Perhaps no other decade of a woman’s adult life involves as many drastic changes in her health as the age of 50.
The average age of menopause in the US is 51 years, and both menopause and the years leading up to it involve changes in almost every system in a woman’s body. But many women are surprised by the changes that will occur and how to manage them.
“Most women don’t know what to expect before it happens,” says Asima Ahmad, a reproductive endocrinology and fertility specialist and medical director of Carrot Fertility in the United States: “Then, even when symptoms start to appear, they don’t have really a high level of understanding about the differences between perimenopause and menopause.
Menopause is when a woman has not had a period for at least a year. Perimenopause is the period before menopause, when women begin to experience symptoms associated with the gradual decrease in estrogen production.
“Every person’s journey is a little different,” Ahmad says. The average number of years a person is affected is 7.4, but in some women it lasts between 14 and 20 years. More importantly, it is also a key period of change in women’s cardiac and metabolic health.
“Menopause is an inevitable part of life, and I really see it as another window into future cardiovascular health,” says Kathryn Lindley, a cardiologist at Vanderbilt University Medical Center. Women may seek care for perimenopausal and menopausal symptoms, “but that’s also when their cardiovascular risk factors really start to increase,” Lindley says. “We start to see blood pressure go up, weight go up, blood sugar go up, cholesterol go up, and there’s really an acceleration in the risk of things like heart attacks, heart failure and stroke.”
Heart attacks can be perceived differently in women than in men, so it is important to familiarize yourself with heart attack symptoms in women. Stroke is an even greater risk in women than heart attack, so you should be aware of those signs as well.
Fortunately, there are many treatments for most menopause symptoms and to reduce the risk factors for cardiovascular disease.
“It’s not like one thing is going to work for everyone,” Ahmad says. “Sometimes it takes a little trial and error. The really important thing when it comes to treatment options is finding the right provider.”
Many women are lucky enough to feel comfortable discussing perimenopause symptoms with their primary care doctor. But Ahmad’s company, Carrot Fertility, found last year that one in three women surveyed said they had never discussed menopause with their doctor. It’s worth starting those conversations early so you can determine if your doctor will be able to meet your needs.
“If your doctor isn’t comfortable with menopause treatment, or if you’re looking for a more personal experience, you can start looking for someone else sooner,” Ahmad says.
Despite all the changes that women in their 50s face, it’s helpful to know that they don’t last forever.
“I try to impart to patients that, for most women, perimenopause is a finite period of time,” says Angela Wilson, and OBGYN at Montefiore Einstein Advanced Care: “At some point, you get to the other side and the Things are starting to level out a little bit.
The first thing that comes to many women’s minds when they hear “menopause” is “hot flashes.” But perimenopause and menopause can involve a much wider range of symptoms than women realize.
“There are changes in energy levels and fatigue, there is brain fog and difficulty concentrating, there are problems falling asleep and staying asleep, there is depression, there are changes in the distribution of body fat, there is hair loss, changes in skin and changes in bone mineral density,” says Ahmad.
Mood symptoms can be a consequence of other symptoms or appear independently.
“There are many emotional symptoms that can accompany menopause, such as increased irritability and an increased risk of depression and anxiety,” says Wilson. In addition, the loss of estrogen can cause vaginal dryness, which affects sexual relations. Between 17 and 45% of women report feeling pain during intercourse at this time, although the proportion may be even higher if it is not reported. Vaginal dryness happens to everyone, says Wilson, “but often women are surprised when they start experiencing it.”
Not all women will experience all of these symptoms, but they are common for millions of women.
Since many changes occur due to the loss of estrogen in the body, hormone therapy can be an important treatment option. Unfortunately, the misinterpretation of an influential 2002 study led to years of confusion, misinformation, and unfounded fears about hormone therapy. It is true that hormone therapy is not suitable for all women and that it carries both risks and benefits, like any treatment, but for the vast majority of women, the pros outweigh the cons throughout their fifties.
But hormone therapy is not a panacea either.
“For many people, it will be a combination of hormone therapy and other treatments,” Ahmad says. These include vaginal lubricants, alternative hot flash therapies such as selective serotonin reuptake inhibitors (SSRIs), or lifestyle modifications such as wearing cooler clothing and limiting foods that exacerbate symptoms.
Cognitive symptoms may be especially worrying for women at first, especially if they have a family history of dementia. So how do you know if your difficulty concentrating or remembering things is menopause or the first signs of early dementia?
“If it’s affecting your daily life, your job, your family life, or your ability to do everyday activities, there may be a problem that needs to be addressed,” says Jorge Ruiz, a geriatrician at Memorial Healthcare System in Hollywood, Florida. US): “If it’s annoying, but you can still do everything you personally need to do,” then there’s no reason to worry.
Finally, postmenopausal women begin to lose bone and muscle mass while gaining fat, says Lindley. “So it’s important to continue doing weight-bearing exercises, both to maintain muscle tone and to maintain bone mass.” But you also have to be aware of the risk of injury, he adds. Lindley recommends patients use lighter weights with higher repetitions to reduce the risk of injury, and some women may have to choose to cycle or swim instead of running for cardiovascular health.
Ahmad recommends having a baseline bone densitometry done early in perimenopause so you can see what changes start to occur over time. Women can also protect their bone health with strength exercises and by making sure they get enough vitamin D and calcium.
Wilson says her priority when talking to women in their 50s is to examine their cardiovascular health and screen for diabetes, hypertension and high cholesterol.
“I really try to advise patients to take a good look at their lifestyle at the time,” Lindley says. “If you didn’t exercise before, you really have to do it. If you didn’t eat well before, now you really have to change your diet.” It usually recommends a Mediterranean diet rich in fruits and vegetables, whole grains and lean meats, such as fish and poultry, and low in fats, sugars and processed foods.
Although many women are aware that menopause can be accompanied by weight gain, Wilson emphasizes that this is a general change in metabolism.
That is why exercise and good nutrition become even more important.
“We know that a healthy diet and exercise should be the cornerstones of heart health, so even if the scale doesn’t move, those habits help maintain cholesterol, blood sugar and blood pressure, and keep people living longer. more,” says Lindley.
Cardiovascular health is also inextricably linked to brain health, so maintaining healthy blood pressure also protects the brain in the long term, says Lindley.
Lifestyle modifications that help keep blood pressure low include avoiding excess salt in the diet, exercising regularly, losing excess fat, and treating sleep apnea if diagnosed.
“If these lifestyle changes don’t get your blood pressure where it should be, it’s very important to treat it with medication, because untreated hypertension, even if you feel fine, has pretty serious cumulative effects on your heart, brain, and body.” kidneys,” says Lindley.
Cancer reviews from previous decades continue, with one or two more, depending on risk factors:
4) Lung cancer screening begins at age 50 for people who smoke or have quit smoking within the last 15 years and have a history of severe smoking (for example, one pack a day for 20 years or two packages a day for 10 years).
5) Although the U.S. Preventive Services Task Force has not found enough evidence to recommend routine skin cancer screening, April Armstrong, a dermatologist at the University of California, advises an exam every year or so because starting in 50 precancerous and cancerous skin lesions may begin to appear, especially in patients with light skin.
Unfortunately, menopause can interfere with many basic wellness needs, such as sleeping well and managing stress. Menopause-related weight gain, for example, can sometimes lead women to develop obstructive sleep apnea. If you don’t feel rested after a full night’s sleep, or you snore or wake up with a headache, consider getting evaluated for sleep apnea.
Other habits remain to maintain general well-being:
1) Ask your ophthalmologist how often you need an exam if you don’t have symptoms or wear corrective glasses.
2) Continue with dental cleanings and checkups twice a year.
According to Armstrong, the hormonal changes of menopause can also cause dryness and loss of elasticity in women’s skin, as well as an increase in wrinkles. If you haven’t yet started using a retinol or retinoid in your nighttime skin care routine, now is the time to start undoing some of the sun damage on your skin.