Menopause: It’s Much More Than Hot Flashes

Ask Google to name the most common symptom of menopause and you’re going to get “hot flashes” in response. Certainly that’s what most people think of most often, but there’s much more to menopause, and the specifics can range widely from person to person.

“Menopause is not just one set of symptoms,” says Kristin Friel, MD. “The menopause experience is unique for each woman.”

Dr. Friel specializes in gynecology at Lehigh Valley Health Network (LVHN), in addition to serving as Vice Chair of Education for the Department of Obstetrics and Gynecology. She’s been in practice for more than 25 years and notes that menopause “is having a moment right now.” Significant articles on the topic published recently in places such as The New York Times and Ms. Magazine illustrate her point. In addition, social media and podcast content creators provide a flood of information. Yet, for many women, there is a lot to read and filter through in order to understand what makes sense for their specific situation and constellation of symptoms.

Dr. Friel describes the various issues and symptoms of menopause as being divided into two basic phases. The first includes vasomotor symptoms or hot flashes, irregular heartbeats, joint pain, brain fog, sensitivity to temperature, fatigue, loss of libido and other bothersome concerns. The majority of these symptoms will pass in time, although it can take several years for some. And if you’re especially worried about brain fog, Dr. Friel has good news:

“Brain fog will often get better with time, and it is NOT a marker for dementia in the future, as some fear.”

Unfortunately, the news is less upbeat for the issues in phase two, which pertain to the condition of a woman’s anatomy, particularly the vulva, vagina and bladder.

“The second phase can be chronic and progressive,” Dr. Friel says.

As estrogen decreases in a woman’s body, these organs suffer. For example, the bladder loses elasticity, leading to the need to urinate more often, including in the middle of the night. Some women may feel increased urgency and/or find it hard to control urination. Vulvar skin tissues will thin and lose fat. Hair growth will decrease. The vagina can atrophy, narrow and become more sensitive. Penetrative vaginal sex often becomes painful, as lubrication decreases.

Dr. Friel wants to be sure women don’t overlook these common symptoms of menopause.

“We need to remind women to pay attention to their vulvas, vaginas and bladders,” she says.

The good news is that phase two issues can be easily treated and managed with localized hormone therapy and minimal risk, according to Dr. Friel.

Hormone therapy is primarily about supplementing declining levels of estrogen. In addition to addressing symptoms of menopause mentioned above, estrogen also helps prevent osteoporosis and may possibly benefit heart health and brain health.

Other important hormones that decline with menopause are progesterone and testosterone. Progesterone is used in menopause to mitigate estrogen’s effects on the lining of the uterus. Testosterone can improve a woman’s libido, and some studies suggest it is a benefit to mood and energy levels. Currently there is no Food and Drug Administration (FDA)-approved testosterone product for women, Dr. Friel notes.

“To provide testosterone, we give women the male drug using a transdermal gel and then we carefully monitor blood levels to make sure patients don’t use too much,” Dr. Friel says. Too much testosterone in women can cause unpleasant side effects such as acne, unwanted hair growth, male-pattern baldness and mood changes.

Who could benefit from hormone therapy? Dr. Friel says that about 60 percent of menopausal women would, yet few get the treatment or are offered treatment that might help them.

“Less than 10 percent of women who are candidates for hormonal treatment take hormones,” she says.

“Of course hormone therapy will not cure everything, and not every woman is able to take estrogen,” Dr. Friel adds. There are some non-hormonal, FDA-approved medications available. These are primarily for vasomotor symptoms. Women who are interested should discuss them with their clinician.

What else does Dr. Friel advise?

“At menopause, take time to reflect on where you are in life. Consider how to chart a course for good health through the rest of your life. Commit to the lifestyle changes — good nutrition, movement with a focus on strength training, restorative sleep and stress management. Having a strategy to optimize lifestyle factors is paramount during this second act. Remember that you will be in menopause for the rest of your life.”

Dr. Friel also advises women to be wary of supplements and unnecessary testing promoted in the media.

“Watch out for solutions marketed widely on the internet,” she says. “Lots of people are selling stuff, and women want to feel better, but too often they are being taken advantage of.”

Dr. Friel also has advice for the partners of women facing menopause:

“Get on board with the biological changes. Be supportive, be curious, be patient. We owe women the time to talk about how they are feeling.”

To learn more about menopause and the associated conditions and treatments, women should talk with their primary care clinician or gynecologist.