Ask Dr. Pat · Menopause

Menopause: Getting It Right

Dr. Pat Responds:

Dear Jane:

You have worked most of your life to create a life different from your mother’s life. It is often frightening for women who had mothers who were such poor role models for the management of midlife to think about and plan for the menopausal transition.

The menopausal transition is confusing to patients because the language used to describe this often decade-long period 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 starts in women in their 40s and is accompanied by a change in the menstrual cycle and the onset of some symptoms, like 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.


Find a short period of time for an evening meditation practice; many people listen to meditation tapes.

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 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 the is uncertainty — accompanied by the memories of the poor choices your mother made during her menopausal transition, along with some very likely unpleasant physiologic and emotional symptoms that may accompany your menopause — as fuel for transformation and reinvention.
  1. 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. Some women find that no matter how organic their diet, how much they exercise, how often they use integrative medical techniques or meditate, they still need hormone therapy to improve the quality of their lives.  Each woman going through the menopausal transition is unique and needs to weigh the pros and cons of therapeutic choices with her health care provider.
  1. 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 transitions. 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.
  1. Fix your sleep disorder now.  Use the time freed up from saying NO to find meditation and yoga classes. Daily exercise and small meals consumed earlier in the evening are help you sleep better. Find a short period of time for evening meditation practice, which will calm your brain before you sleep. Many people listen to meditation tapes, like 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.
  1. Stop drinking completely for the next six months. Your mother’s 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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