Menopause may be the last thing you want to ask your gynecologist about.
It’s uncomfortable—hello, hot flashes. It can be embarrassing, as in vaginal dryness. And it can be a topic that no one wants to admit—especially when “the change” also changes how interested you are in sex.
But, said Dr. Renee Page, an obstetrician/gynecologist at Augusta University Health, “We want a patient to feel comfortable about every single concern she has. You can ask your doctor anything, and we can help address it.”
In other words, there’s not much that Page hasn’t heard. So as a start, here are some of the most common and not-so-common questions women have about menopause—but don’t necessarily want to ask.
- When do I really need to start worrying about menopause?
According to Page, the average age for menopause in the United States is 51. But that number includes a wide range in ages of real women undergoing menopause, from their 30s to their 60s. Still, anyone under 40 who starts getting menopausal symptoms should see their doctor as that’s considered an “abnormal” age, even for early menopause.
- Does the age when I started my period have anything to do with when I start menopause?
Nope. But what does matter is when your mom went into menopause and the types of symptoms she had—your experience is likely to be very similar. (And if your mom had a hysterectomy or if you don’t know her history, the family history of other female relatives can provide some clues.) “So say you are 42 and your mom was 45 when she went into menopause, now is a good time to prepare,” said Page.
- I think I may be menopausal…how do I know for sure?
Most of us know the symptoms, right? Hot flashes, irregular periods, sleep problems and moodiness that would rival a 14-year-old’s are the most common. But, any of those taken alone might not mean menopause. Other signs could be losing interest in sex, vaginal dryness, bone loss, even urinary incontinence. So it’s important to talk to your doctor about what exactly you’re feeling.
- What does a hot flash really feel like?
A hot flash is more than just feeling a little overheated. It’s sudden flushing and thinking, “I can’t believe not everyone is hot in here.” It’s when your bedroom is 67 degrees, but you’re throwing off the covers and taking off your PJs because it’s so unbearably hot. It’s sudden, but after a few minutes, it’s gone just as suddenly and you’re cold again. “It’s almost like fever and chills,” said Page.
Some lucky women never get hot flashes. But most of us will. Some might have 10 a week, others 10 a day.
- I’m getting older and I think my period’s changing. Should I worry about menopause?
Maybe. But, said Page, “The period is so sensitive and responsive to many things. It could be stress, it could be fibroids, it could be a precancerous condition. There are tons of other things that could cause irregular periods, not just menopause.” Here’s a good rule of thumb: If your irregular period happens once or twice a year, there’s nothing to worry about. But if your period is usually 28 days on the dot, and then it’s every 35 or 40 days or you’re having three periods a month, definitely talk to your doctor to check if it’s menopause or another condition that might need to be treated.
- OK, so I’m feeling pretty dry and uncomfortable down there. What’s going on?
As estrogen levels drop, we tend to lose moisture in our skin—and that’s in our skin everywhere. That can set us up for vaginal dryness. And it can be about more than being uncomfortable during sex. “For some women, it is really significant,” said Page. “As in they feel like they can’t wear pants. And they’re absolutely more prone to bacterial vaginosis and yeast infections. Besides hot flashes, this is the main reason women come to see me.”
- I didn’t know that menopause could cause urinary incontinence. What can I do?
Makers of adult diapers and bladder pads have worked hard the past few years to make these intimate items feel sexy. “But it’s not sexy,” said Page. “And there are good treatments, including estrogen cream. You don’t have to wear adult diapers or even pads.”
- What exactly is the deal with hormones and hormone therapy? In other words, is it safe?
“The main treatment for the symptoms of menopause is hormones,” said Page. “Not because I’m a hormone pusher, but because it’s the most effective treatment.”
Hormone therapy—typically a combination of estrogen with progesterone or other hormones—can effectively stop hot flashes and vaginal dryness, while increasing bone density and libido. Testosterone can also be used to help with libido. And Page also recommends regular exercise on top of all that to help boost strength, prevent falls, reduce stress and improve mood.
But—“Hormone therapy is an art, not a science,” said Page. Page makes sure to talk to a patient about her family history and her specific symptoms to come up with the specific cocktail of hormones that will work best for her.
For example, if someone has a strong family history of breast cancer—especially early breast cancer—Page will discuss how estrogen can increase that risk. Women who still have their uterus should take estrogen combined with progesterone to reduce the risk of endometrial cancer.
Page also starts hormone treatments at the lowest dose—“If it works, then great, and if it doesn’t we can go up”—to help further reduce any associated cancer risks.
Then there are the multiple forms of hormones available, from pills or patches to vaginal creams or a combination. “No one size fits all,” said Page.
That also goes for how long women need to stay on hormone therapy. For some it might be years, then they’re able to taper treatment down. For others, treatment is only needed occasionally, and then it can stop.
- I’m really struggling with the idea of facing menopause. Any words of advice?
If it helps, most women feel exactly the same way. But working with your OB/GYN and taking advantage of therapies available really do help.
“Your body is going to feel different, but that’s OK. Menopause is not an impossible mountain to climb,” said Page. “The best and most important thing to remember is that this is a part of life, but there are tons of treatments available. Patients can go on this journey with their doctor, and you can get through it.”