DR. HOOK- Hot topic: Menopause brings host of changes

"I'm a girl and by me that's only great. I enjoy being a girl!" Go, Flower Drum Song! In that Rogers & Hammerstein song, Nancy Kwan sings about all the great things women get to do that are fun and sassy. I tell you, the ladies have all the fun: hair, makeup, shoes, clothes– and accessories. 

So is menopause cruel payback time for all this fun?

Menopause is a subject of interest to many women. "Dr. Hong, why don't we talk more about menopause? It's ruining my life, and my husband doesn't seem to understand." (Do husbands really understand anything? Just a question.)

Menopause means no more menstrual periods, semicolons, colons, or question marks. The bleeding stops for 12 months, and it's a done deal. Celebrate! or Celebrate? Average age is 51 years for menopause. Five percent of women experience menopause between the ages of 40-45, and five percent after 55. 

Early menopause starts with a change that throws the menstrual cycle off by more than seven days of normal. The ovaries are beginning to retire, and that's what causes the shift in the cycle. In the first five years after the final menstrual period, hot flashes are pretty common– but some women can be vulnerable to having them for from one to five years (though for a small percentage of unfortunate ones, for life). During this phase, bones thin at an accelerated pace, so calcium, vitamin D, and weight-bearing exercises are a good thing.

As menopause kicks in for real, two or more cycles are skipped, resulting in no periods for 60 days or more. A woman might worry she's pregnant (always a possibility), but 75 percent of women will have hot flashes– heat arising from the chest and spreading out– and sweating, palpitations, maybe followed by chills.

In full-fledged menopause, there are no more menstrual periods for 12 months after the final period. The ovaries don't produce any more eggs and stop secreting estrogen.

Once it's over, for many women, the hot flashes abate. But other symptoms can occur. Let's talk sex. I can't count the number of times I've heard postmenopausal women say, "I'm done with sex."

That's like saying, "I'm done with riding roller coasters." The interest and the excitement is gone. There are numerous reasons for lost interest, but part of it might be from atrophic vagina– meaning a withering vagina. So sexual intercourse is as pleasurable as being dragged across gravel. Also the nerves supplying the area can be affected to decrease sensation, making feelings lukewarm to cold.

Also the waning vagina often leads to urinary incontinence because the bladder and urethra don't have the support they used to have. So bladder infections as well as vaginal infections are more common.

Mood swings, in particular irritability, are common complaints during the whole menopause experience. Many factors are related to depression and mood swings, including dealing with entering a new stage in life. It doesn't help that poor sleep often occurs with menopause, especially from waking up with hot flashes. Thinning hair to increased wrinkles also can affect self-esteem in some women going through this change in life. 

Dementia? It might be related to low estrogen. I do have quite a few patients say their memory isn't as good as it used to be while going through menopause– although that can be mood related. One main issue is women catch up to men in cardiovascular disease after menopause. 

Estrogen replacement therapy? That's for a whole other article. It has its pluses and minuses, and depends upon the individual. I wonder if Menopause, The Musical addresses this. 

I'm telling you, singing and dancing make everything better. 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.



I suspect there's an editing error in this article. I think Dr. Hong means to say hot flashes are common five years *before*, not "after," the final menstrual period, and then continue one to five years following the last period. Otherwise, the next sequence of sentences makes no sense. And as one who is sweating through perimenopause, I know from experience that it can get mighty hot even though my cranky clock is still ticking along.

Dr. Hook,

Some of the symptoms sound so familiar. I'm 53 and experiencing most of this.I had a hysterectomy at the age of 30 but did not start menopause right away (Thank God). I do have the heart palpitations and frustration, especially while I'm experiencing a hot flash. My Dr. is sending me to a cardio to check it out. My Mom and grandma had heart disease. I'm not currenly taken vitamins or any HRT replacetment if I started would this help? My memory is decreasing. I can't think sometimes of things or names I've known for decades. My husband has done some reading on Menopause so he's very understanding.