The truth about 'the change'

Three experts chart the myths and misperceptions of menopause
By Judy Peres
December 5, 2006

          [ P H O T O ]
With the aging of the baby boom generation, about 2 million U.S.
women a year are now entering menopause, which signals the end of
their reproductive life. That's about 180,000 women a month, or
about 6,000 a day.

The shutdown of all those ovaries leads to some major hormonal
shifts that have been blamed for everything from dry skin to mental
illness. (It also leads to a multibillion-dollar trade in
prescription medications, over-the-counter remedies, how-to
publications, designer fans and lines of loose-fitting or
perspiration-wicking clothing, among other commodities.)
But much of what we know about menopause comes from
less-than-reliable sources, including older women who delicately
refer to it as “the change,” friends whose experiences may be
different from ours, and Web sites that may not be authoritative.

Three experts explained what's scientifically established and what's
just (pardon the expression) old wives' tales: Dr. Leon Speroff,
professor of obstetrics and gynecology at Oregon Health and Science
University; Dr. Linda Hughey Holt, associate clinical professor of
obstetrics and gynecology at Northwestern University and author of
“50 Ways to Cope With Menopause”; and Dr. Wulf Utian, director of
the North American Menopause Society.

Here's what they said:

You can find yourself in menopause even before your 40th birthday.
TRUE. The average age of menopause in this country is 51, and for
the vast majority of women it occurs between 44 and 56. But about 1
percent of women experience it before age 40. Perimenopause, which
literally means “around menopause,” is the transition that begins
when your menstrual periods start to become irregular and ends one
year after they stop altogether. Perimenopause, which for the
average woman starts at age 46, usually lasts from two to eight
years.

Menopause is just a single day.
TRUE. Technically, menopause is the last day of your final period.
But doctors can't confirm that you've gone through menopause until a
year later, after you've missed 12 consecutive periods. So the
critical date is really the first anniversary of your last period.
Before that, you're perimenopausal; afterward, you're
postmenopausal.

Are those symptoms menopause?
Many symptoms attributed to menopause may be caused by
other medical problems. Doctors say this is the time to
have a thorough checkup.
Directly related to hormone changes:
Erratic menstrual periods, hot flashes and night sweats,
vaginal dryness and thinning.
Possibly caused by hormone changes:
Insomnia, sore breasts, loss of libido, acne, thinning
hair, dry skin, facial hair, urine leakage,
palpitations.
Most likely not menopause related:
Fatigue, irritability, depression, anxiety, panic
attacks, nervousness, forgetfulness, loss of
concentration, headaches, joint and muscle pain, dizzy
spells, weird dreams, bloating, indigestion, snoring,
varicose veins, lower back pain.

You can't get pregnant after you enter perimenopause.
FALSE. For the average woman, fertility begins to decline around age
37, because the eggs left in her ovaries are getting old. But,
according to Speroff, “variability is the rule.”
One woman in Portland, Ore., delivered a baby at age 57 after
conceiving the old-fashioned way. So women who don't want to get
pregnant should continue to use contraception until they are
definitely postmenopausal.

Going through the change means you can say goodbye to sex.
Not unless you really want to. One study of women age 50 to 82 found
that half had an ongoing sexual relationship. According to Speroff,
people who are sexually active earlier in life continue to be
sexually active into old age. The main reason for not having regular
sex is the unavailability of partners because of divorce and the
fact that women outlive men: By the time you're 85, there are only
39 men for every 100 women. On the other hand, decreasing estrogen
sometimes makes for painful sex, because there's a loss of vaginal
elasticity and a drop in lubrication. One way around that is to have
sex more often – the converse of use-it-or-lose-it. Another is
estrogen therapy. For women who prefer not to take hormone pills or
patches, there are estrogen rings and suppositories that deliver the
hormone directly to the genital area and keep most of it out of the
bloodstream.

Estrogen levels decline in the years leading up to menopause.
FALSE. It was long assumed that estrogen tapers off gradually in the
run-up to menopause, and that those lower estrogen levels were
responsible for the hot flashes and night sweats that characterize
that period. Scientists now know that estrogen levels don't begin a
major decline until about a year before menopause. In fact, women in
perimenopause actually have higher overall estrogen levels. The
problem is, there's a lot of fluctuation in hormone levels during
this time. Some experts now believe the flashes of perimenopause are
caused by those ups and downs, but no one knows for sure.

The symptoms of perimenopause disappear after menopause.
PARTLY TRUE. Hot flashes are more common in early postmenopause than
in perimenopause, but they do peter out eventually. Acne and
thinning hair, which sometimes reflect hormonal changes, might stop
after hormone levels settle down. But osteoporosis and vaginal
thinning are more likely to get worse with age, unless you're taking
estrogen. Many women report nonspecific symptoms, such as
irritability or fuzzy thinking, which could be caused by many
different things. If those symptoms go away after menopause, Speroff
says, it could be “because she adjusted to her midlife status.”

Hormone-replacement therapy is bad for you.
NOT EXACTLY. The federally funded Women's Health Initiative reported
in 2002 that Prempro, a popular combination of synthetic estrogen
and progesterone, increased the risk of heart attacks and breast
cancer while decreasing the chance of bone fractures. It concluded
that postmenopausal women should not take hormones for disease
prevention, as opposed to relief from menopausal symptoms, because
the risks outweighed the benefits. But the women in the WHI study
had a median age of 63 and were well past menopause when they signed
up. Later studies showed that hormone therapy actually prevents
heart attacks in women who start close to menopause, rather than
years later. There may still be an increased risk for breast cancer
with combined hormones, but it's smaller than the risk from other
known factors, such as obesity and heavy drinking. (In another WHI
study, taking estrogen without progesterone reduced both breast
cancer and heart attack risk; but doctors usually prescribe estrogen
alone only for women who have had hysterectomies.) Holt says most
women seeking relief from hot flashes “can feel comfortable taking
hormone therapy. And for women with vaginal problems, virtually
everybody can use topical estrogen.” Where doctors start to disagree
is over how long it's safe to take hormones. Holt says: “Many
experts say forever; many others say a year or two; and a handful
say never, because nobody ever died of a hot flash. But I can bet
those are all men.”

Bioidentical hormones are the safest kind of hormone-replacement
therapy.
UNPROVEN. Proponents of bioidentical hormones-compounds with the
same molecular structure as the hormones your body produces – often
imply they are safe because they are “natural.” These products have
been increasing in popularity since the first WHI results were
reported. Advocates of bioidenticals, including actress Suzanne
Somers, were quick to point out that Premarin and Prempro, the pills
used in WHI, contain estrogen synthesized from the urine of pregnant
mares. But experts say there is no scientific evidence that
bioidentical estrogen is any safer. “If you give biologically
equivalent amounts of various estrogens, natural or synthetic, you
can expect the same effect,” Speroff says.

Menopause is bad for your mental health.
FALSE. There are no scientific studies to support the belief that
menopause is responsible for depression, anxiety, severe memory
lapses or erratic behavior. “Menopausal depression is a myth,” Utian
says. Although women with a history of psychological problems may be
vulnerable to a relapse when menopause hits, depression is actually
less common in middle-aged women than in their younger peers. On the
other hand, many women report that hot flashes make it hard to get a
good night's sleep, and sleep deprivation can cause a host of other
problems, including emotional instability.

The hormonal changes of menopause turn your brain to mush.
UNPROVEN. There is some evidence that women with low estrogen levels
experience faster cognitive decline, and women who take estrogen
supplements sometimes do better on certain memory tests. But the
evidence is inconsistent. According to the WHI, women older than 65
who took Prempro had a higher risk of getting Alzheimer's disease
and other forms of dementia than women taking dummy pills. Other
studies, however, have suggested that estrogen use protects against
Alzheimer's if it's started near the onset of menopause. Some
experts now believe estrogen can protect both the brain and the
heart if it's started early, before age-related deterioration sets
in, but not after that window of opportunity closes.

... Fact:  3 out of 5 people aren't the other 2.
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