What’s Your Menopause Plan?

Shira Miller, M.D.Women5 Comments

How to Prepare for Menopause in 3 Easy Steps
So You Won’t  Have to Suffer for Even One Day

Contrary to popular belief, menopause is not a phase but rather a permanent shut down of ovarian function.  The average age a woman goes into menopause is 52, though it could occur as early as your mid-40s or as late as your mid-50s.  Unlike many diseases– heart disease, diabetes, dementia, cancer–which you may or may not get as you get older, EVERY woman (if she lives long enough) will go into menopause.  And with the average woman living into her 80s, that means you will most likely spend 1/3 of your life in menopause.  You got it, postmenopause is a misnomer.

So, do you have a menopause plan?  Are you going to power through it?  Deal with it when you get there? Do whatever your doctor recommends?

As a menopause physician, I see that most women are completely blindsided by menopause. They suffer for anywhere from six months to decades without seeking treatment because they don’t think anything can be done.  Or because they hear hormones are dangerous.  And it’s true, some hormone therapies are dangerous–especially in the wrong hands.  But arguably, it could be more dangerous for a woman to subject her body to a double hormone deficiency for the rest of her life.  So what is a woman to do?  How can she navigate this often confusing but inevitable part of life that she must face?

Below I have outlined 3 easy steps you can take to prepare yourself for menopause:

1.  Understand Menopause.
The term “menopause” literally means the end of a woman’s monthly cycles, from the Greek men- which means month, and pausis which means cessation.  It’s also commonly known as marking the end of a woman’s fertility.  And for many, including many doctors, this is where their understanding of menopause ends.

So, what more is there to know about menopause?  Let’s start with the ovaries themselves.  The main function of the ovaries is to store, develop, and release eggs for reproduction.  Many women know this, but what most don’t know is that:  It’s this process of developing and releasing eggs that produces the hormones estrogen and progesterone.  When the ovaries’ supply of stored eggs runs out, this is menopause, and a woman is left with both infertility and permanent estrogen and progesterone deficiencies.  No more eggs also means no more estrogen and progesterone.

Some women pray for the day when they no longer have to worry about regular vaginal bleeding.  But during menopause, the lack of estrogen and progesterone effects on the uterine lining, also means that estrogen and progesterone aren’t getting to the rest of her body.  Estrogen and progesterone are two of the most important hormones necessary for reproduction, and they are also responsible for the monthly build up and shedding of the uterine lining (resulting in a period, which occurs if pregnancy does not).  But, an overlooked fact is that there are estrogen and progesterone receptors all over the female body, not just in the uterus.  For example, there are receptors in the brain, breasts, heart, skin, bladder, and bones.  This is why estrogen and progesterone are required for a woman’s overall health.

The most common symptoms of menopause are hot flashes, night sweats, vaginal dryness, and cessation of the menstrual cycle. But there are MANY other symptoms:  weight gain, insomnia, fatigue, depression, anxiety, mood swings, joint aches, heart palpitations, vaginal dryness, loss of libido, painful intercourse, itching, urine leakage, “brain fog,” and accelerated skin wrinkling.  And then there is also an increased risk of osteoporosis, dementia, and atherosclerosis (hardening of the arteries) in the long term. And don’t forget about the decline in productivity and relationship stress.  It’s not because of just aging.  Menopause makes a huge toll.

2. Know Your Menopause Treatment Options
In traditional medicine, a chronic disease is one which has persistent signs and symptoms, no cure, and requires chronic treatment.  Menopause, although it causes permanent hormone deficiencies, is communicated as merely “a change” or “passing phase” which women must endure and accept–or somehow even look forward to!  I disagree.  I view menopause like any other permanent hormone deficiency…as a chronic disease which requires treatment.  When people (diabetics) run out of the hormone insulin, we give them insulin replacement.  If you run out of thyroid hormone, you will be prescribed thyroid replacement.  I approach menopause in the same way.  So that when a woman permanently runs out of estrogen and progesterone, i.e. when she is in menopause, she should receive estrogen and progesterone replacement.

Traditional hormone replacement therapy (HRT) for menopause, unfortunately, mainly consists of molecules which look like estrogen and progesterone, but aren’t exactly the same and aren’t administered in a way which mimics how the ovaries rhythmically produced them. These estrogen and progesterone substitutes, although they may help some menopause symptoms, also have side-effects and in 2002 were implicated to increase the risk of heart disease and breast cancer in the Women’s Health Initiative.  The repercussions have an been an ongoing controversy and fear of hormone replacement for the treatment of menopause.

The good news is that there are estrogen and progesterone replacement therapies which consist of molecules which are identical in molecular structure to those produced by the ovaries; aka “bio-identical” hormones.  And there is a type of bioidentical hormone replacement therapy (BHRT) which is biomimetic, which means it is administered in a way which mimics normal ovarian function.  These type of hormone replacement therapies are safer and more effective than traditional HRT, and current evidence suggests they prevent chronic diseases–most notably, osteoporosis.

3.  Get your hormone levels checked while you are still having a normal menstrual cycle.
Having a baseline of your hormone levels during your reproductive years may help optimize hormone treatment once you are in menopause.  There are laboratory ranges of estrogen and progesterone levels for healthy reproductive women, but every woman is different.  Knowing your levels could help optimize your treatment in the future.  Although, please realize, this is a theoretical advantage as I treat menopausal women every day using only their symptoms and hormone levels as a guide and they do great.  Levels should be checked at their peak times during the cycle, so estradiol should be checked on day 12 of the menstrual cycle, and progesterone levels should be checked on day 21.  (The first day of bleeding always marks day 1 of the menstrual cycle, so start counting from there).  Other hormones that decline with the aging process are DHEA-S, testosterone, and IGF-1, so I recommend checking those too.

In conclusion, research menopause.  Study online, read books, interview menopause doctors, and have a treatment plan.  And if you can, find out your baseline hormone levels.  All of the hormones I mentioned above, and many other wellness tests, are included in my Executive New Patient Evaluation.

You don’t have to wait until your period stops or you start having hot flashes.  In any case, there are women in menopause who still get their period but suffer from a lot of other menopause symptoms.  And there are women in menopause who never get hot flashes, but suffer from a lot of other menopause symptoms.   You can do your research and have a plan in place for when you need it.  My favorite menopause book is Sex, Lies, and Menopause, by T.S. Wiley, so I recommend starting your exploration there.

If you time it right, you may be able to avoid suffering from menopause for even one day.  That’s the goal I have for my patients, my friends and family, and myself.  And wouldn’t it be great if one day women everywhere would never have to suffer from the ravages of menopause.


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A version of this article was originally written for WorkingMomsOnly.com and posted there on July 5, 2012.

  • Kate

    Hi, how old should i start taking the baseline hormone level test?

  • Julie

    I have tried to get medication for my hormones! I had a partical hysterectomy only in my uterus was taken because my Dr didn’t want me to go through menopause but I did a year all most to the date of my surgery! I can’t find anyone to help me , and when I asked my Dr about bio identical hormones and she said Premarin was bio identical? I am questioning that!

    There is so much wrong I have every symptom you have Described but a little worse!

    Can you direct me to a Dr that does what you do? I am desperate and need help considering I haven’t had sex in almost 8 years because of the pain and I am surprised my husband is still married to me!

    Please I live in the Inland Empire so you have anyone you can recommend? I am 56 years old and no one to help if I go to a regular gynecologist

    Thank you for listening via email.

  • Jean Schroeder

    I wish there were doctors with this knowledge in the Milwaukee area. So frustrating.

  • Ellen

    Thank you very much

  • samia Akhter

    Thanks for the primary help,but the question is what should a patient do where a menopause specialist is not available in a country like Bangladesh. Gynecologists generally advice the issue here.