“She’s going through her changes….”

There’s no doubt you’ve heard this term before, and without any further information or explanation, you know what it means: menopause. Some women meet it with dread; others greet it as a natural next step. To take the mystery out of menopause and understand its real implications, it’s important to maximize your knowledge of this often-misunderstood time of life.

Menopause for beginners

When it comes to menopause, “there’s a lot of mixing of definitions,” cautions gynecologist and obstetrician Rhona Magaril, MD. “Menopause is a definition given in retrospect: It’s the time of life that occurs after you have not had a menstrual period for 12 months. Perimenopause is the two to five years that happens before the final menstrual period. And a woman’s entire life after menopause is considered post-menopausal.”

In actuality, it’s that perimenopausal period that has given menopause its bad rap. The hot flashes, night sweats, and mood changes of which so many women speak occur during this time. Other women complain of insomnia, weight gain, and skin dryness. Although you don’t want to dwell on any of these symptoms, it is necessary to pay attention to them. “It’s important to have a consciousness of symptoms so patients can be sure there isn’t something more serious going on,” says Russell R. Hoffman, MD, chief of Overlook’s department of obstetrics and gynecology. “Menopause can be a very scary and overwhelming time in a woman’s life. Some welcome it—they’re ready for a more mature time of life; others see it as a time of being old—a conclusion to their youth. But you may go through the transition better if you recognize symptoms—recognize that your body is going through changes.”

Fortunately, by the time most women get to their final menstrual period, the worst of the symptoms are already gone. Remember, though, that not every woman experiences every symptom. “Nobody experiences menopause exactly the same, just as no two teens experience adolescence the same way,” says Hoffman. “Some patients have every one of these things. Others will get some; some will get none. Although we don’t know of a direct genetic link to menopause, often what the mother experienced, the patient experiences.”

What you can do

“We’ve made menopause so clinical, and it isn’t,” says Magaril. “It’s just a normal part of life. We have to stop making this into a medical issue.” In fact, most women will make their way through menopause without any intervention, and healthy living—eating right and exercising—can even reverse some symptoms. But for those women whose quality of life is affected, there are options. Among them is the selective use of hormone-replacement therapy (HRT)—but the benefits and risks of HRT are not clearly known. A Women’s Health Initiative study was prematurely terminated in 2002 when it was determined that taking HRT may in small part increase a woman’s chances of developing breast cancer and cardiovascular diseases.

“In the past, HRT was an absolute therapy, but now we’re entertaining that it may not be for everybody,” says Hoffman. “This is how I approach HRT: I weigh it in balance of risk, taking versus not taking. If a patient complains of overwhelming symptoms relating to menopause—enough so it’s affecting her quality of life and she’s tried alternative means—then I try to consider HRT at the lowest possible dosage that she’s relieved of symptoms. I treat each individual on an individual basis. The cookbook approach, where every recipe is prepared the same by different people, doesn’t work. Our society is too sophisticated for a blanket approach.”

Says Magaril, “The decision to use any therapy”—whether it’s HRT, other medications, or even nutritional supplements—“is based on whether the symptoms are affecting quality of life. If quality of life is not adversely affected, we don’t need to treat menopause medically. If it affects quality of life, we need to talk about treatment. If you’re not sleeping, if you’re sweating so much you can’t function, clearly you need help.”

One area where all menopausal women need help is with their bones; osteoporosis becomes a serious concern because perimenopause and menopause result in rapid decreases in bone loss. “That’s why it’s important to increase calcium levels,” Hoffman says. “Calcium plus vitamin D is integral in bone metabolism. They won’t add bone, but they’ll help to maintain bone health and help to maintain bone loss.”

For most women, Magaril suggests 1,200 to 1,500 milligrams of calcium with vitamin D daily, and encourages her patients to partake in weight-bearing exercise for 20 minutes three times a week. She also recommends a baseline bone-density test so that bone loss can be detected. For stabilizing and preventing more rapid bone loss, medications like Fosamax, Actonel, and Boniva can be beneficial, although these are not necessarily recommended for long-term use anymore.

What is recommended is an open dialogue—with family, with friends, with physicians. “My generation talks about it a lot,” says Magaril, who is in her fifties. “When I was first in practice, that wasn’t the case. But women talk to each other now. They talk to me. It’s a very open conversation, as opposed to when my mother went through it—nobody talked about it.

“Remember that we tend to make normal transitions into bodily things,” she says. “Menopause is a part of life. Women have been going through it for centuries. It’s only recently that menopause has become a bad thing. It’s not a bad thing—it’s just another life change that we have to go through. And we’re all going to get through it together.”

For a referral to any member of Overlook’s Department of Obstetrics and Gynecology, call (866) 798-8263.