An often taboo topic for social discussions, menopause is a life transition that occurs for every female with reproductive organs. Humans have become so good at prolonging life through modern medicine, emergency care, and technological advances. But we often fail to acknowledge and give credit to the natural processes our bodies go through as we move through life.
Menopause is just that - a transition. It is not a disease, though it might be unpleasant for many women. Physiologically, the body is saying that it is done pro-creating. Eggs or follicles are not being released in order to be fertilized and develop into a future baby. This release and preparation for fertilization each month is responsible for the hormone cascade of female reproductive physiology. During menopause, these hormones are secreted at very different levels and the hormone dance changes.
When a woman goes through menopause, she may or not experience a variety of symptoms, some isolated to the genitourinary tract and some felt systemically. With the significant drop in estrogen, atrophy of the vaginal wall occurs. This often causes symptoms of vaginal dryness, pain during sex, and often increased susceptibility to urinary tract infections. The vaginal pH and microbiome might be altered when these hormonal changes occur, which are key players in the prevention of infections. Furthermore, studies show that HPV may be diagnosed in women during menopause that represents an infection from years earlier, suggesting that it is reactivated when the host environment is possibly not as robust as it previously was. For this reason, it is important that women continue to get screened with PAP smears and HPV testing.
Systemic symptoms include hot flashes, night sweats, mood swings, memory difficulties, and many others. With a drop in estrogen, women may also see loss in their bone mineral density as well. This is concerning in those that are predisposed to osteoporosis. If you or your family members are at a higher risk of developing osteoporosis, it is important to see your provider about getting a bone mineral density scan.
There are various schools of thought when it comes to “treating” menopause, and it is important to talk with your provider about what is right for you. Some women choose to use hormone replacement therapy to manage symptoms, and others prefer to stay the natural route. Hormone replacement therapy is controversial due to multiple reasons, a major one being the susceptibility to hormone mediated cancers, such as breast cancer.
Generally, it is recommended to use the lowest dose of hormones for the shortest amount of time to manage symptoms that are affecting quality of life. Hormones are recommended to be started as closely to the time of menopause as possible. It is not recommended to be on estrogen without also being on progesterone, as estrogen alone can increase endometrial growth. Again, it is a dance of hormones that is unique to each woman.
One can be on hormone replacement therapy through oral, vaginal, or transdermal routes, and each woman is different in what works for her. It is great to have a conversation with your provider about your options.
If you feel drawn to natural remedies, there is also a lot you can do to support this transition. Many plants have hormone balancing properties that can mitigate the bothersome symptoms of menopause. Some common supplements used in managing menopausal symptoms include maca, sage, black cohosh, and vitex. Many botanicals are safe to use, but it is always recommended to check with your healthcare provider for any interactions with current medications or risk factors for your specific case.
Menopause does not need to be a miserable process, nor an experience to be ashamed of. There are countless ways to support your transition into and through menopause.