Know How to Handle Menopause

At age 48, Jennifer feels like she has the world by the tail. She’s excited about the latest expansion of her small import business she co-owns with her husband. She recently completed a term as president of the local chamber of commerce, and her alma mater honored her as an outstanding alumnus. She seems to successfully juggle all the inevitable stresses that come with a two-career marriage, children and aging parents.

But image5.jpg (17306 bytes) less than a year after the business expansion,
Jennifer feels much more tired than usual. Sometimes
she wakes up exhausted after a seemingly good night’s sleep. Thus she’s finding it harder to get to work on time. Jennifer struggles to stay on top of her busy schedule.
Her mind feels unusually dull, and she can barely
express herself in meetings. She can’t remember as well as she used to, so she jots down notes about everything.

To compensate, Jennifer works longer hours and accepts more difficult projects rather than delegating them to her staff. But then she feels more tense and irritable. Her constant muscle tension and an occasional energetic buzz remind her of a caffeine high. Personally, Jennifer’s menstrual periods have become less predictable and more frequent. She experiences occasional hot flashes and vaginal dryness, making intercourse uncomfortable.

But it’s only after her husband and colleagues begin commenting about her moodiness and difficulty concentrating that Jennifer finally visits her doctor. She’s afraid she might have Alzheimer’s or some other illness. Thankfully, her doctor reassures her that it’s just the early stages of menopause. This diagnosis comforts Jennifer, whose older sister and mother both went through menopause around age 50 without much inconvenience.

Her doctor starts estrogen replacement therapy. Almost immediately Jennifer feels a difference in the quality of her sleep. Her periods become more regular and her vaginal secretions return to normal. Much to her relief, her mind regains its previous sharpness.

Jennifer’s mental, emotional and physical symptoms are not unusual for women approaching menopause. In fact, most women know the physical changes that occur during their late 40s or 50s will produce hot flashes. However, fewer women know that lower estrogen levels can significantly interfere with their mental functioning and sleep. The lack of estrogen can decrease both the deep, restorative sleep known as rapid eye movement (REM) sleep and sleep duration.

Estrogen also directly affects the brain’s ability to function well. It regulates many other brain chemicals, including those known as neurotransmitters. These chemicals connect the nerve cells, helping them communicate. In addition, estrogen affects the metabolic functioning of nerve cells, so it plays a key role in hot flashes, cognitive changes, mood fluctuations, anxiety and other symptoms of menopause. Thus menopause is primarily defined by estrogen deficit.

Within a few weeks of starting a low to medium dose of estrogen, most symptomatic women will begin sleeping better and feeling more rested. They’ll also discover their concentrating improving and their moodiness decreasing. If improvement occurs too slowly or less extensively than desired, further evaluation and possibly a higher dose of estrogen may be needed.

In menopausal women like Jennifer, estrogen replacement therapy (ERT) has improved verbal memory, language, abstract reasoning and mood. And ERT often provides similar benefits for women who’ve undergone a radical hysterectomy (removal of both ovaries and the uterus). In addition, preliminary research suggests that ERT can reduce the risk of Alzheimer’s disease and may improve cognition in women already diagnosed with it.

Although not every woman develops all these symptoms at menopause, it’s important to know your treatment options and to have a strong relationship with a doctor you trust. When you can document symptoms and your doctor takes them seriously, you can speed up treatment.

Women nearing menopause can benefit from getting plenty of rest, exercising regularly, eating nutritious meals and reducing their intake of sugar, caffeine and alcohol. Knowing how to handle menopause can save you a lot of headaches and many sleepless nights down the road.