Barbara Hannah Grufferman

Excerpted from LOVE YOUR AGE: THE SMALL-STEP SOLUTION TO A BETTER, LONGER, HAPPIER LIFE (National Geographic 2018)

“There is no more creative force in the world than the menopausal woman with zest.”

–Margaret Mead

Ah yes. Now things get really exciting.

Maybe you’ve already gone through “the change” – a quaint little euphemism from days of yore. Or maybe you’re in the throes of it right now. But if you’re not yet at the point when estrogen levels start going down, down, down, you might want to heed the words of Bette Davis in All About Eve: “Fasten your seat belts. It’s going to be a bumpy night.”

Except it’s far more than a night. It’s years.

You heard right.  Years.

Perimenopause – the transition to menopause – usually starts in your 40s or even earlier, but according to the North American Menopause Society (NAMS), the average woman doesn’t actually reach menopause until age 51.

Then once you get through menopause (and you will, I promise), you are then, officially, a postmenopausal woman – for the rest of your life. And since most women born after 1950 will live well into their 80s or beyond, that means almost half of your life will probably be spent as a postmenopausal woman.

YOUR CHEATSHEET TO WHAT’S HAPPENING

Whatever stage you’re in, estrogen (and, to a lesser degree, its BFF progesterone) is probably rocking your world just about now. Here’s why in one word: estrogen.

Estrogen hormones have many functions in our bodies, but their biggest responsibility is controlling reproductive health, so as we age out of prime pregnancy years, estrogen levels start to fluctuate, jumpstarting perimenopause. And when we get to menopause itself? Estrogen goes into free fall. When we come out the other side – and we all do – our estrogen levels are significantly lower than when we started.

 AND THEN?

The drop in estrogen brings a lot of changes including dry skin, dry eyes, dry everything (Yes. Everything.); decrease in bone density; irregular heartbeat and palpitations, and oh so much more. But for most women, the most obvious – and problematic – symptoms of menopause are what I call the terrible menopause trifecta (TMT) of hot flashes, night sweats, and mood swings. All three can make us feel miserable, grumpy, sad, confused, and yes . . . really hot and sweaty. Women run the spectrum of how the TMT affects them and their quality of life (I had it pretty easy), but – good news — they are all treatable and they’re all temporary. Yay!

HOW TO CALM THE CHAOS

Whatever degree of discomfort you have, there are things you can do to cope with the symptoms of menopause. The best strategy is to think about your short game and your long game at the same time.

Short-Term: Address the temporary symptoms of menopause as soon as they crop up.

Long-Term: Protect your body from the negative health effects of reduced estrogen.

Bonus: Many of the options at your disposal will do both!

BRING OUT THE BIG GUNS: HORMONE REPLACEMENT THERAPY

One of the biggest and most controversial advances in managing menopause over the past few decades has been hormone replacement therapy (HRT), which uses low doses of synthetic hormones to compensate for the loss of estrogen and alleviate the most common symptoms of menopause, including hot flashes, mood swings, and bone loss.  HRT has been shown to be highly effective in easing the menopausal transition, but several clinical studies in recent years have shown that it does not protect against memory loss as was once believed and can slightly increase the risk of breast cancer, uterine cancer, heart disease, and stroke, although these risks go back down once treatment is stopped.

Based on the current evidence, however, both the NAMS and the Endocrine Society agree that HRT can be the right treatment to address temporary symptoms for many otherwise healthy women. While HRT should not be used to treat chronic illnesses and should be prescribed only after your doctor has factored in your health risks and family history of cancer, it can offer welcome relief to many women who are experiencing the most debilitating symptoms of menopause.

WONDERING IF HRT IS RIGHT FOR YOU?

Ask an expert. Discuss your personal needs and healthy history with your PCP or ob-gyn, and get the most up-to-date information about HRT.

THERE ARE NON-HORMONAL OPTIONS, TOO

Several prescription medications other than HRT are available to help reduce temporary menopause symptoms, like hot flashes and mood swings. Talk to your doctor to figure out if any of these alternative treatments are right for you:

• Low-dose mesylate salt of paroxetine (LDMP) is the only nonhormonal treatment that is FDA-approved for menopausal symptoms. Paroxetine was originally developed as an antidepressant, a dose of 7.5 mg per day has proved to reduce the severity and frequency of hot flashes.
• Other low-dose antidepressants, including certain selective serotonin reuptake inhibitors (SSRIs), like escitalopram, and serotonin-norepinephrine reuptake inhibitors (SNRIs), like venlafaxine, have been shown to alleviate hot flashes as well as regulate mood. None are FDA-approved for this purpose yet, but physicians may be able to prescript them as an off-label treatment option.
• Gabapentin is an epilepsy drug that has also been shown to reduce hot flashes and may be prescribed as an off-label treatment option.

WHAT ELSE CAN YOU DO TO TAME THE FLAMES OF MENOPAUSE?

Anything that promotes a healthy lifestyle will help you get through the worst parts of menopause: vigorous exercise, a Mediterranean-style diet, massage, yoga, and mindfulness meditation will help you feel healthier, better, and calmer.

REMEMBER THIS: YOU WILL GET THROUGH IT

True, menopause isn’t the most fun you’ll ever have with your body. But I swear to you there is a light at the end of the hormonal tunnel. I, and so many other women before me, have managed – with a little help from modern medicine and a lot of help from our friends – to break on through to the other side.

And that’s when the magic begins.

Barbara Hannah Grufferman, a recognized expert on positive aging, is the author of “Love Your Age: The Small Step Solution to a Better, Longer, Happier Life” which was published by National Geographic and branded by AARP in February 2018. Her first book, “The Best of Everything After 50: The Experts’ Guide to Style, Sex, Health, Money and More,” is a highly regarded resource for women over 50, and one of the first books to focus on the power of embracing your age. She contributes to HuffPost and AARP, consults with multi-national companies that seek to engage with the 45+ consumer, and has been spokesperson for several of them.