About Menopause


Expansive II. Watercolor on paper. Wauwatosa, August 2021.

In the podcast interview that I did for Dr Katrina Ubell on Misconceptions About Aging, we talked a bit about menopause and how there could be more support for women around this important biological milestone.


Menopause is an excellent example of a biological consequence of aging that is inevitable for women. Most choose to take a passive, reactive approach. Like, “I’ll worry about/deal with it when it happens, and meanwhile let’s hope it won’t be so bad.” But there is also an option to take a more proactive approach.


Stigma


As a Women’s Health specialist for over thirty years, I have supported hundreds of women through the menopausal transition. But I have rarely shared my personal thoughts or experience with anyone other than my gynecologist. In other words, I’ve had countless clinical conversations on this topic, but somehow felt uncomfortable talking about it on a personal level.



Photo by Ian Keefe on Unsplash

I know that this is in part due to cultural/familial programming, as in, “It’s shameful and embarrassing to talk about menstrual anything.” So why would you go there? It’s taken me years to see that I was participating in my own oppression through the patriarchal programming that made it not okay to even have periods.


But what ran deeper than my shame about having periods was the shame of aging and being thought of as being old or obsolete. There was an internally contradictory dialogue that had me losing on both sides of the argument. I was feeling shame whether I was still young enough to be menstruating (but not okay to talk about it), or if I was too old/menopausal (and therefore undesirable/unattractive).


What is menopause?


Because of our reluctance to talk about menopause, there is a kind of mystery that surrounds it. In that sense, I’ve been delighted to see that like sex, there has been a growing movement to create more transparency around the science and also the human experience of menopause. There are so many more books, articles and websites now that help women to understand what is happening.


Having said that, there is still plenty of confusion around the word menopause because that term refers not only to a biological event, but also a transitional interval of time. In addition, menopause refers to a diagnosis with a set of symptoms, and furthermore our respective subjective experiences of menopause, both physically and emotionally.


Schematic representation of hormonal changes during menopausal transition

To be clear: menopause as a biological event means the last period a woman experiences. Which can only be determined retroactively, because we can’t call it a “last” period until a year has gone by with no further periods. You are considered postmenopausal only after that year has passed. On average, this will happen somewhere around the age of 55, with a broad range of variation on either end, reaching down to 50 and up past 60.


The perimenopause is the interval of time leading up to that last period, which is when the ovaries are making less and less estrogen. This causes the brain to create more stimulating hormones which attempt to “wake up” the ovaries.. I like to think of this as the ovaries responding with “last gasp” energy, so instead of having a nice even monthly cycling of hormones, we see a lot of erratic fluctuation in hormone levels.

When we can trust ourselves to figure out how to age proactively, we are choosing life.

These fluctuations can cause a huge range of symptoms, like hot flushes, night sweats, insomnia. Menstrual bleeding can be absent, spotty, prolonged or heavy, or all of the above. And unfortunately the perimenopausal transition can last for anywhere from 2 to 5 years.


What can I do?


The most common question I’ve gotten over the years is, “What will happen to me when I go through menopause?” And in my experience, each woman will have her own unique experience. As with childbirth, very few stories will be the same between women. So while we cannot predict what anyone’s individual journey will be like, we can prepare proactively to respond to what comes.


  1. Educate yourself. What are the possible symptoms I could encounter? Understand what your options are for managing symptoms. What are your risks for each option?

  2. Make a plan for the most common symptoms, so you will be ready. For example, if I get hot flushes, I want to try option A first for X amount of time, and then move to option B.

  3. Be prepared to experiment. This means tracking your data. Track your menstruation - When? How long? How much? Track your sleep, hot flushes, etc. It’s the only way you can know if what you’re trying is making a difference.

  4. Get support. Find some good trustworthy sources of information and potential support. Will this be through family? Friends? An online forum?

Choosing life


Many of us are inclined to be frustrated with the inconvenience of having to deal with yet another part of womanhood. And yet this is just the next stage in our biological life cycles. We are blessed to be part of the miracle of birth and family in this life. Whether or not we choose to participate, our bodies are going to do their thing.



Photo by Dario Valenzuela on Unsplash

When we hate on our bodies for aging or having menopausal symptoms, we are only layering on emotional suffering for ourselves by resisting the reality of what is. I’d like to teach you instead is that you can commit to loving your body unconditionally, which means that you take care of yourself even when it feels like your body isn’t cooperating.


Consider how you would want to look after your best friend or your daughter if she was experiencing troubling symptoms. When we can accept and trust ourselves to figure out how to age proactively, we are embracing our future and choosing life.





 

Resources


Weight Loss for Busy Physicians Podcast by Dr Katrina Ubell



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