Women often want to know when they will reach menopause, but they rarely ask a more important question- how will they reach menopause?
As a woman approaches menopause, her ovaries gradually stop production of the sex hormones estrogen and progesterone. This can be a bumpy road of fits and starts, for up to a decade before the end of menstruation. Health care providers diagnose menopause only after a woman has been period-free for 12 consecutive months, or the ovaries have been surgically removed. Most women on the far side of this transition will say that they feel better than ever. It is the unpredictable time of perimenopause and early menopause that is harder to navigate. The entire process is normal and natural, of course. What isn’t always normal and natural is the way that we lead our lives as we enter this transition. Our behaviors and expectations can sabotage a smooth passage.
There are several known risk factors for a difficult menopause. It wouldn’t be fair not to mention that they all require further study (a real pet peeve of mine since it applies to most women’s health topics). But that shouldn’t stop you from taking a personal inventory of your risks and improving what you can. Here are 9 clues to a difficult menopause and how to solve them:
1. Weight Extremes
Women with higher BMIs have more hot flashes. This means if you’re significantly overweight or obese, you should optimize your weight through sound nutrition and exercise before reaching menopause. Good cardiovascular health and supple blood vessels decrease the severity of hot flashes and night sweats. It is easier to shed abdominal fat while you’re still cycling than it is after menopause. Extremely thin women may have increased hot flashes too. With less body fat to produce estrone after menopause, they have little to compensate for the loss of estradiol from the ovaries.
The diminished estrogen of menopause can decrease the production of serotonin, one of the neurotransmitters responsible for mood. In women with a history of depression, menopausal transition is even more likely to trigger depressive symptoms. Poor sleep and nighttime anxiety often go hand in hand with depressed mood for women in this group. Mindfulness techniques, meditation and yoga can be helpful in a prevention strategy. Over-the-counter supplements like Vitamin D3, omega-3 fatty acids, and SAMe may be useful in prevention. Herbs like saffron and Rhodiola improve mood for some women, but cannot be used by all. Prescription SSRIs and SNRIs may improve mood as well as alleviating hot flashes for some women, but have multiple side effects. Discuss these options with a knowledgeable provider before you try them.
3. Thyroid problems
An overactive or underactive thyroid gland can mimic many symptoms of the menopause transition. Hot flashes, sweating, anxiety, mood changes, palpitations, forgetfulness, weight gain or loss, dry skin, or cold hands and feet are all symptoms of thyroid dysfunction as well as menopause. Ask your provider to check your thyroid function, and be persistent. Ask her to explain which tests she will order and whether she is using up-to-date laboratory reference values for stricter thyroid control. In women with known hypothyroidism, menopause symptoms may be more severe even if they are being treated with replacement thyroid hormone. Untreated thyroid disease increases the risk of osteoporosis and cardiovascular disease.
4. Adrenal fatigue
Living in a state of constant hurry and worry? Juggling the multiple demands of work, family, health, and finances? Eventually this leads to burnout. The adrenal glands produce many hormones, including adrenaline and cortisol, the primary hormones of the stress response. The adrenal glands do not distinguish between an immediate threat to physical safety and the mundane daily stress of a sick child, a lost set of keys, or a difficult meeting at work. In normal conditions, episodes of increased stress are complemented by longer periods of rest and recovery, and the body remains in balance. Women in the U.S. experience high levels of stress between the ages of 35 to 50, just as they enter the late reproductive years and perimenopause. The female sex hormones are less important to safety and survival than the stress hormone cortisol. Under stress, the body will continue to produce cortisol in high levels for as long as possible, reducing the production of progesterone and the body’s sensitivity to the progesterone that is available. Reduced progesterone leads to premenstrual and perimenopausal symptoms, increased anxiety and impaired sleep. The single most important thing you can do to improve your change is to make a serious commitment to manage stress better. Lifestyle changes are the primary solution. Hint: if you can’t possibly “make time” to improve your diet, exercise, and get adequate rest, then it’s time for a much bigger change. Ditching a toxic job or relationship, renegotiating roles, or taking a leave of absence from some aspect of your life might be necessary if you’ve already reached the burnout phase. Adaptogenic herbs can improve the stress response and shepherd you through this difficult phase.
5. Sugar addiction
Sugar addiction is the evil twin of adrenal fatigue, and is pervasive in the U.S. culture of eating. We rely on sugar to pick us up, then we crash and feel the need to consume even more sugar. Sugar taxes the liver and causes inflammation throughout the body. Sugar addiction is usually a symptom of an underlying problem that we are unconsciously trying to fix: depression, burnout, hormone imbalance, etc. The good news is that breaking the behavior of eating sugar often breaks the intense craving for sugar. Find out why you are craving sugar, address the cause, and then resist getting cozy with sugar again. I know this one’s difficult – sugar is so sweet and sexy, and comes in such pretty packages! Making sour and bitter flavors prominent in your diet is key to breaking a sugar addiction. Eat a variety of flavorful greens, artichokes, and lemon-infused water.
Some research suggests that women with more intense premenstrual symptoms will also experience a more difficult menopausal transition. This may be due to long term hormone imbalance. PMS is caused in part by diminished progesterone in relation to estrogen. This same pattern occurs as women enter the late reproductive stage and perimenopause. In other words, premenstrual symptoms become more pronounced as you approach menopause. There is nothing normal about PMS! Most symptoms can be eliminated with changes in nutrition and supplementation, enhancing the liver’s ability to detoxify hormones, and using herbs including Vitex (chasteberry). Some women are inherently more sensitive to fluctuating hormone levels. Lab testing of hormone levels is rarely useful in predicting symptom severity.
7. Tobacco use
Smokers and other tobacco users have more hot flashes and undergo menopause earlier than non-users. Chemicals in cigarette smoke alter the metabolism of hormones and make liver detoxification less efficient. The blood vessels of smokers are less pliant, worsening vasomotor symptoms. All aspects of aging are accelerated in smokers. Quit early!
Alcohol increases estrogen levels, exacerbating the imbalance of estrogen and progesterone that already exists in the years before menopause. Alcohol also taxes the liver- a common theme in this article. I notice that women often increase their nighttime drinking or establish a new nighttime drinking habit during perimenopause. This is usually an attempt to relax at the end of the day or induce sleep, and it is totally counterproductive. Drinking alcohol encourages hot flashes and disrupts sleep later at night. Craving a nightcap may be triggered by low progesterone. Pretty ironic, since more drinking leads to more hormonal disharmony. Put away the Cabernet.
9. Lack of exercise
A sedentary lifestyle and poor cardiovascular tone predict a difficult menopause. This risk factor is more important than weight alone. Frequency and consistency of exercise matter more than the type of exercise you choose, but be sure to include weight-bearing activities to support healthy bones. You should be active for at least 30 to 60 minutes every day.
How will you choose to enter the change?
April Ward, MSN, CNM is an integrative women’s health specialist in Skaneateles, NY. To learn more, call 315-200-2349.