The period of menopause is a challenging time for women in their fifties. The average age for menopause in France is fifty years old. Menopause and the years leading up to it bring about changes at almost every level of a woman’s body. However, many women are surprised by the changes that occur and wonder about the best way to manage them.
“Most women do not know what to expect before it happens,” explains Asima Ahmad, an endocrinologist, reproductive and fertility specialist, and chief physician at Carrot Fertility in Pennsylvania. “When symptoms occur, they do not fully understand the differences between perimenopause and menopause.”
Menopause is when a woman has not had her period for at least a year. Perimenopause is what leads up to menopause, when women begin to experience symptoms related to the gradual decrease in estrogen production in the body.
“The experience will be a little different for each woman,” notes Asima Ahmad. The median number of years during which a person experiences these symptoms is 7.4 years, but it can last up to fourteen to twenty years for some women. More importantly, it is also a key period of transformation for women’s heart and metabolic health.
“Menopause is an inevitable period, and I prefer to see it as a window into future cardiovascular health,” explains Kathryn Lindley, a cardiologist at Vanderbilt University Medical Center. Women may seek care for perimenopausal and menopausal symptoms, “but this is also when cardiovascular risk factors really start to rise,” says Lindley. “We start to see blood pressure, weight, blood sugar, and cholesterol levels increase, and there is a real increase in the risk of heart diseases such as a heart attack, heart failure, or stroke.”
Heart attacks can be felt differently in women than in men, so it is important to be familiar with the symptoms of a heart attack in women. However, there is a higher risk of having a stroke than a heart attack in women, so it is important to be aware of these signs as well.
Fortunately, there are many treatments available for most menopausal symptoms or to reduce the risk factors for cardiovascular diseases.
“It’s not like one thing is going to work for everyone,” says Asima Ahmad. “Sometimes you have to trial and error. What is really important, in terms of treatment options, is finding the right healthcare provider.”
Many women are fortunate to already feel comfortable discussing perimenopausal symptoms with their primary care physician. But Ahmad’s company, Carrot Fertility, found last year that one in three women surveyed reported never discussing menopause with their doctor. However, starting these discussions early would be beneficial in order to determine if your doctor will meet your needs.
“If you have a doctor who is not comfortable treating menopause, or if you are looking for someone with more personal experience, then you need to start looking for someone in advance,” says Ahmad.
Despite all the changes women in their fifties face, it is important to remember that this period does not last forever.
“I try to make my patients understand that, for most women, perimenopause is a long but limited period,” explains Angela Wilson, a gynecologist-obstetrician at Montefiore Einstein Advanced Care. “At some point, you come out on the other side and things start to stabilize a bit.”
The first thing that comes to mind for women when they hear the word “menopause” is “hot flashes.” But perimenopause and menopause can include a much wider range of symptoms.
“These include changes in energy levels and fatigue, brain fog and difficulty concentrating, difficulty falling and staying asleep, depression, changes in fat distribution in the body, hair loss, skin changes, and changes in bone density,” explains Ahmad.
Mood symptoms can result from other symptoms or manifest independently.
“Menopause can come with many emotional symptoms, such as increased irritability and an increased risk of depression and anxiety,” says Wilson. Additionally, the loss of estrogen in the body can also lead to vaginal dryness, which has implications for sexual intercourse. Between 17 and 45% of women report pain during intercourse during this period, and underreporting is significant on these issues, so the numbers could be much higher. Vaginal dryness affects everyone,” says Wilson, “but women are often surprised when they start to suffer from it.”
Not all women experience all of these symptoms, but they are common to millions of women.
Since many changes occur due to the gradual decrease in estrogen in the body, hormone therapy may be an important therapeutic option. Unfortunately, the misinterpretation of an influential study conducted in 2002 led to years of confusion, misinformation, and unfounded fears about hormone therapy. While it is true that hormone therapy is not suitable for all women and carries risks and benefits, like any treatment, for the vast majority of women, the benefits outweigh the risks throughout their fifties.
But hormone therapy is not a cure-all either. “For many people, hormone therapy will be combined with other treatments,” explains Ahmad. This may include vaginal lubricants, alternative therapies for hot flashes, such as selective serotonin reuptake inhibitors (SSRIs), or lifestyle changes, such as wearing lighter clothes and limiting foods that exacerbate your symptoms.
Cognitive symptoms can be particularly concerning for women at the onset, especially if they have a family history of dementia. So how do you know if your concentration or memory difficulties are due to menopause or early signs of dementia?
“If it affects their daily life, work, family life, or ability to perform daily activities, there may be an issue to address,” explains Jorge Ruiz, a geriatrician at Memorial Healthcare System in Hollywood, Florida. “If it’s bothersome but you can do everything you need to do, there’s no need to worry.”
Finally, menopausal women begin to lose bone and muscle mass while gaining fat, explains Lindley. “So it’s important to continue exercising with weights and resistance, both to maintain your muscle tone and bone mass.” But it’s also important to be aware of the risk of injury, she adds. Lindley recommends that patients use lighter weights and do more repetitions to reduce the risk of injury, and some women will definitely need to opt for cycling or swimming instead of running for their cardiovascular health.
Ahmad recommends getting a baseline bone mineral density test early in perimenopause to monitor changes that begin to occur over time. Women can also strengthen their bone health by weight training and ensuring they get enough vitamin D and calcium.
Wilson explains that her priority when talking to women in their fifties is to check their cardiovascular health and screen for diabetes, high blood pressure, and high cholesterol.
“I advise my patients to carefully examine their lifestyle at this time,” says Lindley. “If you weren’t exercising before, you need to start. If you weren’t eating well before, you need to change your diet.” She typically recommends a Mediterranean diet rich in fruits and vegetables, whole grains, and poultry, and low in fat, sugars, and processed foods.
While many women are aware that menopause often comes with weight gain, Wilson emphasizes that it is a global change in metabolism that occurs in their bodies. This is why exercising and eating healthily become even more important.
“We know that a healthy diet and exercise can help maintain good heart health, so even if the scale doesn’t move, these habits help maintain our cholesterol, blood sugar, and blood pressure levels and extend our life expectancy,” explains Lindley.
Cardiovascular health is also intricately linked to brain health, so maintaining a healthy blood pressure also protects the brain in the long run, according to Lindley.
Lifestyle changes that help maintain low blood pressure include avoiding excess salt in the diet, regular exercise, losing excess fat, and treating sleep apnea if diagnosed.
“If these lifestyle changes do not bring your blood pressure back to normal, it is very important to treat it with medication, as untreated high blood pressure, even if you feel fine, has quite serious cumulative effects on your heart, brain, and kidneys,” Lindley explains.
Cancer screenings done in previous decades continue, with one or two additional screenings, depending on risk factors:
1) Cervical cancer screening continues with a Pap smear every three years, a high-risk human papillomavirus (hrHPV) screening test every five years, or both every five years.
2) Breast cancer screening by mammography, or possibly by MRI for some populations, continues every two years.
3) Lung cancer screening begins at the age of fifty for people who smoke or have quit smoking in the past fifteen years and have at least twenty years of smoking history, for example, a pack a day for twenty years or two packs a day for ten years.
4) Regarding skin cancers, April Armstrong, a dermatologist at the University of California, Los Angeles, recommends an examination every year or so, as the fifties are the time when precancerous and cancerous skin lesions can begin to appear, especially in patients with fair skin.
Unfortunately, menopause can interfere with many fundamental well-being needs, such as good sleep and stress management. Weight gain related to menopause, for example, can sometimes lead women to develop obstructive sleep apnea. If you do not feel refreshed after a full night’s sleep, snore, or wake up with headaches, consider having your sleep apnea evaluated.
Here are other habits to adopt to maintain overall well-being:
1) Ask your ophthalmologist how often you should get checked if you have no symptoms or do not wear corrective lenses.
2) Continue to practice dental cleanings and screenings twice a year.
3) In addition to the seasonal flu vaccine and the COVID vaccine, adults fifty and older should get vaccinated against shingles to reduce the risk of contracting this disease, which one in three people will develop in their lifetime.
The hormonal changes of menopause can also lead to dryness and loss of elasticity in women’s skin, as well as accentuated wrinkles, explains Armstrong. If you have not yet started using a retinol or retinoid in your evening skincare routine, now is the time to start repairing some of the sun damage.