Menopause and Women’s Midlife Transitions

Today women can expect to live one third of their lives after menopause. Postmenopausal women make up the fastest growing segment of the population with the average woman now living into her mid-80ʼs. Menopause marks the end of a woman’s menstrual cycle and child-bearing years. While it’s a natural transition for women into healthy aging, a wide range of symptoms may affect both physical and emotional health. At Riverwood Healthcare Center, we offer personalized care for women’s midlife transitions.

Our Trusted Team for Menopause

At Riverwood’s specialty clinic in Aitkin, women have access to a team of three highly skilled OB/GYN physicians and surgeons with the Minnesota Center for Obstetrics & Gynecology at Riverwood Healthcare Center in Aitkin and Cuyuna Regional Medical Center in Crosby. All three doctors are National Certified Menopause Practitioners of the North American Menopause Society. They provide evidence-based information and treatment options in a comprehensive manner with one-stop convenience.

Common Menopause Symptoms

The spectrum of concerns, questions and bothersome symptoms associated with perimenopause/menopause are extremely varied. Common consults with our team of gynecologists are for:

  • Bleeding concerns
  • Pelvic pain/pressure
  • Vulvar itching/pain
  • Vaginal dryness
  • Sleep disturbances
  • Hot flashes
  • Urinary or Bowel Incontinence
  • Libido/arousal/orgasm concerns
  • Painful intercourse
  • Weight gain
  • Mood changes
  • Vulvar abnormalities

Frequently Asked Questions

The most common symptom of menopause is hot flashes. About 70 percent of U.S. women will have them. A hot flash is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You may also break out in a sweat. A hot flash may last from a few seconds to several minutes or longer. They happen any time of day or night. They can be mild or severe. Most women experience hot flashes for two years or less, but it is not uncommon for hot flashes to last for many years.

There are some steps you can take to prevent or reduce hot flashes. Some triggers at avoid include stress, caffeine, alcohol, spicy foods, smoking, and heat. Turn the temperature down, especially at night. Exercise helps! Maintain a healthy body weight and use relaxation techniques like mindfulness, yoga and acupuncture. Hot flashes are a nuisance but not harmful to your health.
Menopause does not have to affect your ability to enjoy sexual relations. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sexual intercourse more comfortable. There are a number of over-the-counter lubricants available. Regular sex may help the vagina keep its natural elasticity. If you have not been sexually active for a while, you may want to talk with your partner and perhaps your doctor about ways to make sexual intercourse more comfortable.

Our three OBGYN physicians have expertise in sexual medicine and can evaluate symptoms such as low desire, low arousal, vulvar skin problems and painful sex.
A woman is not completely free of the risk of pregnancy until one year after her last menstrual period. Until this time, if you do not want to become pregnant, use a method of birth control. Keep in mind that you still need to use protection to prevent sexually transmitted diseases (STD’s). If you are at risk for STD’s, use a latex condom.
During the menopausal and hormonal change aging bodies go through, women experience difficulties in their day-to-day activities. The consequences of these problematic physical and mental health issues can cause anxiety, negative relationship issues, low libido and sexual avoidance, and the feeling of being out of control of your body. As women, we tend to think there is something wrong with us and can easily get into a pattern of negative thinking.

Antidepressants and cognitive behavioral therapy are first line treatments for depression. Estrogen itself is not FDA-approved, but it definitely has an antidepressant effect in perimenopausal patients. If you don’t want to take medication or do therapy, exercise is the answer supported by the most data. Healthy eating can help too. Avoid snacking on junk food; aim for regular nutritious meals.
In the perimenopause years, about 90 percent of women will notice a change in their menstrual cycles. During perimenopause, the ovaries are not regularly ovulating (releasing an egg), which can lead to a thickened lining of the uterus. When the lining becomes thickened, it can be shed at irregular intervals. Irregular bleeding should never be considered normal. Most causes are benign, but it’s important to see your doctor for a work-up to determine the cause of irregular bleeding and the best treatment option.

See your doctor if you notice any of the following irregular bleeding: 1) a change in your monthly cycle; 2) have very heavy bleeding; 3) have bleeding that lasts longer than normal; 4) bleed more often than every three weeks; or 5) bleed after sex or between periods. An evaluation may include a pregnancy test, thyroid test, a pelvic ultrasound, pelvic exam and/or endometrial biopsy.
Hormone Therapy (HT) can relieve menopause symptoms. It replaces female hormones no longer made by the ovaries. Depending on your situation, you may begin HT before menopause. If you are taking birth control pills, they will be stopped when you begin treatment. For women with a uterus, estrogen usually is given along with progestin, a synthetic version of the hormone, progesterone. This helps reduce the risk of cancer of the lining of the uterus that may occur when estrogen is used alone.

HT is most often prescribed in the form of pills, injections, vaginal rings or patches placed on the skin. Estrogen creams and tablets used in the vagina can help treat dryness but do not work well with other symptoms.
Like any treatment, Hormone Therapy carries risks. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking progestin along with estrogen will help reduce the risk of uterine problems. The drawback of using progestin is that menopausal women may start bleeding again. Although bleeding may occur only for a short time, man women don’t want to go through having periods again.

There is an increased risk of breast cancer in women who use combined (estrogen and progestin) HT. The increased risk appears to be small, but increases depending on how long a woman takes HT. HT also modestly increases the risk of a heart attack, stroke and blood clots.
Nearly half of all U.S. women over the age of 40 report problems sleeping. In fact, women in midlife report problems sleeping as often as they do with weight gain. Midlife and menopausal women sleep less, report insomnia, and seek help more often than premenopausal women. It’s important to distinguish if the sleep problem is due to menopause or a primary sleep disorder that does not involve menopause symptoms. Sleep apnea is commonly diagnosed in midlife and results in poor sleep quality. The diagnosis of sleep apnea is made through a sleep study.

While menopause does not cause sleeping problems, symptoms of menopause certainly do! Hot flashes occur more often at night and result in disrupted sleep/problems getting back to sleep. Anxiety is another menopausal symptom that widely affects women at midlife who are often juggling a lot of responsibilities between raising children and caring for aging parents.

What can be done for sleep problems? Treating hot flashes for some women is all that is needed. If mood swings, depression or anxiety are part of the woman’s history, vitamin B or magnesium helps some as do other prescription medications. Nonprescription and prescription remedies exist but are not part of a good long-term care plan. If you increasingly rely on medicines such as Tylenol Pm or Rozarem to get a good night’s sleep, you should see your healthcare provider.
As your estrogen levels decrease, changes take place in the vagina. Over time, the vaginal lining gets thin, dryer and less flexible. Some women have vaginal burning and itching. The vagina also takes longer to become moist during sex. This may cause pain during sex. Vaginal infections also may occur more often.

The decrease in estrogen may thin the lining of the urinary tract and weaken supporting tissues. This can cause women to urinate more often. Also, the bladder may become more prone to infection. When the tissues get weak, some women may leak when they sneeze cough or laugh. This is known as stress incontinence. Some women get this problem even before perimenopause because their tissues have been stretched by childbirth. If you notice a loss of bladder control, tell your doctor. It often can be treated.
A small amount of bone loss after age 35 years is normal in all women and men. It usually does not cause any problems. However, bone loss that happens too fast can result in osteoporosis. Osteoporosis causes bones to become too thin, which can result in a break and disability.

Hormone Therapy can slow or stop bone loss. For women who cannot take estrogen, there are other medications that may help. Calcitonin is one that slows bone loss. A group of medicines called biophosphonates have been shown to increase bone density and reduce fractures.

To prevent osteoporosis, you should focus on building and keeping as much bone as you can before menopause. You can do that by getting plenty of calcium and exercise.

Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need, 500 mg per day. Milk fortified with vitamin D is a good source as well as yogurt, cheese, ice cream, seafood and vegetables. Vitamin D helps the body absorb calcium. A woman should take the recommended daily amount of vitamin D, which is 400-800 international units.

Regular weight-bearing exercise is best to strengthen bones and slow bone loss. Brisk walking is good. So is aerobic dancing, stair stepping, tennis and running. Lifting weights also improves bone strength.