An inevitable part of aging, menopause is a natural process that happens to every woman, although it affects everyone differently. Some women struggle with severe hot flashes, moodiness and weight gain, while others hardly notice any changes.
But many myths exist about what to expect when going through “the change.”
“It’s important to know your body well enough to know what’s happening,” says Dr. Sheryl Ross, OB/GYN at Providence Saint John’s Health Center in Santa Monica, Calif. Ross refers to changes associated with menopause as “hormonal havoc,” which can begin in the early 40s to around age 55.
Here are six common menopause myths and the fact behind the fiction:
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Myth: Menopause happens suddenly.
Reality: A transition time called peri-menopause refers to the beginning of hormonal shifts leading up to menopause, defined as an absence of menstrual periods for one year.
“During the reproductive years, there’s a rise and fall of hormones, which doesn’t always happen during this period,” says Dr. Nina Athar Ali, a gynecologist with the Menopause Center at Texas Children's Hospital's Pavilion for Women. “Some may notice a tapering off of periods. For most women who go through natural menopause (vs. a hysterectomy or menopause due to chemotherapy), the changes are gradual.”
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Myth: Weight gain is inevitable.
Reality: While many women tend to gain weight after menopause they can, in fact, control it. A 2003 study of 535 premenopausal women who were followed throughout menopause showed the women were able to remain at or below their baseline weight after five years by following a 1,300 calorie diet and burning 1,000 to 1,500 calories a week.
“It does take more effort,” says Ross. “You need to eat about 200 calories less per day to maintain weight after menopause or you’ll see a gradual one- to two-pound weight gain per year. And you have to make exercise a priority.” Weight gain increases heart disease risk, the number one killer of women in the U.S.
Myth: Hot flashes make life miserable for every woman.
Reality: Hormonal shifts trigger hot flashes in the majority of menopausal women — one of the most common complaints. But they vary in intensity and frequency.
“The first two to three years are usually the worst,” says Ross. “Some women have hot flashes only at night while others have them all day long. Doing something about it — or not — depends on how disruptive they are to you.”
Several treatment options may help ease severe hot flashes including acupuncture (which a small study showed significantly helped decrease hot flashes), the prescription anti-depressant medication Paxil and hormone therapy. Exercising, staying well-hydrated and dressing in layers (so you remove an outer layer when necessary) also help.
Myth: You can’t do anything about painful sex.
Reality: A drop in estrogen causes vaginal dryness that can make sex painful. The vaginal walls also become thinner and less elastic, which adds to discomfort. “It can lead to painful intercourse as well as dryness that leads to burning,” says Ross.
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Hormone therapy can help, but the fear of increased risk of heart attack, stroke and breast cancer make this an unattractive option for many women (see No. 5). Local and topical low-dose treatment options such as the vaginal estrogen ring, estrogen cream and vaginal estrogen tablets are additional treatments that also work well to ease discomfort and with less risk than oral hormone methods.
Myth: A definite link exists between cancer, heart disease and hormone treatment.
Reality: Hormone treatment to alleviate or lessen hot flashes and other menopausal discomforts typically involves estrogen therapy (ET) alone, estrogen-progestin therapy (EPT) or bio-identical hormones. Studies vary as to the dangers of an increased risk of heart disease and various types of cancers.
“You have to gauge the risk versus benefits if you have heart disease history in your family,” says Ross. “And if you took hormones for 10 years, your breast cancer risk isn’t really increased. It’s all individual.”
According to the Women’s Health Initiative, women treated with EPT did not develop any increased risk of endometrial cancer compared to women who took placebos. The risk of breast cancer increased only slightly, with eight more cases of breast cancer per year per 10,000 women, although the longer the EPT continued, the higher the risk. Talk to your doctor to decide the best approach for you.
Myth: Menopause means you’re officially old.
Reality: Hot flashes, weight gain and other menopausal side effects can be depressing for some women, but it’s important to keep a positive perspective, says Ali. “Think of menopause as a time of change, a time when you can find out more about what you want out of your life. It’s a new chapter. A lot of it is your own outlook and seeing the glass as half-full.”
Ali suggests making time for yourself by doing yoga, exercise and activities that make you laugh. “Find time to do things that make you happy. There’s a lot of beauty in being a women of experience, something a 17-year-old doesn’t have.”