inside the vagina. Regardless of sexual orientation, women and their partners should take advantage of “outercourse”: stimulation of the clitoris, as well as the rest of a woman’s body. When menopausal women say “sex hurts,” they generally mean a penis or something else inserted into their vagina.
While lube, lube, lube is the watchword (perhaps along with estrogen suppositories) when insertive sex hurts, some older women and couples may need to say goodbye to insertion.
~ Vibrators aren’t a substitute for intercourse, but they can provide a great deal of pleasure, regardless of a woman’s age, and whether she has a partner or not.
~ This leads to the existential issue around menopause: just as we all have to choose the way we cope with other body changes as we age (such as unreliable erections, knees that can’t play tennis, eyes that can’t drive at night, acquired lactose or gluten intolerance), we have to—we get to—decide what menopause means, and how we’re going to deal with it.
Some women decide it means they aren’t feminine anymore; someone may decide their partner isn’t attractive anymore. While these decisions are culturally supported, they are mistakes—and not the fault of menopause.
~ Everyone going through perimenopause needs a knowledgeable physician. The ob-gyn who was great delivering your kids or helping you through chlamydia in your 30s may not be the right doc when you’re 45. Make sure you have a gynecologist (or nurse practitioner) who understands the latest treatments—and to whom you can speak honestly.
~ For ongoing information about menopause and women’s health, get the periodic newsletter of Dr. Kelly Casperson or Dr. Rachel Rubin. And check out Dr. Casperson’s book The Menopause Moment.
THE MENOPAUSE REVOLUTION
For most of human history, women didn’t live long enough to go through menopause. As science has increased our lifespan in the last century, more women live to and beyond menopause than ever in human history.
Most of us accept the ways science can help us deal with age-related health challenges (with reading glasses, protein shakes, hip replacements, Viagra, etc.), making our lives more enjoyable. Now that most Americans live long enough to go through menopause, physicians and their patients should embrace how medical science can make it easier and healthier.
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