Dr. Patricia Yarberry Allen, publisher of Women’s Voices for Change, posts a column on medical issues  every Monday. Dr. Allen, a gynecologist, is Director of the New York Menopause Center, a Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and an Assistant Attending Obstetrician and Gynecologist at New York–Presbyterian Hospital.

 

Dear Dr. Pat:

I am 42 years old and am terrified of menopause. My mother, who was a great beauty when she was young, had terrible symptoms with depression and drinking in her late 40s.  She was never easy, but became really bad-tempered beginning during this time. She gained weight, and before she was 50 was a divorced, angry, overweight, stay-at-home woman whose children were happy to be out of the house and away from the mess.  She finally got sober and moved back to her hometown in the Midwest after many unhappy years in a big city. My brother and I rarely see her, because she may be sober but she is still self-absorbed and demanding.  My brother, unfortunately, has a drinking problem and has work and marriage problems as well.

I want to do everything I can to prevent my life from turning out this way. I have two teenage daughters who are doing well, and both will be in college in two years.  I have a really good marriage with a great sex life.  I eat in a healthy way and exercise daily but have noticed that I have begun to gain some weight. I do have a drink most nights, and a bit more socially, but don’t have any other bad habits.  I have a great job where I have the opportunity for advancement, and, of course, I have the usual overwork that everyone complains about.

I now have some night sweats before each period and my periods are less frequent.  In the last six months, the periods occur every eight weeks. I used to sleep a sound seven hours, and now I fall asleep and wake up in the middle of the night.  I am not sure why I wake up, but I have a hard time turning my brain off when I do wake up.  When I wake up in the night, I generally think about never getting back to sleep, being exhausted the next day, and then begin to worry about MENOPAUSE. These symptoms have triggered my fear that I will become like my mother as I become menopausal.  I saw my GP, who did blood tests and an exam, and I have no health problems.  My gynecologist told me that I was too young to have menopause and that these symptoms were nothing to worry about anyway. My girlfriends and I talk all the time about how we will manage menopause. What can I do to prepare for this horrible time so that I don’t ruin my life like my mother did?

Jane

 

Dr. Pat Responds:

Dear Jane:

This is not your mother’s menopause.  You chose early in life to follow a different path from the one your mother chose. However, it can be frightening for women to think about and plan for the menopausal transition when they have had mothers who were such poor role models for the management of this part of life—the beginning of the second half of life.

The menopausal transition is confusing to patients because the language used to describe this often decade-long transition is confusing.  The ovaries produce several hormones, but primarily estrogen and progesterone.  As the ovaries age, there is less predictable production of estrogen and progesterone, with many changes in periods and the development of symptoms that are troubling to many women. Generally, menopause (no periods for a full year) does not happen suddenly. Perimenopause is the time before menopause, and is divided into two stages.

 

1. Early Perimenopause sometimes begins in women in their 30s, but generally begins in your age group:  40 to 45, accompanied by a change in the menstrual cycle and the onset of some symptoms such as hot flashes.

2. Late Perimenopause typically occurs in women in their late 40s or early 50s.  Periods generally become much less frequent, and the symptoms of menopause that each woman may have begin to become more significant.

You are in the early perimenopause stage.  Since each woman is different, and menopause does occur in the early 40s in some women, this is just the right time for you to hone the lifelong skills you have used so successfully thus far to create a personal, marital, parental, and professional life that is different from the template given to you by your mother in order to create a productive menopausal road map that you can follow. Here are some ideas to keep in mind.

1. Fear is useless. This is the time in your life when you can use this period of uncertainty—accompanied by the memories of the poor choices your mother made during her menopausal transition, along with the some very likely unpleasant physiologic and emotional symptoms that may accompany your menopause—as fuel for transformation and reinvention.

2. Menopause is an inevitable and normal physiologic change that occurs in all women who are lucky enough to live this long. It is not a disease. The symptoms can be managed.

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3. Create a new schedule now that gives you some personal time. This is not the time for you to be the perfect wife, the perfect mother, and the perfect friend. Discuss this life stage with your husband and daughters in a positive way.  Remind them that you are going to do all that you need to do for this period of time to avoid your mother’s choices and behavior.  Husbands like yours, supportive life partners with sex as an important component of the relationship, will be grateful to be part of the solution instead of fearing the worst that they have heard from their fathers, their friends, and the media. A frank discussion about making the right choices in the menopausal transition and the belief that management of symptoms is certainly possible is a great life lesson that mothers can give their daughters.  A focus on the positive is so important. Twenty-five years from now your daughters will have the memory of your menopause to guide them through their transition. Explain to your husband and daughters that you will need their help with household management, if you don’t have their help already. Tell them that you will need fewer social responsibilities at times so that you can begin more self-care. Get rid of committees and relationships that take your precious time from you and give little or nothing back.

4. Fix your sleep disorder now.  Use the time freed up from saying NO to find meditation and yoga classes. Daily exercise and small evening meals consumed earlier in the evening are helpful to better sleep. Find a short period of time for evening meditation practice, which will calm your brain before you sleep.  Many people listen to meditation tapes such as those produced by Dharma Seed. Three teachers recommended to us from this organization are Jack Kornfield, Sylvia Boorstein, and Tara Brach.  Tapes can be used before sleep and then again if you wake up, so you can return to sleep instead of engaging in battle with ruminating thoughts. Waking up rested gives everyone a great opportunity to have a more productive day.

5. Stop drinking completely for the next six months. Your mother and brother’s lives were terribly affected by alcohol, and there can be a genetic predisposition to alcohol overuse. In addition, nightly alcohol consumption has become such an expected part of life for women in your demographic that you may not be aware of how much you are drinking.  Ask your husband to support this decision; remember, alcohol overuse is not someone else’s problem . . . but it could be yours. Alcohol affects sleep in many negative ways, causing disrupted sleep and difficulty returning to sleep. In six months you can decide about your relationship with alcohol and develop a more mindful approach to drinking.

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6. Choose to eat mindfully at work. Eat frequently and have small amounts.  Carbs and sugar consumption often affect energy, mood, and concentration.

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7. Create small breaks throughout the day. Find time during lunch to walk outside and be fully present in the joy of this experience.  Take breaks every 30 minutes, if possible, to stretch and breathe deeply for just 2 minutes. Certainly take a breathing and stretching break every hour.  This prevents muscle tension and poor posture and reminds you, even for this short period of time, that you have given yourself the gift of mindfulness.

8. Weight gain is more common as we age, and it often begins in mid-life. The truth is, we need to consume fewer calories and exercise more after 40. Alcohol, processed foods, mindless eating, overeating, excessive nighttime eating, constant socializing where food and drink are the lubricants, all contribute to the problem of middle-age weigh gain.  Some women don’t mind the increase in midlife weight gain or the change in body shape, but weight gain is also a medical problem for many.  Mindfulness and choices that support the goals that are yours will prevent weight gain.

9. As you progress through the years of your menopausal transition there are many therapeutic choices available that you can discuss with a gynecologist who has an interest in the care of women in this life stage.  Each choice you make should be for a specific symptom, and each choice may have side effects that will inform your decision. A complete and current review of options for medical choices available for menopausal management was recently made and written by Dr. Clarisa R. Gracia, in the January 2014 issue of the journal Obstetrics & Gynecology.

Health-care providers must remain current, listen to their patients’ fears and symptoms, and work with patients to create the symptom management necessary for each woman for this period of life when she needs to feel and function at her best.

The interesting thing about menopause management is that the subject is never old, the information never final, and the recruits to this life stage come in day after day, year after year.  Menopause may be old news to women in their 60s and 70s, but to women in their 40s and 50s it is news that is always  “hot off the presses.”

We at www.womensvoicesforchange.org believe that excellent and timely information about health and hormonal change; general templates that can be personalized by each woman for her goals for management of symptoms; and a focus on self care and mindfulness, along with a relationship with a thoughtful and informed health care practitioner, will prevent the old news that menopause defined women in only negative ways.

We know that informed management of the menopausal transition offers women the opportunity to move into the next half of life with awareness of confidence based on  personal strengths and perhaps the planned pursuit of new life goals. We are a community where this message is delivered whenever there is news or whenever someone wants to know “how to get it right”, once again.