Demystifying Menopause: Identifying Normal Symptoms, Finding Relief, and Preventing Other Complications.

Menopause is defined as the last menstrual period, and it’s a normal biological process that every woman who reaches a certain age goes through. But, many women don’t really know what to expect when it comes to uncomfortable or disruptive symptoms—or how to manage them and prevent diabetes-related complications, like vision loss, nerve damage, and heart disease.

Every woman’s experience with symptoms is different based on her lifestyle, hormones, and body. However, most women begin experiencing menopause-related symptoms eight to ten years before their final menstruation. This time period is called perimenopause. It’s when the body begins the process and your period may start to become irregular either in frequency or duration. 

Typical symptoms in the years leading up to menopause.

There’s a wide range for what’s considered normal when it comes to unwelcome menopause symptoms during perimenopause, but it’s all caused by changing hormone levels. Because nearly every body organ and system has hormone receptors, it’s normal for these hormone fluctuations to affect how we feel physically, mentally, and emotionally.

Hot flashes.

This is one of the most common dreaded symptoms that women have heard of. Hot flashes are usually described as an intense feeling of heat, often in your chest, throat, or face. They can be accompanied by sweating both during the day or at night (called night sweats), but not always. Some women also get heart palpitations at the same time. 

We don’t know exactly what causes them. However, the hypothalamus in the brain is in charge of thermal regulation, and we think that it becomes more sensitive to temperature changes as estrogen levels decrease. Although it sounds counterproductive, this causes the body to respond by sweating, which is the body’s natural response to cooling itself down when it feels overheated.  

For some women, hot flashes are mild and don’t interfere with daily living. For others, hot flashes can be incredibly uncomfortable and disruptive to their life. You may be able to reduce the severity of hot flashes by avoiding caffeine, intense exercise, and spicy foods. Hot flashes typically disappear once hormone levels stabilize. However, about 20 percent of women continue to experience occasional hot flashes for a long time or the rest of their lives. 

When this happens at night, it can disrupt sleep, potentially leading to insomnia, which is related to melatonin levels. Studies show that just one bad night of sleep can affect your blood sugar for the next three days, which is why poor sleep is linked to a higher risk of diabetes. That’s why it’s so important to seek treatment if hot flashes are interfering with your quality of life or sleep.

Mood swings.

You may have heard of adrenaline, dopamine, and/or serotonin. These are neurotransmitters that are metabolized into the bloodstream when we’re stressed. This happens quickly when our hormone levels are stable, but when hormones like estrogen and progesterone fluctuate, they can interfere with this physiological process. This can cause you to feel good one moment and the next feel irrational or emotional. 

The impact of hormones on these chemicals is complex and affects everyone differently. But knowing what’s happening in your body can help you to cut yourself some slack. If drastic mood changes begin to affect your life and relationships, it’s always good to talk to a doctor who can help recommend strategies or treatments for navigating this stage.

Physical changes.

As we get older, some women start to over exercise which can actually make menopause-related symptoms worse. That’s because too much physical activity can put excessive stress on your body and raise cortisol levels. This can prompt hot flashes and also cause the body to store more fat in the abdomen. Unfortunately, this weight gain in the belly is worsened with a diet high in sugar or simple carbohydrates, like bread or pasta. 

In addition, decreased estrogen levels can make your body more sensitive to insulin, leading to high blood sugar. Over time, this can affect weight gain and fat distribution, which can also increase your risk of type 2 diabetes.

It can be helpful to know that you can minimize these symptoms by modifying your lifestyle a bit. For example, avoiding sugar altogether can help you to maintain a stable blood sugar level and avoid insulin resistance. And healthy changes in your diet can also reduce the severity of hot flashes. Likewise, exercise is good for your body but remember not to overdo it, especially if menopause brings on minor joint aches and pains. You can strike a good balance of rest and activity by aiming for gentle exercise, like walking or yoga, for 30 minutes every day.

Sexual and urinary health.

As hormone levels decrease, mucosal surfaces in the body can dry out. For example, vaginal dryness is common, which can make sex more painful. Fortunately, there are treatment options that can relieve genitourinary symptoms related to menopause. Vaginal estrogen therapy is an effective, safe treatment delivered vaginally as a suppository or cream. It uses a low dose of estrogen to level out hormone levels locally in the vagina, and it’s safe enough for most women to take for the remainder of their life if they need to. There are some instances where your doctor may not recommend it, especially if you have a history of estrogen-positive breast cancer.  

Vaginal dryness can also increase a woman’s risk of developing recurring urinary tract infections (UTIs). However, women who are still in the perimenopause process may benefit from D-Mannose, an over-the-counter supplement that prevents recurrent UTIs. In fact, this has been proven to be more effective in preventing UTIs than a daily antibiotic treatment.

The connection between diabetes and menopause.

Both diabetes and menopause tend to affect women in the same stage of life in their 40s and 50s. While every woman will go through menopause at some point, diabetes is a serious condition that is often preventable. While menopause doesn’t cause diabetes, changing hormones affect how a woman’s body responds to insulin, which can increase a woman’s risk for developing type 2 diabetes. Here’s how.

• The sharp drop in estrogen can make you more sensitive to insulin, causing your blood sugar to rise. This can lead to weight gain and more abdominal fat, which can elevate your risk for type 2 diabetes. 
• If you already have prediabetes or type 2 diabetes, erratic hormone changes can also cause your blood sugar levels to fluctuate, making it harder to manage your condition.
• Hot flashes at night or night sweats can interrupt sleep and lead to sleep deprivation, which is linked to a higher risk of diabetes.
• Stress is related to the hormone cortisol, and depression can be worse during perimenopause. Left unchecked, rising cortisol levels can also increase your blood sugar.

Watch our Facebook Live broadcast with Dr. Enzmann and Dr. Kulkarni to learn more about the connection between diabetes and menopause:

Alleviating symptoms with hormone replacement therapy.

The best place to start for treatment is lifestyle changes like moving more and eating a well-balanced diet that helps to keep your blood sugar stable. Eating a diet high in greens, vegetables, nuts, and seeds and avoiding sugar can help you keep your insulin levels in check. This is important for lowering your risk of diabetes, but it can often help you manage menopause-related symptoms.

If menopausal symptoms are disruptive and severe, you may benefit from hormone replacement therapy. This is a treatment that can replace physiological hormone levels during the time when you are feeling most symptomatic. There are two hormone replacement therapies, both with FDA-approved treatments for minimizing hot flashes and preventing post-menopausal bone loss. They can also help with sleep quality, mood symptoms, and brain fog. In addition, they can help you to stabilize your blood sugar and potentially lower your risk of diabetes.

The type of hormone replacement therapy your doctor recommends will vary based on whether or not you’ve had a hysterectomy and if you have a high-risk for breast cancer. Today, we generally prescribe bioidentical hormone therapies, which are molecular replicas of estrogen or progesterone. Progesterone is typically delivered as an oral therapy, while estrogen can be delivered orally or via a patch or spray. When possible, I try to prescribe it transdermally as opposed to orally so that it doesn't have to pass through the liver, thereby reducing the risk of blood clots. (Although low, there is a risk of blood clotting, especially if you have uncontrolled hypertension or stroke risk factors.)

Your doctor will work with you to determine if this treatment option is right for you. According to the North American Menopause Society, for most young women under 50, the benefits far outweigh the risks. The opposite is true for women over the age of 60.

There’s no strict cut-off for the length of time you can remain on hormone replacement therapy. Most women begin to taper off after three to five years, but it depends on the risk profile of the patient. Your doctor will regularly monitor your symptoms and health and provide recommendations personalized to you so you can make educated decisions about your treatment.

When can I expect menopause to start?

If these symptoms occur after age 45, we can probably expect that they’re related to menopause. For women after age 40, these symptoms may still be considered normal, but since it’s a bit early, it’s always good to rule out more serious conditions, like blood sugar or thyroid conditions.

The average age for that final period is age 51, but you won’t know for sure you’re through menopause until one whole year has passed without a menstrual cycle. Once it has, you are officially in post-menopause. It’s still possible to experience late post-menopause symptoms as low estrogen levels affect the bladder and vaginal tissue. Continue to talk to your doctor about how to manage these symptoms, as vaginal estrogen therapy may be a good option.

Don’t let fear or uncertainty about menopause cause you to dread getting older. My best advice is to educate yourself on what to expect, begin to adopt healthier lifestyle changes, and do your best to control your stress. One menopause study reported that 70 percent of women say they are happier after menopause than when they were in their 30s, which means the best is yet to come.