Discovering Health After Menopause
For most of us, the narrative has been that menopause, which marks the end of a woman’s reproductive years, is the beginning of the end of a lot of things. This may have been true some time in the past but the postmenopausal years make up quite a large portion of a woman’s life and those years can be filled with vibrant health, athleticism, and overall wellness. In reshaping this narrative for our generation and future generations, it’s important to lead by example and use the changes in the body that occur through menopause to promote a healthy and happy life, and not a steady decline.
First of all, what is menopause? Most of us have heard the word without really understanding what it is, what it means for our bodies, and why it happens in the first place. Menopause is defined as having gone 12 months without a period. The average age of menopause, in Canada, is 51.5 years but of course it can happen before or after that age. Most of what happens physiologically that we refer to as “menopause,” societally, is actually perimenopause, or the time before the moment of menopause. Perimenopause can stretch on for eight to 10 years before menopause, and for those who are still menstruating regularly, begins with a change or irregularity in your cycles. This doesn’t mean that your cycles will necessarily just get longer and longer until they disappear and it doesn’t mean that pregnancy is not possible. I have seen many women who had surprise pregnancies in the years leading up to menopause because they assumed that once their cycle becomes irregular, pregnancy is no longer possible but of course it is, just less likely.
Menopause is driven by the decrease in hormones (estrogen and progesterone) produced by the ovaries which can begin in your late 30’s. As less of these hormones are produced, ovulation eventually stops and fertility declines. Most (if not all) of the symptoms associated with perimenopause or menopause are a result of declining levels of progesterone and estrogen and we are not only interested in managing symptoms from a comfort perspective (air conditioning, anyone?) but also in preparing for and mitigating the physical changes that may have an impact on your health. Most people are familiar with symptoms of menopause such as hot flashes but it is also common to experience vaginal dryness, sleep disturbances, difficulty concentrating, decreased sexuality and poor self-image. Menopause can also be associated with decreased bone density, increased cardiovascular risk, and joint pain.
Treatments for menopause can include lifestyle modifications, prescription medications, botanical (herbal) supplements, nutritional supplements or “nutraceuticals,” IV and injection therapies, acupuncture, physical treatments such as chiropractic and massage, and counselling. Historically, conventional treatments were limited to hormone replacement therapy, or HRT but now the treatment options, as well as the overall understanding of menopause, have vastly improved. While conventional HRT is appropriate for some people in menopause, there are risks associated with hormone-based treatment so the ideal is to tailor treatments to the patient.
A comprehensive approach will consider the history of the individual and assess their risk for reproductive cancers, cardiovascular disease, and osteopenia. If screening hasn’t been implemented, now is the time to set up a schedule. A treatment plan should be established that either replaces or promotes the diminishing hormones, supports symptoms as they come with one (or many) of the many modalities available, and emphasizes the role that lifestyle modifications play in decreasing risk of cancer, cardiovascular disease and osteoporosis. Supplementation (again, tailored to the individual) will at minimum play a role in promoting bone health. I think that one of the most important pieces is to check in every few months in the beginning to make adjustments and then a bit less frequently as things continue to change. Management of menopause is by no means “one-size fits all” and it will evolve as you move through the process.
While all of this is important, I am also interested in knowing what comes next for people going through menopause. What are their goals? What do they want to see happen for them physically? Emotionally? In many cultures, postmenopausal women are celebrated. This can be the beginning of a new, exciting part of life. If you see it coming, try to use it as an opportunity for growth, for change, and for health.
Photo by Renee Fairchild