Why Don’t Women Want To Talk About Menopause?

When I read about the AARP Menopause Survey in last month’s AARP THE MAGAZINE, I was surprised to find out that 42% of the more than 400 women between the ages 50 and 59 who participated in the survey, say they’ve never discussed menopause with a health provider.

Really ladies?

Why don’t women want to talk about menopause?

The same survey also reported that 84% of women say their symptoms interfere with their lives, with 12% who say they interfere “a great deal” or are debilitating. The most common symptoms of menopause for women: 50% hot flashes (thankfully, haven’t had too many of those); 42% night sweats (yep, still getting those flashes even at 60); 38% vaginal dryness (check, check, check – count me in this percentage).

There we go. Now we’re talking about menopause!

*AARP surveyed more than 400 women between ages 50 and 59 to ask about their experiences with, and attitudes toward, menopause.

An Interview with Dr. Charlotte Yeh

Recently, I had a chance to talk about menopause with Charlotte Yeh, MD FACEP, who is the Chief Medical Officer for AARP Services, Inc. Dr. Yeh has more than 30 years of health care experience. She is an expert in health care delivery in the areas of quality, safety, and efficiency. I asked Dr. Yeh some basic questions that I thought might be useful to women for whom menopause is a new experience. (However, even those of us like me who are post-menopausal may find Dr. Yeh’s guidance reassuring.)

As always, if you have questions or comments about your health or any of Dr. Yeh’s suggestions, I encourage you to talk with your gynecologist or general practitioner. These answers are the philosophy of Dr. Yeh and may not be the same as your doctor’s or your own.

Charlotte Yeh, MD FACEP, is the Chief Medical Officer for AARP Services, Inc.

♥ What are the top symptoms of menopause?
Dr. Yeh: The most common symptoms of menopause are:

– Hot Flashes: Sixty to eighty percent of women experience this symptom. These are vasomotor changes that cause one to feel a sudden heat sensation in the upper chest and face which then spreads throughout the body, lasting typically 2-4 minutes. Some women break out in a sweat from the hot flash. Once the hot flash ends, one might feel chills and shiver. The hot flashes can occur 1-2 times per day or as often as every hour.

– Night Sweats: When hot flashes occur at night, which is a more common time frame, they are called night sweats because they occur while sleeping. Such nighttime hot flashes can cause sweating through one’s clothing, and even wake one up from feeling either too hot or too cold.  These night sweats disrupt sleep, often 1-2 times a night. The sleep disruption causes poor sleep which can lead to fatigue, mood swings, anxiety, difficulty concentrating, and irritability. (Ugh, I hate night sweats!!)

– Sleep disturbances: Even without night sweats, some women can have difficulty falling asleep or staying asleep. Again the sleep interruptions can lead to fatigue, mood swings and irritability. (Ugh, my menopausal insomnia is awful, it goes in cycles. Any tips are welcome.)

– Vaginal dryness: The dropping levels of estrogen causes the vaginal tissues to become thinner and dry. This can explain why some women experience discomfort, itching or pain during sex. (I thought I had a vaginal infection, but my doctor told me it was just dryness.)

– Depression: Along with the mood swings, sadness, disinterest in usual activities, and sleeping difficulties, depression may occur either as a new problem or exacerbation of depression if one has had it before.

– Memory Loss and cognitive dysfunction: These concentration and cognitive disorders can occur even without the night sweats. Loss of a key neuroprotective element in the female brain during menopause is why one may experience cognitive and memory declines. (Glad to know why I’m forgetting everything.)

– Joint aches and pains also can occur with menopause. (I didn’t know that.)

♥ What’s the best way to alleviate these symptoms in a natural way?
Dr. Yeh: While not having conclusive evidence of effectiveness, some women have tried phytoestrogens which are plant derived estrogens. Many foods such as soybean, chick peas, lentil, flaxseed, grains, fruits, vegetables and red clover contain phytoestrogen.  Isoflavone supplements is also a form of phytoestrogen.

Other women have tried herbal treatments such as black cohosh. However, again there are no studies to demonstrate it works any better than placebo, but also is not known to be harmful at this time.

Again, while research findings are inconsistent, trying other programs to decrease stress, such as mindfulness, meditation, relaxation and deep breathing techniques and yoga might be helpful.

Acupuncture may help reduce hot flashes.

Over the counter vaginal lubricants can also help reduce the symptoms of vaginal dryness.

♥ Why is sleep such an issue for menopausal and post-menopausal women? Any tips to address insomnia?
Dr. Yeh: Sleep issues are very common with menopause. Typically the sleep interruptions caused by hot flashes occurring at night, and waking one up can lead to interrupted sleep. Such interruptions over time cause fatigue, cognitive difficulties such as attention span and concentration, and mood disorders.

Sleep hygiene techniques such as avoiding caffeine in the afternoons and evening, only sleeping in the bedroom, turning off all electronic devices, plus a regular time for bedtime are all part of creating a safe time and place for sleeping and may help.

Those with hot flashes and night sweats, especially when they cause sleep disruption could benefit from estrogen or hormonal therapy.

♥ How can women feel more comfortable talking about menopause with their healthcare professionals? What’s the best way to approach it?
Dr. Yeh: If you feel you are going through menopause, and are having symptoms disrupting your daily life, it is totally appropriate to speak with your doctor. For women between 50-60 with menopause, hormonal therapy can provide relief and is the best treatment available for hot flashes.

It’s important to speak up, share your specific symptoms and specifically ask if hormonal therapy for hot flashes or vaginal estrogen for vaginal dryness would be appropriate for you.  And if you don’t feel your doctor is listening or dismisses your concerns, ask for a referral to a menopausal specialist.

*AARP surveyed more than 400 women between ages 50 and 59 to ask about their experiences with, and attitudes toward, menopause.

♥ Any other advice for women who are going through menopause or are post-menopausal but still having symptoms?
Dr. Yeh: Many women may be afraid of taking estrogen or hormonal therapy, due to a widely circulated study in 2002 from the Women’s Health Initiative that had followed women from ages 50-79 showing an increased risk of heart attacks, strokes, blood clots and breast and ovarian cancer.  We now know that the study did not correct for age, especially women 60 and over who already have had these conditions.

Relooking at the data revealed that women 50-59 actually had a lower mortality rate than the control group. So currently, hormonal replacement therapy is considered a safe and effective treatment for symptoms of menopause, particularly hot flashes or vaginal dryness, and for those in the 50-60 age range to continue until the hot flashes have stopped, typically 4-5 years, although for some women the symptoms can last 7-8 years.  If vaginal dryness is the main problem, vaginal estrogen is quite helpful and considered to be safe indefinitely.

(Note: Hormonal therapy is not something I ever chose to do for night sweats. I do use vaginal estrogen for my vaginal dryness and find it helps.)

♥ This time of a woman’s life is one of great change, not only for her body, but also her mind and spirit. Can you talk more about the emotional aspects of menopause?
Dr. Yeh: Menopause is a rite of passage, and an inevitable event in the life of a woman.  Yes, it can be stressful, irritating, and discomforting to go through the range of stress from hot flashes to night sweats, vaginal dryness and cognitive impact. Just remember that you are not alone.

It often can help to talk about it with other women and share your stories, with maybe a good laugh or two. Having to face your body changing once again, as one did through puberty, can be quite disconcerting and challenging to address on a daily life basis. On the other hand, while there may be wistfulness at giving up the reproductive capability, when you are finally through the hot flashes, many women speak of a wonderful freedom to no longer worry about tampons, sanitary pad disposal, ruined clothing and bedsheets or an unexpected pregnancy.

With the availability of vaginal estrogen, one need not fear intimacy, since such treatment is effective to reverse dryness and pain during sex. Talk to women who are suffering as you are and to women who are past the worst of menopause to know there is light at the end of the tunnel.

We are learning all the time about the effects of estrogen not just on ovaries, but also how it impacts your whole body and mental health as well.  So, it’s not “in your head” and imaginary. Menopause and its symptoms are as real as any other medical condition, with one piece of good news. The hot flashes are temporary and will eventually end. And as we have noted in other AARP surveys, after 50, one’s overall happiness tends to generally climb and exceed the happiness in your youth. This is your chance to grow, learn and explore without being tied to a monthly calendar.  So, commiserate with your women buddies, and know you will be enjoying your new freedom to come.

Thank you Dr. Yeh for that comprehensive guide to menopause. For more information about menopause check out the AARP Menopause Survival Guide. Let’s continue the menopause conversation. Leave a comment. It’s okay to laugh, cry or just feel what you feel. 

Judi