What’s in it for me? Find out why menopause matters.
Do you remember what it’s like being a teen?
The hormonal mayhem of puberty can be totally overwhelming – especially the landmark experience of your first period.
Luckily, there are plenty of books and movies that can guide menstruators through the big transition.
But what about stories of menopause – the second big transition in our hormones?
Unlike puberty, menopause is largely absent from our public discourse.
As a result, the topic is shrouded in myth, misinformation, and outright terror.
Why do we stop menstruating at a certain age?
What happens when we do?
And how can we best care for our health during and after the transition?
This Blink is here to help.
We need to start talking about menopause!
How often have you heard the word “menopause” in a movie, book, or TV show?
Maybe once or twice at most.
Probably never.
Periods, at least, are joked about.
But menopause is one of those topics that our society prefers not to discuss.
We have the patriarchy to thank for that.
For centuries, our culture has nursed the idea that when a woman is no longer able to reproduce, she loses her social worth.
Menopause was – and still is – viewed as some kind of biological flaw.
It’s not.
Menopause occurs when there are no more follicles in our ovaries capable of ovulating.
The final menstrual period, or FMP, typically happens between the ages of 50 and 52.
But the menopause transition starts much earlier.
Just like with puberty, the years leading up to the FMP are a bit of a hormonal mess.
Irregular, missing, or very heavy periods are common.
The natural drop of our estrogen levels is associated with a variety of other symptoms – from hot flashes to sleep disturbances to more serious health concerns, like osteoporosis.
But menopause itself isn’t some kind of disease.
It’s a universal and purposeful feature of our biology.
The word “menopause” itself may not be very good at conveying that.
Conceived by a French doctor in 1812, it’s a combination of the Greek words menes, meaning month, and pausie, meaning cessation.
In the US, the term rose to prominence in the 1960s, when it was used to market hormone therapy.
Pharma companies used it because “pause” sounds temporary – as if your periods would come back at some point.
That’s misleading.
“Pause” can also sound a little negative – as if life is on hold when you stop having periods.
Other countries have nicer expressions.
The Dutch call menopause overgang, meaning “passage” or “bridge.
” The Japanese call it kōnenki, which translates to “change of life.
” Research suggests that women in countries with more positive terms suffer less with menopause symptoms.
It might be too big a task to change the word “menopause.
” But we need to break our cultural silence around the topic.
Many people today still don’t know what to expect when they enter the menopause transition.
As a consequence, they don’t get the support they deserve.
Considering that most of us will spend at least a third of our life menopausal, this is outrageous.
It’s time we talked about menopause.
Menopause isn’t a flaw – it’s an essential feature of our biology.
Menopause is essentially puberty – just in reverse.
Puberty marks the beginning of our ability to reproduce.
Menopause marks the end of it.
During puberty, our hormone levels rise, and we become capable of ovulating.
The follicles in our ovaries ripen during each menstrual cycle.
One of them eventually releases a mature egg.
If that egg is fertilized, it nests itself into the uterus and grows into a fetus.
If it’s not fertilized, the uterus lining eventually sheds to renew itself – we have our period.
Every follicle needed for each menstrual cycle is made before we’re even born.
At week 20, a female fetus will have developed the maximum of 6 to 7 million primordial follicles.
By the time we have our first period, there are about 300,000 follicles left.
In our forties, we lose more and more of these follicles.
As a result, our levels of the hormones estrogen and progesterone, which play an important role in coordinating the menstrual cycle, drop.
Our periods become more and more irregular – and eventually stop altogether.
When we have our final menstrual period, around 1,000 follicles or less remain, but none of them can ovulate anymore.
In the US, the average age for this is 51.
When and how we experience our menopause transition depends on factors like genetics, health, and environment.
Smoking, for example, advances the onset of menopause by about 2 years.
Very early menopause is associated with an increased risk for osteoporosis and cardiovascular disease, while very late menopause is associated with breast and ovarian cancer.
But even when menopause comes as scheduled, it brings with it physical changes such as hot flashes, insomnia, and vaginal dryness.
This begs the question: Why would evolution do this to us?
There’s a false belief that menopause is a biological mistake, caused by modern humans living longer than nature intended us to.
That’s nonsense.
Throughout history, plenty of people have lived past the age of 50, and even the ancient Greeks and Chinese knew of menopause.
Menopause evolved because it gives us one big survival advantage: grandmothers.
Raising children is a long, costly task for humans.
If duties and resources are shared, children are more likely to survive.
Long-lived grandmothers can help source food and take care of their grandchildren.
But they can only do this if they don’t have young children of their own.
That’s why it makes sense for women to eventually stop being able to reproduce.
This theory is known as the grandmother hypothesis.
It means that menopause is no accident.
It’s an important feature of our biology that allows human societies to thrive.
The physical changes of menopause can be daunting, but they are normal and manageable.
Is it hot in here, or is it just me?
If you’re over the age of 45, chances are you’ve experienced a premenopausal hot flash.
The temperature may feel chilly to everyone else, but for two to four minutes, your body feels like it’s in a Finnish sauna.
And while two to four minutes don’t seem like much, hot flashes typically occur for seven years – sometimes multiple times a day.
The reason for them seems to be dropping estrogen levels that mess with the inner thermostat of our brain.
Menopause ushers in many physical symptoms, most of them unwelcome.
The good thing is, symptoms like hot flashes, insomnia, and mood swings are temporary.
Other, more permanent changes of menopause may require us to start paying closer attention to our health.
Let’s have a look at them.
The first thing most people notice during menopause is that their body shape starts to change.
Typically, we start losing muscle mass around age 30.
But during the menopause transition, muscle loss accelerates.
In addition, hormonal changes mean that more fat is stored as visceral fat around the organs and the stomach.
Medically speaking, a little bit of padding is not an issue, but visceral fat is linked to an increased risk of cardiovascular disease.
Cardiovascular disease is the number one cause of death for women, so it’s a serious matter.
People with a history of endometriosis, polycystic ovarian syndrome, or diabetes are at especially high risk – and should have their blood pressure and cholesterol checked regularly.
Everyone else over the age of 40 should get screened every two to three years.
The other big risk after menopause is osteoporosis.
Like muscle loss, bone loss accelerates during menopause.
In the US, 51 percent of women over the age of 50 have low bone mass, and 15 percent already have osteoporosis.
Overly fragile bones can lead to fractures and breaks that severely impact a person’s independence and quality of life.
That’s why women over the age of 65 should have their bone density screened regularly.
If there’s a high genetic risk for osteoporosis, screening should start even earlier.
Hot flashes and weight gain sound annoying, but heart disease and osteoporosis sound downright scary!
Luckily, there are plenty of interventions that can help alleviate symptoms and offset risks.
The best one is a healthy lifestyle – more on that later.
Menopausal hormone therapy, which we’ll discuss next, is another option.
Menopausal hormone therapy can help with many symptoms, but it’s no miracle cure.
Menopausal hormone therapy, or MHT for short, is a blanket term for pharmaceutical hormone supplementation.
Mostly, this concerns estrogen and progesterone – hormones which naturally decrease during the menopause transition.
MHT can come in the form of pills, creams, transdermal patches, vaginal rings, or even a hormonal IUD.
It had its big break in the 1940s, when US scientists developed the estrogen pill Premarin.
Named after its source – pregnant mares’ urine – Premarin was marketed as a miracle “cure” for the “disease” of menopause.
Problematic marketing wasn’t the only issue.
The first formulations of Premarin failed to include a sufficient amount of progesterone, the hormone that protects the uterus lining.
As a result, the 1970s saw a sharp spike in endometrial cancers.
Pharmaceutical companies scrambled to revise their formulations.
But a 2002 study by the Women’s Health Initiative cast new doubts.
The study linked MHT to an increased risk for breast cancer, coronary heart disease, stroke, and pulmonary embolism.
It was a scandal.
MHT use plummeted.
Today we know that the way risks were communicated was exaggerated.
When the data was reviewed in 2007, a different picture emerged.
Overall life expectancy was the same for women on MHT.
And those who’d started MHT within 10 years of their FMP actually had a decreased risk of coronary heart disease.
The idea of a “window of safety” for MHT emerged.
In this window, meaning before age 60, MHT can be very useful.
Despite a slightly increased risk of stroke, blood clots, and breast cancer, it can significantly improve hot flashes, insomnia, and hormonal depression.
So given what we know today, what are the dos and don’ts of MHT?
For one, start small.
You want to find the lowest effective dose that helps with your symptoms.
With estrogen, transdermal applications such as creams and patches are lower-risk than oral medications.
Progesterone isn’t absorbed as well through the skin.
Next, opt for pharmaceutical-grade hormones, and steer clear of “compounded” or “natural” products.
Compounded hormones are mixtures of hormones made by pharmacies.
They are largely untested and unregulated.
The same goes for “natural” supplement mixes that claim to deliver “bioidentical” hormones.
Finally, be patient and curb your expectations.
Hormonal therapy can take up to six months to take full effect.
It also might simply not work for your symptoms.
But when it does, it can be a very powerful tool in your “happy menopause” toolbox.
With some adjustments, a happy and healthy sex life is possible at any age.
Can you have a good sex life during menopause?
The answer is yes, of course.
But for some, it may require a little more work.
During the menopause transition, many people notice their genitals changing.
The tissues of the vulva and vagina become thinner and shrink.
This used to be called vaginal atrophy, but it’s now called genito-urinary syndrome of menopause, or GUSM.
Not only is this more accurate because it affects the bladder and urethra – it also sounds much less horrifying.
GUSM is perfectly normal, and over 80 percent of women experience it.
Still, some people find that it impacts their sex life.
For instance, they may find it harder to achieve orgasm as the clitoris grows smaller.
On top of that, the vaginal microbiome changes.
This can lead to dryness, itching, and pain with sex.
Vaginal estrogen and a hormone called DHEA are proven to work well for GUSM.
They are also used to treat recurrent UTIs – another common complaint during the menopause transition.
In addition, cleansers, lubricants, and moisturizers can work wonders.
Be sure to use a cleanser instead of soap to protect the pH balance of your vulva – a cheap facial cleanser can do the trick.
For moisturizing, coconut oil or petroleum jelly are all you need.
Kegel exercises that strengthen the pelvic floor may increase pleasure during sex and improve your orgasm.
They also help with urinary incontinence that develops for some people during the menopause transition.
Often, physical changes are only part of the issue.
You may find that you’re simply not in the mood for sex.
Decreased desire is only a problem if it bothers you – but if it’s a side effect of hormonal depression, seek treatment for your mental health first.
MHT and the antidepressant Bupropion can help with both hormonal depression and a low sex drive.
Generally though, sexual desire is a bit more complicated than a few hormones.
Try communicating with your partner, trying out new things, and – yes – even scheduling sex.
You may find that you simply need a little more foreplay to get into it!
Knowledge is the key to separating the myth and medicine of menopause.
So, how do you best manage your menopause transition?
The somewhat frustrating answer is: it depends.
But the more you know about the changes your body is going through, the better you’ll be able to choose the right treatment for you – which includes no treatment at all.
MHT can help with many symptoms, but it isn’t without risk.
The best things you can do for your menopausal health are those that benefit your health in general.
They include quitting smoking, getting regular exercise, and eating a healthy diet.
Quitting smoking should be a no-brainer.
But what exactly is “regular exercise?
” In short, it’s either 150 minutes of light aerobic activity – such as walking – or 75 minutes of moderate aerobic activity – such as jogging – per week.
In addition, weight training two times a week will strengthen your bones and muscles.
And what does a “healthy diet” mean?
It means avoiding ultraprocessed foods and eating lots of whole grains, veggies, and fruits.
Add in fish or seafood for omega-3 fatty acids, and make sure to get 25 grams of fiber a day.
It doesn’t need to be more complicated than that.
If you suffer from mood swings or depression, you may also consider therapy.
Cognitive behavioral therapy can even help you manage uncomfortable physical symptoms, like hot flashes.
If you do decide to take a pharmaceutical, be aware that there’s a lot of snake oil out there.
Most supplements aren’t well studied or understood.
Calcium, vitamin B12, vitamin D, and omega-3 fatty acids are the exception, but most people can get these through a healthy diet.
If you’re unsure about a product, check what reputable medical organizations – such as the National Institute of Health or the International Menopause Society – have to say about it.
Apply the same scrutiny to the medical professionals you seek out.
If your doctor talks about estrogen as if it’s a wonder drug, recommends topical progesterone, or sells products themselves, find a different doctor!
If they want to check your hormones with a saliva test, run for the hills.
Hormone levels don’t correspond to symptoms, and saliva tests are notoriously unreliable.
Finally, let’s return to the Dutch word overgang from the beginning of this Blink.
It’s best to think about menopause as a transition from one stage of life to the next.
It may be a bumpy ride, but it doesn’t last forever.
Eventually, your body and mind will adapt.
Armed with knowledge and tools, you can be healthy and happy throughout – and after – the process.
Final Summary
During the menopause transition, things can get a little messy.
Dropping hormone levels may lead to symptoms like hot flashes, GUSM, and mood disturbances – and can increase the risk of cardiovascular disease and osteoporosis.
It’s important to know about these physical changes and your treatment options.
Exercise and a healthy diet can alleviate symptoms and mitigate health risks.
In addition, many women benefit from Menopausal hormone therapy – but pharmaceutical hormones are not without risks.
In the end, information is your best friend during your menopause transition.