For many women, the notion of menopause and the resulting end to periods, cramping, and bloating sounds extremely appealing. And while it’s nice to say goodbye to some aspects of a pre-menopause life, there are some new realities that need to be recognized and embraced.
A look at the changes that come with “the change”
According to Dr. James Wang, an obstetrician-gynecologist with Baystate Medical Center, “Women often think of menopause as an event that occurs at a particular time in one’s life. But the truth is it’s a transition that takes place gradually over many months or several years, with effects and impact that continue well after menstruation has ceased.” He adds, “Menopause is brought on by the decline in the production of the two hormones that control your reproductive system— estrogen and progesterone. The reduced hormone levels impact virtually every organ in your body. From your heart and bones to your emotional and sexual health, menopause is a full-body experience. While some effects, like hot flashes, are a nuisance others can pose real health risks to women as they age. It’s important to be aware of the extent of the changes taking place and be proactive in combating them.”
1. Increased risk of heart disease
According to Dr. Sabeen Chaudry, a cardiologist with Baystate Cardiology, “Estrogen plays an important role in heart health. It increases good cholesterol levels, decreases bad cholesterol levels, reduces the build-up of fatty plaque, and more. While menopause doesn’t cause heart disease, the resulting reduced estrogen levels can increase your risk of developing heart and circulatory disease.”
She adds, “Heart disease is the number one killer of women. The risk only increases with age and the onset of menopause. As women age, it’s very important for women to discuss heart health with their physician at their annual check-ups and take steps to minimize their risks.”
These steps include:
- Engaging in regular moderate exercise (150+ minutes per week)
- Enjoying healthy diet rich in vegetables, fruits, nuts, whole grains, and fish
- Reducing the amount of salt, caffeine, and refined sugars in your diet
- Quitting smoking
- Limiting alcohol intake to 0 to 3 drinks per week
- Getting seven to eight hours sleep regularly
2. Loss of bone density
One of the hidden side effects of menopause is bone loss. According to Wang, “Estrogen is vital to maintaining bone health. It’s possible for a woman to lose up to 20% of their bone mass in the first 5 years of menopause as estrogen levels drop. While bone strength is important at every age, it’s particularly critical as we age. The majority of women now live well into their 80s. Good bone health is important for avoiding fractures from inevitable falls. Unfortunately for many seniors, even minor trauma from a fall can require hospitalization, and, often, individuals never regain the level of functionality, mobility, and confidence they enjoyed before their fall.”
Wang encourages patients to be proactive in maintaining their bone health throughout their lives. “Loss of bone density is part of the natural progression of aging. But when you pair it with certain behaviors known to contribute to bone loss, you’re really setting yourself up for trouble later.”
Key changes he urges patients to make include:
- Get moving: engage in weight bearing exercises that build bone strength (think golf, walking, yoga, and dance). Exercise also improves balance, reducing the risk of falls.
- Quit smoking.
- Avoid drinking more than 2 alcoholic beverages a day.
- Continue to see your doctor once you are postmenopausal for regular checkups and to help with any conditions that may develop after menopause.
Wang also advises women over 50 to bump up their calcium intake. "We need more calcium as we age, so it’s important to add more to your diet." He recommends 1200 mg of calcium daily, ideally from dietary sources including dairy, leafy greens, broccoli, and fortified juices. He notes, “There are a lot of great online guides that can help you find foods rich in calcium that also appeal to your tastes and accommodate any food intolerances.”
In addition to calcium, he reminds patients to be mindful of their Vitamin D intake. “Vitamin D is really the most important vitamin for bone health. It not only contributes to bone strength, it’s also what enables our bodies to effectively absorb calcium.” While Vitamin D is found in foods including egg yolks, mushrooms, and fatty fish like salmon, tuna, and mackerel, he encourages patients to take supplements, aiming for a daily intake of 2000 international units of the vitamin.
3. Physical and emotional changes
For many women, the first signs of menopause start in their 40s. “At that age, the changes aren’t typically noticeable,” says Wang. But by age 52—the average age of menopause—some changes are hard to miss.
Hot flashes, a sudden and urgent need to urinate, sleep disruption, night sweats, and vaginal dryness, are among the potential symptoms of menopause.
“The onset of these changes can be very disconcerting,” says Wang. “There’s a sense of loss of control over your own body. Many women find themselves experiencing increased irritability, depression, and anxiety. Some of that’s likely attributable to the physical discomfort being experienced and lack of sleep but changing hormone levels also contribute to one’s emotional state.”
Wang notes there’s no predicting what side effects a woman may experience or how long they might last. “For many years it was thought 1-2 years was the average for experiencing hot flashes and night sweats, but new research suggests that they may never fully cease. They will likely decrease in frequency and intensity, but it’s possible that they may endure for the balance of a woman’s life.”
For women experiencing disruptive side effects, he recommends trying over-the-counter herbal supplements. “In my experience, patients have found some relief with herbal supplements. The important thing is to first consult your healthcare clinician before you begin taking any supplements, and second, to check the label to ensure the product was produced in accordance with USP standards which assesses the quality, strength, identity, and purity of the ingredients."
Other treatments to alleviate menopausal symptoms, including non-hormonal and hormone therapy, can be prescribed by a woman’s medical practitioner. Deciding which treatment is best will depend on an individual’s medical history and personal preference.
4. Changes to sexual health
One of the least discussed side effects of menopause is the impact it has on sexual health.
Wang explains, “During menopause, the walls of the vagina begin to thin, or atrophy. This can lead to vaginal dryness that can make having intercourse difficult or even painful. This change is further complicated for women with male partners by the fact that his libido is dropping as he ages. Sexual encounters are likely to become less frequent. Often, the greater amount of time between sexual encounters, the greater the problem of dryness and pain becomes. If you’re able to maintain a more frequent schedule of sex, it’s likely you won’t experience issues. But, honestly, there’s no reason to endure any degree of discomfort from what should be a pleasurable experience, especially when personal lubricants are so readily available in retail settings and online.”
For patients who continue to experience discomfort even with lubricant, Wang often recommends a topical vaginal estrogen noting “It’s an extremely safe option for restoring vaginal tissue and natural lubrication.”
Maintaining Health in Your Later Years
Understanding what to expect during and after menopause is an important first step to maintaining your physical and emotional health in your later years. If you have questions about any aspect of menopause and post-menopause, talk with your doctor or find a gynecologist.
Learn more about Women’s Health services at Baystate Health.