A Few Reminders About Menopause

1. Menopause marks the end of ovulation, which is the stage of the menstrual cycle when a mature egg is released from the ovary. Every egg that a woman will have in her lifetime is made during fetal development. Once mature eggs cease to be released - that is, the follicles no longer function in a normal fashion, the menstrual cycle stops. We refer to the day 12 months after your final period as menopause.

2. Perimenopause is the time prior to menopause, often 3-4 years, when your supply of immature eggs has dwindled so a mature egg may or may not be released during your menstrual cycle. The irregularity of egg development and release disrupts the finely balance hormonal systems that control reproduction. As a result, women experience the most disruptive symptoms of menopause during that time.

3. Menopause isn't a disease or a defect. Women are programmed before they are born to go through puberty and menopause. Our physiology changes radically during puberty and does so again during menopause. And like puberty, there are some troublesome symptoms that can be addressed to assure our quality of life.

4. Since menopause isn't a disease, women don't need to "replace" their hormones. Women may take menopause hormone therapy (MHT) to reduce some of their symptoms, but the levels of hormones in MHT is much lower than those they made themselves during their reproductive years. Don't let anyone tell you that you have an "estrogen deficiency," or "incompetent or tired ovaries" or "need to restore your hormone levels to premenopausal levels." Those words imply that something is wrong with you, but lower hormones and running out of eggs is exactly how you were intended to be. It's no more wrong than puberty was.

5. Your sex hormones (estrogen, progesterone, and testosterone) do not need to be "balanced" as a consequence of menopause. Throughout our reproductive lives, our sex hormones rise and fall through a monthly menstrual cycle. It is the cycling of those hormones that permit a woman to produce eggs that can be fertilized and prepare the uterus for implantation and development of a fertilized egg. As a gynecologist who has practiced for over 20 years, I have no idea what "balancing hormones" means for healthy, menopausal women. Science and medicine has not identified an ideal level of estrogen or progesterone outside of which you should have medical intervention. If "balancing" means that women who have a uterus need to take an appropriate amount of progesterone if they are taking estrogen to protect their uterus from cancer, then I agree, but that isn't typically what the people who use the term intend. "Balance" when speaking about sex hormones in menopausal women is an ambigious-to-the-point-of-being-meaningless term. It's just one more way that people try to make menopausal women think that their "condition" needs to be corrected.

6. Blood tests for hormone levels are not useful. Nor are urine tests. With menopause, we treat symptoms, not numbers. Hormone levels, particularly during perimenopause, can change dramatically over hours, days, or weeks so it's impossible to make much sense of a number that represents only one moment in time. To make things more complicated, we see women with the same hormone levels who experience vastly different types and intensities of symptoms. A specific level of blood estrogen doesn't give any information about whether you need to be treated for hot flashes, for example. The fact that you experience hot flashes, no matter your hormone numbers, is what drives how I treat you for hot flashes.

7. Some health risks increase with menopause - osteoporosis, heart disease, diabetes, and dementia, for example. But menopause is multi-factorial and complicated, not just a decrease in estrogen and progesterone. We continue to learn about the myriad of physiological changes that occur during menopause, but to date, scientific evidence does not support using MHT as a preventative for any medical condition except osteoporosis. (And note that there are other drugs to reduce your risk of osteoporosis so discuss what works best for you with your doctor.) There also are many other drugs and lifestyle changes that can reduce your risk of other serious conditions that might arise during menopause.

8. Most women will experience some level of the genitourinary syndrome of menopause (GSM), a chronic, progressive condition of the vulva, vagina, and lower urinary tract that begins during menopause and continues throughout a woman's life. Talk to your doctor before you have symptoms since early intervention is key to the best outcome.

9. There are many kinds of FDA-approved MHT, as well as non-hormonal drugs and lifestyle interventions, that have been proven safe and effective for treating some menopause symptoms. MHT is not just one thing - there are different doses, types, brands, preparations, and delivery systems. Your doctor will work with you to find the solution that is right for you. Don't be dissuaded to try MHT just because you had side effects from hormonal birth control when you were younger.

10. Talk with your doctor about menopause when you are in your 40s. There are symptoms that you might not initially recognize as being related to menopause that you could manage differently if you and your doctor were considering menopause in the equation.