Menopause is a natural biological process that marks the end of experiencing menstrual cycles, and is defined as going 12 months without having a menstrual period. Perimenopause refers to the process leading up to menopause, in which the ovaries gradually stop producing eggs, and may include longer periods, longer gaps between periods, and irregular menstrual cycles before ovulation stops. The average age to reach menopause is 51 in the United States. Surgical removal of a person’s ovaries such as in a total hysterectomy also cause the onset of menopause.
What to Expect
Hormones shift around perimenopause and menopause, when production of estrogen and progesterone by the ovaries declines. People experience menopause differently, and for some the transition can be particularly challenging, while others hardly notice any changes. Some common changes around menopause may include:
- Hot Flashes: Hot flashes can be a very mild or very severe sudden flush of warmth, and may occur for several years around the menopause transition. They are related to changing estrogen levels and can even be strong enough to wake you at night.
- Urinary Leakage: Estrogen plays an important role in optimizing pelvic floor muscle tissue so that the muscles can appropriately do their job and help you keep your pants dry. Many peri- and post-menopausal people may experience an increase in, or onset of urinary leakage as menstrual cycles come to a stop
- Vaginal Lubrication and Sexuality: For many people, decreasing estrogen leads to vaginal dryness, which can make vaginal intercourse less pleasurable and even painful.
- Emotional and Mood Changes: The onset of menopause may also be related to an onset or increase in difficulty concentrating, anxiety, depression, and decreased energy.
- Sleep Problems: Hot flashes and changes in mood can adversely affect sleep, further contributing to decreased energy and emotional changes around menopause.
- Physical Changes: An increase in aches and pains, headaches, changes in body composition and more easily gaining weight, and thinning skin are all associated with menopause.
Navigating New Territory
While the onset of menopause may sound daunting, it is a very personal and individualized journey, and many people do not experience any symptoms at all. Some may even be relieved to no longer have to have menstrual cycles, especially if menstrual cycles have been painful in the past. Understanding that menopause is a normal biological process and not a disease process, seeking social support, and seeking healthcare support may help alleviate uncomfortable changes associated with menopause. Many choose to navigate new challenges with hormone therapy, lifestyle changes, and a combination of the two.
Hormone Therapy: After consulting with their physician, many people elect to undergo hormone replacement therapy, either to replace estrogen or both estrogen and progesterone. Often prescribed as a pill, patch, cream, or spray, hormone therapy can help reduce symptoms such as hot flashes, vaginal dryness, and changes in mood.
Lifestyle Changes: Increasing exercise and activity, improving sleep, and making dietary changes, can make positive impacts on the most common issues associated with menopause.
- Increase Exercise and Activity: Exercise has positive benefits on mood, sleep, and has been shown to help decrease hot flashes. It also is important to note that postmenopausal people are also more at risk for osteoporosis due to the shift in hormones. Research tells us that resistance training is key to maintaining good bone density (for more information, check out our recent blog post). Similarly, researchers have also found that cardiovascular disease is the leading cause of death among postmenopausal women. While the normal aging process increases the risk for cardiovascular disease, research shows that the menopausal transition can accelerate this risk. The good news is that exercise, and other modifiable lifestyle changes to lower the risk of cardiovascular disease.
- Focus on Good Sleep: Getting good sleep affects all areas of life, and a lack of good sleep can increase irritability and depression, feeling fatigued, increase pain sensitivity, and decrease our immune function. Healthy sleep practices include following a regular schedule, getting plenty of sunshine and exercise, decreasing caffeine intake later in the day, avoiding alcohol, and keeping the room a cool temperature at night. For more information on why sleep is so important and strategies to improve sleep, refer to our blog post on Sleep Hygiene
- Eat a Healthy Diet: Dietary changes around menopause can make a significant and positive impact on managing new symptoms and decreasing the risk of future symptoms. While eating to nourish your body is important in all phases of life, it can be particularly impactful around menopause as your metabolism shifts, and you are more at risk for bone density and cardiovascular issues. In particular, focus on a diet rich in protein, calcium, and vegetables for overall health and symptom management. Similarly, avoiding caffeine, spicy foods, and alcohol may help reduce hot flashes throughout the day.
Pelvic Floor Physical Therapy: Pelvic floor physical therapy can help identify and improve factors contributing to symptoms such as vaginal dryness, pain with sexual activity, increased heaviness in the vagina/rectum or pelvic organ prolapse symptoms, and issues with urinary leakage. Through techniques such as hands on manual therapy, teaching new exercises and supporting people in starting new exercise programs, coaching movement strategies, and teaching behavioral modifications, pelvic floor physical therapists are an integral part of helping people navigate new pelvic floor challenges around menopause.
Sources:
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912?cookieSet=1
https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do
https://www.nia.nih.gov/healthy-eating
https://www.nia.nih.gov/about/aging-strategic-directions-research/understanding-dynamics-aging