By MICKIE GRIFFITH-AUTRY, PhD, NP-C
Menopause! What Do I Do Now?
Menopause is a natural, normal event and is defined as the final menstrual period or FMP. Physiologically, it occurs when a woman’s menses (monthly periods) cease to exist from a loss of function within the ovaries. It can occur naturally or spontaneously, or it may result from a medical intervention such as hysterectomy, chemotherapy, or radiation therapy to the pelvic region.
Aging of the female reproductive system actually begins at birth and proceeds on a continual basis. The ultimate result of this aging process is a progressive loss of the ability of the ovaries to produce hormones and ultimately ends with the inability to produce an egg for reproduction. Due to the wide range of differences in women, age is a poor indicator of menopause.
Every woman is eventually affected by menopause. It is estimated that 6,000 women reach menopause every day in the U.S. As women are now living to 79.7 years of age and beyond, most can expect to live in a state of menopause for more years than she did in the reproductive years. While all women experience menopause, each woman will respond in her own unique way.
A woman’s perception of menopause is dependent upon her lifestyle, attitude, and demographic factors. Many view it as merely the end of their menstrual cycle. She may feel liberated from the fact that she can no longer become pregnant, or she may grieve from the realization that she can no longer have children.
However, women who have troublesome symptoms such as hot flashes, night sweats, depression, irritability, anxiety, sleep disturbance, heart palpitations, sexual dysfunction, urinary urgency, frequency or leakage, painful sex, vaginal dryness, weight gain, or joint and muscle pain, can experience menopause as negatively impacting their quality of life.
Social and cultural differences can also have an impact on a woman’s view of menopause. Aging, disease risk factors, mortality, access to a health care provider who is willing to treat menopause, existing hormone replacement therapy, and economic status are just a few of the factors that affect how menopause is perceived.
According to one study, 80% of women experience a significant decrease in their quality of life from the beginning of their menopause transition and throughout their life. And 75% of women see themselves as aging and losing their sense of attractiveness. A follow-up study suggested that 10% of women view menopause as essentially inconsequential to their quality of life.
While a woman is accustomed to annual pelvic, breast, and PAP smear exams in her reproductive years, it is important that continued health evaluation be sought at menopause and throughout her life span. This exam should include aspects of her physical and psychological health and individualized specifically for her. This type of approach provides the opportunity to identify specific issues related to menopause, obtain appropriate anticipatory guidance, develop a comprehensive preventive health care plan, diagnose diseases early, and determine intervention and treatment early.
In general, women should expect the following during an evaluation:
- A detailed medical, social, and family history;
- Complete physical examination including vital signs, height, weight, thyroid, breast, pelvic, and rectovaginal examination;
- Laboratory tests when indicated, such as fasting cholesterol panel, glucose, PAP testing, urine screening, sexually transmitted disease testing when indicated, and when warranted, hormone testing.
- Age-related and risk-appropriate screening testing such as bone density, mammogram, skin, colon cancer screening and in some cases referral for glaucoma and hearing testing.
Menopause provides a great opportunity for women to incorporate lifestyle and behavioral modifications in order to improve their quality of life, promote individual health, and assess for risk factors for disease. It has been reported that up to 75% of menopausal women make some type of health-related lifestyle change.
Each woman should evaluate the benefit of smoking cessation, avoiding daily intake of alcohol, and consideration of drug safety. Diet choices to limit fat and cholesterol consumption, ensuring adequate vitamin and mineral intake (especially calcium), maintaining caloric balance, and consuming a diet based on whole grains, fruits, vegetables, and water are essential. Emphasis on the importance of regular, daily exercise is paramount.
You should be aware of the changes that are occurring in your body due to aging and lack of hormones. You deserve a clinician who is sensitive to your concerns and understands that each woman is individual in her response to menopause, and can provide you with accurate and current information regarding treatment options.
A woman’s goal, seeking evaluation of her health during menopause and beyond, should be to fully understand the options of care and become an active participant in the decision-making process. Even if you are a woman who is experiencing no bothersome symptoms, you still need to understand the physiological changes that you are going through and the options that are available. Your priorities for treatment and any concerns are paramount.
While hormone replacement therapy is not for everyone, some women have chosen to use alternative therapy that may include herbal preparations for relief of symptoms and disease prevention. It is important to understand that while these preparations may be considered “natural,” they are still medicines.
The decision to use hormones depends on many factors including biological, psychological, tolerance, risk profile, and contraindications. We find that women who are fully evaluated for the risks and benefits of hormone replacement therapy are better informed to make an individualized decision regarding care.
While menopause is inevitable with the aging woman, it is important that quality health care be continued. Don’t be afraid to verbalize your question and concerns with your provider. As women, we are experts of our own body. At this stage of life, become an informed health care consumer, make responsible choices, and enjoy good health into old age.
There is no universal experience for every woman in menopause; however, it can indeed be viewed as the beginning of a new and exciting time in your life.
Mickie Autry is a Menopause & Sexual Wellness Nurse Practitioner specializing in providing individualized focus on the treatment of symptoms associated with menopause, including bioidentical hormone replacement therapy for which Autry has completed intensive training. She works with Ovation Women’s Wellness. For more info, call 844.682.8466 or visit ovationwomen.com.