Question: I am feeling miserable. I am getting hot and cold flashes without any reason. What makes it worse is that I can’t sleep at night. I perspire so much that I must change clothes. I get these spells of perspiration without any warning. Am I going through the change of life? — Amanda, of Coldwater
It seems you might be going through menopause. Menopause is the time in a woman’s life when she stops having monthly periods. Her ovaries stop releasing eggs and stop making the hormones estrogen and progesterone. Menopause usually occurs between the ages of 45 and 55. The average age for American women is 51. In some countries the average ages is 44 years.
I was once invited by the Menopause Society of India to give a talk on how to delay natural menopause because many women do not feel good when the menopause starts.
You did not say anything about your menstrual cycles. Most women start to wonder about menopause when their periods start to change.
Some women go through menopause without symptoms. But most of them started getting irregular periods. Most women have the monthly periods at four weeks. When menopause starts, they may have monthly cycles sooner than four weeks. Many times, they have less frequent menstrual cycles. Sometimes there is skipping of one or more periods.
Besides changing the frequency of menstrual periods, the duration of menstrual bleeding may become less than the usual four or five days. It may be just one or two days.
What about women who have had a hysterectomy? If your uterus has been removed but you still have your ovaries, it might be tough to tell when you are going through menopause. Still, women who do not have a uterus can have menopause symptoms. If your ovaries were removed before the usual age of menopause, you had what doctors call “surgical menopause.” That just means that you went through it early because your ovaries were removed.
What are some of other symptoms of menopause? Many women get bothersome hot flashes. They feel hot or cold and the start perspiring without any apparent reason and become soaking wet.
• Hot flashes. Hot flashes feel like a wave of heat that starts in your chest and face and then moves through your body. Hot flashes usually start happening before you stop having periods. They may indicate a surge of a pituitary hormone called FSH.
• Night sweats. When hot flashes happen during sleep, they are called “night sweats.” They can make it hard to get a good night’s sleep.
• Sleep problems. During the transition to menopause, some women have trouble falling or staying asleep. This can happen even if night sweats are not a problem.
• Vaginal dryness. Menopause can cause the vagina and tissues near the vagina to become dry and thin. This usually starts a few years after menopause. It can be uncomfortable to have sexual activity.
• Depression. During the transition to menopause, many women start having symptoms of depression or anxiety. That is especially true for women who have been depressed before. Depression symptoms include:
Sadness, losing interest in doing things, sleeping too much or too little, trouble concentrating or remembering things. This might be caused by lack of sleep that often happens at menopause, or by the lack of estrogen. Some experts suspect that estrogen is important for good brain function.
Most women go through menopause in a natural way and do not need any help.
When should you see a doctor?
If your periods start changing and you are 45 or older, you do not need to see your doctor. But you should see your doctor if you have symptoms that really bother you. For instance, you should see your doctor if you cannot sleep because of night sweats, if it is hard to work because of your hot flashes or if you feel sad or blue and don’t seem to enjoy things anymore.
You should also see your doctor if you:
• Have your period more often than every three weeks.
• Have very heavy bleeding during your period. It should be treated because it can make you anemic.
• Have spotting between your periods.
• Have been through menopause (have gone 12 months without a period) and start bleeding again, even if it is just a spot of blood.
Is there a test for menopause? There are blood tests that can suggest menopause. Tests are usually used only in women who are too young to be in menopause and are going through what is called premature menopause.
Some women wonder if they can still get pregnant. If you are still having periods, even if they do not happen often, you could get pregnant. If you have not had a period for a full year, it is probably safe to say you have been through menopause and can no longer get pregnant.
How are the symptoms of menopause treated? There are treatments that can help relieve symptoms.
Treatments for hot flashes include:
• Estrogen. The hormone estrogen is the most effective treatment for menopause symptoms. If you have not had a hysterectomy, estrogen is to be taken with another hormone called progesterone. Women who have had surgery to remove the uterus can take estrogen by itself. Woman’s Health Initiative recommended that these hormones are effective and safe for many women in their 40s and 50s with symptoms of menopause. They are not recommended after the age of 60s. They are not recommended if you have had breast cancer, a heart attack, a stroke or a blood clot. It may be risky to take estrogen if you are a smoker.
• Antidepressants. Some types of antidepressants can ease hot flashes and depression. Even women who are not depressed can take them to help with hot flashes.
• Anti-seizure medicine. One of the medicines used to prevent seizures seems to help some women with hot flashes, even if they do not have seizures.
Treatments for vaginal dryness include:
• Vaginal estrogen. This is an option for women who have vaginal dryness without other symptoms of menopause. Vaginal estrogen is any form of estrogen that goes directly into the vagina. It comes in creams, tablets or a flexible ring. It comes in small doses that do not increase the levels of estrogen in other parts of the body very much.
In most cases, doctors recommend vaginal estrogen. That is because there is more evidence that it helps with vaginal dryness compared with other medicines. But for women who do not want to use vaginal estrogen, doctors might suggest one of these medicines:
• Ospemifene (brand name: Osphena) is like estrogen but is not estrogen. It comes as a pill you take once a day. It helps relieve vaginal dryness caused by menopause, but it can also cause hot flashes. It is an option for women who have trouble using a vaginal medicine or prefer a pill. You should not take it if you have a high risk of blood clots.
• Prasterone (brand name: Intrarosa) is also known as DHEA. It comes in tablets you insert into your vagina once a day.
What to do on your own to cope with menopause symptoms?
There are some steps you can try. But ask your doctor before you take any “natural remedies” like black cohosh, especially if you have a history of breast cancer or uterus cancer.
To deal with hot flashes and night sweats you may want to dress in layers so that you can take off clothes if you get hot. You can also try to keep the thermostat down and avoid hot drinks such as coffee or tea. Some people try wet washcloths against their neck during hot flashes. Quitting smoking is a good idea any day. But it is good to know that smoking can make hot flashes worse.
Vaginal dryness can be managed by use of lubricants before sex or using vaginal moisturizers like Lubrin.
If you have problems with sleep, try to use good sleep hygiene. Try to go to sleep and get up the same time every day even when you do not sleep well. It might help to avoid caffeine in the afternoon and reduce use of alcohol.
Mild depression can be helped by staying active, exercising regularly and joining groups which deal with similar problems to get social support.
What can I do to protect my bones? This is an important question. You have a chance to build up bone calcium until the age of 30 years. The decline in bone calcium starts after 30 years. Bone calcium starts declining much faster after menopause.
You can take calcium and vitamin D supplements and be active. Regular exercise helps keep bones strong.
It is a good idea to get bone density test after menopause. If needed, your doctor can prescribe medicines to help keep your bones strong.
I hope you feel better, Amanda.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville