The Many Flushed Faces of Menopause

Mary Catherine DeRosa, MD, FACOG, NCMP, CCD

Menopause is a normal part of aging. However, many women enter the menopausal transition without knowing what to expect. Dr. Mary Catherine DeRosa answers common questions about menopause.

Am I in menopause?

This is a common question that many women ask. Menopause occurs when a woman’s ovaries no longer produce normal amounts of estrogen or release eggs regularly. There isn’t a lab test or specific age when this occurs.

For most women, the process begins around age 45 and lasts about six years with their last period occurring around age 51. Some women have irregular menstrual cycles earlier and stop having periods between ages 40 and 45, which we call early menopause. Some stop before age 40, which is called premature menopause. Women who’ve had surgery to remove their uterus or ovaries, or are undergoing certain treatments for cancer, may experience the symptoms of menopause regardless of their age.

The phases

The age at which the menopause process starts, how long a woman is in perimenopause, and the symptoms that accompany the irregular cycles is variable and unpredictable. Menopause is generally considered to begin on the date of your last period, whereas perimenopause refers to the years prior to that and are often marked by irregular periods. Postmenopause are the years after your last period.

The symptoms

There is no one single symptom that’s commonly seen in all women as everyone has a different menopause experience. Some women have very few symptoms, while others have issues that affect their daily lives. Symptoms are usually the most troublesome during perimenopause and can include:

  • Mild warm flashes or hot flashes with profuse sweating.
  • Poor sleep quality.
  • Anxiety, mild mood swings, flares of depression
  • Brain fogginess.
  • Body changes, including weight gain (about 14 pounds) and
  • fat redistribution to the abdominal area, also known as the "menopouch”, and vaginal dryness and pain with sex.
  • Certain changes should be monitored, including rapid loss of bone and the development of athrosclerotic plaques in vessels and coronary arteries.

What about the dreaded hot flashes?

Hot flashes are a common symptom of menopause caused by the hormonal changes in your body. It's a feeling of intense warmth that can appear suddenly or slowly and cannot be attributed to an external source.

A hot flash may have no clear trigger, but can also be caused by alcohol, hot drinks, caffeine, spicy foods, smoking, or room temperature. They can be as mild as feeling flushed or severe enough to wake you from a sound sleep, also known as “night sweats.” Most hot flashes last 30 seconds to five minutes. They usually disappear within a few years after menopause, but some women may experience them for decades.

Women in menopause can experience hot flashes as often as several times a day. But this experience can vary from one woman to the next and may include:

  • Sudden warm feelings or sweating.
  • Redness of the face, neck, ears, chest, or other areas.
  • Tingling fingers.
  • Racing heart beat or palpitations.
  • Feeling cold or getting the chills as the hot flash ends.

Treatment Options

The Menopause Consultation Program at the Women's Medical Collaborative was developed to help women understand what they’re experiencing, anticipate what they may feel, and try to manage their symptoms while maintaining a healthy lifestyle. Our experts can help you choose the best of several options for relieving your hot flash symptoms: 

  • Hormones. These provide many women with relief and offer added benefits for bone health. But hormones are not for everyone. Some women prefer not to, while others can’t due to certain medical conditions such as breast cancer or a history of blood clots.
  • Antidepressants. Newer studies show that some commonly used antidepressants can provide effective relief.
  • Non-medical treatments. We find that women who exercise and maintain a healthy weight have fewer problems with hot flashes. Relaxation exercises and meditation can also help.
  • Cognitive Behavioral Therapy (CBT). This form of psychotherapy may be beneficial for some women.

Other changes

The loss of estrogen during menopause can cause changes in the vaginal and vulvar skin. These changes can result in vaginal dryness, burning and discomfort, or painful intercourse. Most women need a lubricant. 

There are many different formulations, but silicone-based lubricants are best. Be aware that most over-the-counter lubricants contain preservatives, which can cause irritation. A preservative-free silicone lubricant or natural product, such as extra virgin olive oil or organic unrefined coconut oil, can also work. 

Many women also experience painful spasms of the interior pelvic muscles, called vaginismus. Specialized physical therapy is a very effective treatment. Our center has a group of female physical therapists who are specially trained in pelvic floor rehabilitation. 

Managing menopause

Lifestyle changes involving diet and activity level can help manage menopause symptoms and ensure better health afterwards.

  • Nutrition: Reduce or limit caffeine and alcohol, eat estrogen-containing soy foods, and ensure you receive adequate calcium and vitamin D.
  • Exercise: Daily exercise helps with heart health, muscle and bone health, and stress reduction. Resistance exercises can also help your balance.
  • Mindfulness-based techniques: Yoga and meditation help greatly with mood and sense of well-being and can also relieve hot flashes.
  • Manage your health: Maintain good health and minimize age-related conditions by controlling your blood pressure, cholesterol levels and weight, and quitting smoking.

Discuss any changes or health concerns with your provider. I encourage all women to be an informed and active participant in their health care choices.

Be sure to join us for our free Menopause Education Night on Wednesday, October 25 from 6:00 p.m. to 7:30 pm at the Women’s Medicine Collaborative. Call 401-793-7817 to register. Visit our website for more information on this event

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