Navigating menopause: Embracing change with confidence
By Justine Williams Roper / Photos by Kate Treick Photography and Getty Images
Whether you’re just starting to notice those pesky hot flashes or are knee-deep in hormone roller coasters, menopause impacts nearly every woman at some point later in life. Some may be terrified to experience menopause, while others look at entering this stage as a rite of passage. Either way, curiosity of what it will truly look and feel like is undeniable — so much so that the topic of menopause is one of the most searched questions by women online.
Dr. Karen E. Kennedy, who has a gynecology and aesthetics practice in Gulf Breeze, is no stranger to answering the pressing questions that come with experiencing menopause. With over 20 years of experience in gynecology, Kennedy has a passion for all things women’s health.
“I love women’s health,” she said. “I love fixing gynecologic problems and taking it one step further. For example, looking into other alternative things that can help women help their problems, like using lasers, using radio frequency and using other methods of treatment.”
WHAT IS MENOPAUSE?
There seem to be so many innovative options for the treatment of symptoms related to menopause, but one question comes first. What exactly is menopause?
“Menopause is just the decline of several different hormones in the body, and they all decline at different rates and different times,” Kennedy explained. “This gives people a lot of different symptoms — varying symptoms. Plus, each individual’s body reacts to those varying declines differently. Some people have hardly any symptoms, and some people have just tremendous, debilitating symptoms.”
Kennedy noted that really, menopause is just a definition.
“It’s one year without your period. So, if you have a hysterectomy at age 40 or age 41, you are postmenopausal surgically.”
She also explained that the median age for the onset of menopause is 51, and every woman has a different hormone that’s dominant in her body, that makes her feel better.
“Sometimes it’s estrogen; sometimes it’s testosterone.”
Once hormone imbalance begins to occur, this is when one may or may not experience symptoms such as hot flashes, low libido, night sweats, headaches, vaginal dryness, brain fog and poor sleep.
PERIMENOPAUSE AND POST MENOPAUSE
So, what about perimenopause and post menopause? How are they different from actual menopause?
When a woman is in perimenopause, menstrual cycles will still occur, but she would have any one of the menopausal symptoms. Kennedy stated that perimenopausal time can last five, 10 or 15 years leading up to menopause.
“Now, we have our hormone changes. Our testosterone is high in our teens, and it starts to decline in our twenties,” she said. “So, you got that 28-year-old young lady, mother of three, who’s working and she’s deadbeat tired because she thinks it’s the kids and working, but it could be related to testosterone.”
Other hormones have an effect as well.
“Progesterone starts to take a deep decline in our mid-30s. So that leads to estrogen imbalances, hormonal imbalances in our forties, where estrogen is normal, but it’s not balanced by the progesterone. Then sometime after 50, mid-50s, all the hormones are almost gone and that gives us a whole new set of problems,” Kennedy said.
Post menopause occurs after menopause, and it is defined as a woman not having a period for over a year. Post menopause, you will no longer have periods, but some women do continue to experience symptoms of menopause within this stage.
WEIGHT AND METABOLISM
There are many other symptoms that women are curious about. Weight and metabolism are two that are surprisingly only partly hormone related. In menopause, what can we expect to change?
“You know what I say to people? Weight is heavily based on what we eat,” Kennedy said. “I think sometimes hormones really do play a part in that.”
She explained that if weight were based on hormones, everybody on hormones would lose weight, but that’s not the case.
“It’s an indirect thing where sometimes the hormones do something in our brain and in our bodies, usually in our brain, to make us eat better — healthier — and eat the right things in order to lose weight. So, hormones have an indirect effect on weight. Not a direct effect,” Kennedy said.
She fully supports overall lifestyle changes, such as balanced eating and exercise during menopause.
So, can diet and exercise lessen menopause symptoms? The short answer is yes. Poor diet, smoking, chemotherapy, various medications, certain disorders and being immunosuppressed could make menopausal symptoms more prominent. Things like calcium, vitamin D and weight-bearing exercises should all be a part of a woman in menopause’s routine. Limiting caffeine and alcohol intake has also been shown to be of benefit.
MENTAL HEALTH
One major area that often gets overlooked is the impact of menopause on mental health. What should we know?
Kennedy reports that many women have tremendous, debilitating symptoms such as major depression, anxiety and mood changes. One can only imagine the decline in the quality of life a woman may have with unmanaged symptoms. Many women may feel that these symptoms are unvalidated, yet Kennedy is here to debunk this thought.
Mental health matters, she believes, and often the mental health struggles that come along with menopause can be addressed with treatments like talk therapy and hormone replacement.
DIAGNOSIS AND TREATMENT
So, where does someone start with this process of identifying menopause and getting it treated?
“The first thing is for people to realize how many symptoms are related to hormonal changes,” Kennedy said. “It is important to note that people in their 20s and 30s can have menopause symptoms. Most people within this age range don’t have major problems, but some of them do.”
Symptoms can be treated by hormones. Kennedy emphasized that first, people need a goal of treatment. Do they want to treat everything very aggressively, or do they want to just treat their symptoms conservatively? These are important questions to ask, even before labs are done. Once labs are completed, all options should be discussed with your medical provider. Lastly, once a form of treatment is selected, hormone adjustment is done over time if needed to ensure steady levels.
Hormone replacement therapy (HRT) and bioidentical hormones, which are very similar to what our bodies naturally produce, are commonly used to treat menopause symptoms. While they may come with some risks, as many treatments do, they are effective for many.
There are many methods and modalities to choose from. Some hormones are unsafe if taken orally, so patches, creams or gels are the most appropriate for certain hormones, while injections and oral medications are more appropriate for others. Pellets are also an option where a small incision is made in the fatty layer of the skin, and a dosage of hormones is slowly released into the body over a few months.
NATURAL TREATMENTS
While hormone treatments like HRT are the first major line of defense, many would like to know how to treat menopause symptoms naturally. Is this even possible?
Hot flashes are likely one of the first symptoms that you think of with menopause. Kennedy recommends that women avoid all animal products and try a majority plant-based diet (i.e., elimination of beef, poultry, fish, etc.) to address this.
For symptoms like vaginal dryness and muscle strength, hormone treatments are likely to be the only treatment to provide any relief. Herbs and supplements are popular and attractive alternative treatments as well. However, always discuss these options with your medical provider before consuming.
OTHER EFFECTS OF MENOPAUSE
Menopause can also lead to the decline of hormonal support that directly affects bladder and bowel function. Increased urinary leakage, for example, is huge within the menopause community. Kennedy recommends any combination of various interventions like pelvic floor therapy, laser, O shot and platelet-rich plasma therapy, which can comprehensively treat bladder symptoms. These options can also address intimacy issues like painful intercourse. There is some form of treatment for everyone.
ADDITIONAL HEALTH RISKS
Being in menopause can increase your risk of other health conditions.
“When estrogen declines especially, we have three times the risk for heart disease and heart attacks,” Kennedy explained.
Muscle mass and bone density also take a downward fall due to estrogen and testosterone changes. Mental decline can also occur. There may be a subtle decline in many functions, yet heart, brain, urogenital and musculoskeletal function all seem to be at the forefront.
Menopause is nothing to fear; in fact, women can be empowered by knowledge. Do not be afraid to consult your gynecologist and other providers such as endocrinologists and mental health providers about menopause. One thing menopause should do is push you to use the resources available to you.
You’ve now navigated the complexities of menopause with a wealth of information at your fingertips. Armed with answers to the most pressing questions, you’re better equipped to manage this significant life transition with confidence and clarity.
Remember, menopause is a natural phase that every woman experiences, and with the right knowledge and support, you can navigate it smoothly. Stay informed, seek professional advice when needed and prioritize your well-being. Here’s to embracing this new chapter with grace and resilience.
