Managing Menopause Symptoms
Managing Menopause: Navigating the Menopausal Maze – A Science Journalist's Perspective
Menopause used to be a hushed topic, but thankfully, the conversation is changing. Yet, even for someone like me, a seasoned science journalist, deciphering the best way to manage perimenopausal symptoms feels like a confusing puzzle.
Think of it like this: imagine you're a skilled athlete at the top of your game, feeling strong and in control. Suddenly, an unexpected force blindsides you – that's kind of what perimenopause can feel like.
Is menopause an illness? A natural part of aging? The answer is... it's complicated! Menopause is that biological curveball life throws your way after decades of relatively predictable cycles.
Luckily, thanks to the candid conversations with my supportive female friends, I'm not entirely in the dark about this transition. Instead of feeling ambushed by the sudden mood shifts, fatigue, and creeping anxiety, I have some context.
Managing Menopause: Navigating Perimenopause – A Mosaic of Experiences and the Need for Better Support
However, despite years of reporting on women's health and hormones, my options for managing perimenopause feel disappointingly unclear. If you ask a dozen women to describe their perimenopausal experience, you'll likely get a dozen different stories. They might say things like, "I feel like I'm on an emotional rollercoaster" or "My brain has turned to mush!"
Even doctors seem to have trouble agreeing on a standard set of perimenopausal symptoms. "It's a crucial question in the field – what symptoms are truly caused by menopause?" admits Prof Martha Hickey, who directs the Women’s Gynaecology Research Centre at the Royal Women’s Hospital in Melbourne.
I've spoken with two fantastic GPs about this, and each used a slightly different checklist for identifying symptoms. This lack of consistency can be frustrating, both for those experiencing perimenopause and the professionals trying to help.
While menopause definitely isn't a disease – as Prof Susan Davis, a Monash University endocrinologist and researcher puts it, "it's a stage of life, not an illness" – downplaying it as something women should just "grin and bear" is unhelpful. Davis makes a good point: "We treat age-related conditions like osteoporosis, so why not offer support for menopause?"
Managing Menopause: The Great Hormone Debate – To Treat or Not to Treat?
The central question fueling the menopause conversation is this: when, and how, should we manage perimenopausal symptoms? This is where the debate really heats up, especially when it comes to menopausal hormone therapy (MHT).
MHT works by replacing and stabilizing dropping levels of estrogen and progestin – it's been on a rollercoaster of reputation over the past few decades. The controversial (and often misreported) Women's Health Initiative study of 2003 cast a long shadow. It found a slight increase in risks for breast cancer, heart disease, stroke, and blood clots, causing understandable concern and a decline in MHT availability.
However, as Dr Silvia Rosevear, an Auckland-based obstetrician/gynaecologist and president of the Australasian Menopause Society, explains, the study has major limitations. The average participant was 63 and already post-menopausal. Further, MHT formulations have improved since then.
Despite these criticisms, research from Prof Davis reveals that doctors may still shy away from prescribing MHT unless a person's menopause symptoms are extremely severe. Instead, there seems to be a quiet push towards complementary and alternative therapies, despite their often questionable evidence base. Davis stresses the need for new, updated studies – the Women's Health Initiative effectively stalled research funding for a decade.
Thankfully, funding is returning, and more in-depth studies are underway. However, to fully understand long-term risks and benefits, these studies will need to run for several years. So, in the meantime, what should those of us going through perimenopause do, and where does MHT fit into the picture?
Image Credit - My Menopause Brain
Managing Menopause: Conflicting Perspectives and the Path Forward
It's a perplexing time for menopausal treatment. On one hand, Davis's study shows healthcare providers, while knowledgeable about menopause, are hesitant to prescribe MHT unless symptoms are severe and lifestyle changes or alternative therapies have failed.
On the other hand, many individuals in perimenopause desperately want a treatment that has a good chance of restoring a sense of normalcy – both according to clinical and anecdotal evidence. Dr Rosevear notes, "If a clinician prescribes MHT appropriately for someone suffering moderate to severe symptoms, they're likely to come back feeling much better." For many, MHT seems like a worthwhile option.
Caught in the middle are specialists arguing over whether we're over-medicalizing, over-dramatizing, and over-treating menopause – or if society is dismissing, trivializing, and under-treating perimenopausal women.
Prof Jane Fisher, a clinical psychologist and director of Global and Women's Health at Monash University, believes, "We need to view this life stage as an opportunity, not a time of disability. Framing menopause as an illness for every woman isn't helpful."
Prof Hickey, who has raised concerns about the medicalization of menopause, fears that the negative public discussion may be scaring younger women and reinforcing the harmful stereotype of the "past-it" older woman. "We need to change the negative perceptions of aging for women," she insists.
The Power of Lived Experience
However, Prof Jayashri Kulkarni, a psychiatrist and director of HER Centre Australia at Monash University, feels it's dismissive to tell women to simply "put on a happy face" and avoid discussing the challenges of menopause. "That attitude is outdated." In her clinic, she sees firsthand the struggles women face: low mood, mood swings, anxiety, sleep problems, and other mental health impacts clearly related to more than just normal life stresses (although those certainly exist at this age).
"I see very distressed women who tell me, 'There has to be a solution, I have a hugely successful business; I want to get back on track'," Kulkarni says. "If mental health struggles arise due to hormonal shifts, then hormone therapy makes sense."
In general, clinical guidelines support this. A recent review by Davis and her colleagues confirms that most high-quality guidelines accept the use of MHT to manage both hot flushes and night sweats as well as "mood disturbances."
Finding the Right Path: A Need for Better Research
Sadly, despite affecting half the world's population, there's still a surprising lack of rigorous studies on perimenopause, especially regarding mental health impacts. "We desperately need funding for a well-designed trial comparing HRT or MHT against standard antidepressants, to get true evidence," states Prof Kulkarni.
In the meantime, the growing public conversation about menopause shows just how many women are taking charge of their experiences. They're celebrating the positives, sharing their struggles, finding humor in the chaos, and – importantly – demanding the right to choose how they manage this transition.
For me, (as it is for many women I speak with) the choice is to seek medical help to deal with these unpredictable psychological shifts, so I can continue building the successful career I've worked hard for. My GP is both understanding and supportive while being upfront about potential risks.
While MHT might not be the magic solution I'm hoping for – after all, my anxiety and exhaustion could stem from this globally turbulent period, from raising teenagers and caring for aging parents, or from the existential dread of climate change – I'm doubtful it's entirely down to those things.
Prof Kulkarni emphasizes the importance of listening to the woman's individual experience because ultimately, she knows herself best. "Most women I see don't make it to 45 without developing a pretty good sense of self," she observes.
Navigating the Options
So, while we await better research to guide us, what options exist for managing menopause symptoms? Here's a brief overview:
Menopausal Hormone Therapy (MHT): This involves replacing declining hormones, typically estrogen and progestin (for those who still have a uterus). It comes in various forms like pills, patches, gels, and creams, allowing for personalization. MHT, when prescribed appropriately, can be highly effective but carries some risks – talk to your doctor for an individualized assessment.
Lifestyle Changes: Regular exercise, good sleep habits, managing stress, and a healthy diet can all contribute to smoother sailing through menopause. While these are important for overall well-being, they may not be enough on their own if your symptoms are severe.
Complementary Therapies: There's some evidence for the use of specific herbs and supplements, as well as for practices like acupuncture or mindfulness. However, the evidence overall is mixed, and it's essential to talk to your doctor before starting any such therapies, as they could interact with existing medications.
Antidepressants: For those with significant mood disruptions, antidepressants (particularly SSRIs) can be helpful, even if you don't have a history of depression. However, they come with their own side effects and may not address symptoms like hot flushes.
A Word About "Natural" Options
Many turn to "natural" menopause remedies. It's important to remember that "natural" doesn't always equal "safe". Always discuss these options with your doctor, do your research, and look for products with reputable scientific backing.
The Need for Individualized Care
Unfortunately, there's no single solution that works for everyone. The best approach is an open conversation with a knowledgeable doctor who can help you weigh the risks and benefits of different options based on your individual circumstances and preferences.
Remember, as Prof Hickey reminds us, "Menopause isn't a disease." But, as Prof Davis counters, "Nor is it something to just put up with." Finding the right balance is an ongoing journey, fueled by both better science and women demanding the support they deserve.
Navigating the Options: Beyond MHT
While the spotlight often falls on menopausal hormone therapy (MHT), there's a broader range of strategies to manage those pesky perimenopausal symptoms. Let's take a closer look:
Lifestyle Changes: Regular exercise, prioritizing sleep, finding healthy ways to manage stress, and nourishing your body with a balanced diet can all play a role in easing your menopausal journey. While these are crucial for your overall well-being, it's important to recognize that if your symptoms are significantly disrupting your life, lifestyle shifts alone might not be enough.
Complementary Therapies: You might find some support from specific herbs and supplements or practices like acupuncture or mindfulness meditation. However, the evidence behind complementary therapies is variable. Always consult your doctor before starting new supplements or therapies, as they could interact with your current medications or have potential side effects.
Antidepressants: If you're struggling with severe mood swings, low mood, or anxiety, antidepressants (especially the SSRI class) might be helpful, even if you don't typically experience depression. Keep in mind that these come with their own potential side effects, and while they can improve mood, they might not address other common menopausal symptoms like hot flushes.
Beyond “Putting Up With It
The "Natural" Route: It's understandable to want "natural" solutions for managing menopause. However, it's essential to remember that "natural" doesn't automatically mean "safe" or "effective." Discuss any natural remedies you're considering with your doctor. Do your own research, seek out products backed by credible scientific studies, and be aware of potential interactions with your existing medications.
The Importance of Individualized Care: Sadly, there's no one-size-fits-all answer when it comes to managing menopause. The most successful approach usually involves a candid conversation with a doctor you trust. They can help you carefully consider the pros and cons of various strategies, taking into account your individual health profile, needs, and preferences.
Remember, as Prof Hickey emphasizes, "Menopause isn't a disease." However, as Prof Davis argues, "Nor is it something to just put up with." Finding the right support that fits your unique situation is an ongoing process. This progress is fueled by both the demand for better research into the experience of menopause and women speaking up and advocating for the kind of care they need and deserve during this transition.
Beyond the Symptoms: Reframing Menopause
While managing the physical and emotional challenges of menopause is crucial, there's more to this life phase than hot flushes and mood swings. It's a time when many women feel a powerful shift, both liberating and unsettling.
For some, priorities change significantly. There might be a renewed sense of purpose, a desire to step away from old obligations and forge a new path. Careers flourish, new businesses are born, and creative passions long buried get rekindled. As Prof Fisher advocates, it's important to see menopause as "a life phase of opportunity, not of disability."
Yet, this isn't always an easy transition. Societal expectations that link a woman's worth to her youthfulness and fertility can be a heavy burden. It can be hard to shake the feeling that we're fading into the background, becoming less relevant. This feeds into a fear shared by many that perimenopause signals the start of a long decline.
To counter this harmful narrative, Prof Hickey urges us to change the way we think about aging for women. "We have to stop using negative terminology like 'old woman'," she insists. "There's nothing good about those words."
Thankfully, the public conversation around menopause is evolving. More and more women are rejecting these outdated ideas. They're showcasing the power, wisdom, and confidence that come with age. They're not accepting the notion that they should disappear quietly.
Navigating Challenges and Finding Support
Social media and online communities provide space for these voices to connect and amplify one another. Celebrities are opening up about their experiences, shattering taboos and offering relatable images of women thriving in mid-life and beyond.
However, for some, the mental and emotional struggles can eclipse the potential for growth and empowerment. It's here that the conversation around medical treatment, including MHT, is crucial. If menopause is throwing you into a storm of anxiety or depression, there's no shame in seeking help to calm those waters.
Kulkarni puts it bluntly: "The idea of women just suffering in silence to uphold some idealized notion of stoicism isn't helpful, and it isn't the reality of the modern world."
Ultimately, finding your way through menopause will be a personal journey. It may involve a mix of medical interventions, lifestyle changes, complementary therapies, and perhaps a healthy dose of reframing how you view this new chapter of your life.
Finding resources and support is vital. There are excellent online communities, specialist menopause clinics, and a growing number of knowledgeable and open-minded healthcare providers. Don't be afraid to ask questions, advocate for your needs, and keep searching until you find the answers and support that leave you feeling empowered during this complex and potentially transformational time.
