Menopause Myths
The tea on perimenopause and menopause
Could it really be perimenopause or menopause?
I’ve heard this over and over in clinic. As a menopause provider in Bellingham, WA, I get to walk with women in their menopause journey. Patients are often in disbelief that symptoms can be related to perimenopause or menopause. They’re often waiting for bleeding patterns to change before exploring menopause. Menopause is actually a 3 stage process: Perimenopause, Menopause, and Postmenopause. Menopause is signaled by 12 months since last menstruation, but symptoms typically begin in perimenopause, several years before the last period occurs. Postmenopause begins after menopause has been signaled and continues for the rest of a woman’s life. Symptoms can continue for several years after the last period. If menses can’t be used as an indicator, labs can be performed.
These symptoms often bring patients into clinic, but sometimes it can be more subtle, occurring over several years, or sometimes it just takes someone else piecing it together.
Irregular periods
Vaginal dryness
Hot flashes
Chills
Night sweats
Sleep problems
Fatigue
Joint pain
Mood changes (changes in anxiety, depression, ADHD)
Weight gain and slowed metabolism
Thinning hair and dry skin
Loss of breast fullness
Often women have been having symptoms for years and heard a multitude of excuses discounting menopause, often from their own providers. Unfortunately, this means women have been dismissed and often experienced symptoms for months or even years before getting help and treatment. Menopause is a normal part of aging, but that doesn’t mean you need to suffer.
“Menopause is a normal part of aging, but that doesn’t mean you need to suffer. ”
Think about that…. There is a condition affecting 50% of the population for years, potentially for more than a quarter of their lives, and doctors and nurse practitioners aren’t educated on it unless we seek additional training. Medicine is so specialized that women have often sought answers from cardiologists, psychiatrists, urologists, endocrinologists and rheumatologists because they weren’t able to get menopause treatment and answers in primary care.
I love treating menopause and perimenopause and providing education and answers. Women deserve to feel heard and they deserve evidence based high quality care — without the gaslighting or snake oil.
“Women deserve to feel heard and they deserve evidence based high quality care — without the gaslighting or snake oil. ”
Here are some common menopause myths.
I’m too young for perimenopause.
…. Likely not. The average age of menopause is 44-50 and perimenopause symptoms can start as early as your 30s. If you’re experiencing menopause symptoms and they seem early, lab work to rule out other conditions is likely indicated.
Menopause symptoms only last for a while. I’ll just tough it out.
Women are strong, and you could, but treatment has less risk and is more effective if we start sooner. The average woman will experience symptoms for 5 years. Most symptoms will subside by 7 to 9 years, but about a third of women will have symptoms for a decade or longer.
But what if it’s not menopause.
It’s important to make sure you don’t have other conditions that can mirror menopause symptoms, or make treatment less successful. I request labs that can rule out thyroid concerns, vitamin deficiencies, hormonal conditions if perimenopause symptoms seem premature, and annual screening like cholesterol screening to make sure you’re a good candidate for menopause hormone replacement therapy.
My hormone levels have already been tested and looked normal.
Unfortunately hormone labs checking progesterone and estrogen levels don’t diagnose or rule out perimenopausal symptoms. Perimenopausal changes can cause symptoms for years and changes in menstrual cycles and low hormone levels are typically one of the later symptoms to appear. There can be a wide range of normal lab results, and those numbers can fluctuate based on the day of your menstrual cycle. Symptoms are related to fluctuating levels of estrogen and an overall decreasing level of progesterone, estrogen, and testosterone. It can be difficult for lab work to capture these changes. In fact, the north american menopause society, recommends against hormone panels to diagnose or treat perimenopause. Treatment and diagnosis is individualized and based on symptoms and ruling out other conditions. This is one of the reasons it’s so important to see a provider well versed in menopause.
Okay, so it’s menopause, but I don’t want medication.
All medications come with potential side effects, so it’s natural to have reservations. Unfortunately most patient reservations about menopause/perimenopause hormone treatment come from rumor or inaccurate findings based on a debunked analysis of the Women’s Health Initiative. Even after reanalysis and a retraction of previous findings and new studies showing that the use of HRT as beneficial, the initial statement in 2002 has had a lasting effect. I would challenge some of these reservations by exploring some of the resources on the implications from the initial WHI statement.
Treating menopause can certainly improve quality of life, but also prevent bone loss and osteoporosis, and in some observational studies prevent heart disease and cognitive decline or dementia. Vaginal estrogen can also prevent genitourinary symptoms of menopause which is a cluster of pelvic floor and bladder symptoms that can result in frequent UTIs, painful intercourse and vaginal dryness and discomfort. Here is one of the most comprehensive, credible, up to date documents on menopause.
Okay, but I only want Bioidentical hormones.
Okay, I can do that. Did you know that most of the FDA approved ( insurance covered) therapies are also “bioidentical” ? When I hear patients request bioidentical hormones, that can be a yellow flag that you may have gotten marketing and business decisions wrapped as medical advice. The term usually refers to compounds that have the same chemical and molecular structure as hormones that are produced in the body. They’re derived from compounds present in wild yam and soy plants.
Since most hormone medications on the market are derived from these same compounds and bioidentical, this term is typically only used as a marketing tool to make custom compounded medications without FDA approval sound more appealing, so patients feel good purchasing them out of pocket. We know that bioidentical therapies are not better or more effective, and compounded hormone medications carry some additional risks. Here are some resources from the North American Menopause Society about Bioidentical Hormone Therapy.
I still want to explore natural therapies first.
That’s great. I’m happy to help. Lot’s of research has shown that daily exercise can improve some menopause symptoms over time. Daily exercise can also help with mood and has lots of protective benefits. Decreasing and stopping alcohol and nicotine use can also decrease some menopause symptoms. I’m never going to discourage patients from making beneficial lifestyle changes that also improve menopause symptoms. Sometimes changes that we know will help can seem out of reach if we’re barely surviving. These lifestyle changes can improve symptoms, but they aren’t curative. If they seem unsustainable or just too difficult, it may be time to consider hormonal therapy or rule out other issues. Often once you take one step towards health, the other steps can start to become easier. Hormone therapy is not a magic pill, but it can be a helpful tool. Here are some additional resources.
Unfortunately anyone born with a uterus and ovaries will likely go through menopause, but you don’t have to go through it alone, or wait for things to get bad before you talk about your options. Reach out if you’d like to schedule a visit and discuss your options!
Extra Reading: (Consider sharing these with your medical provider)
