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Coming to terms with menopause

A new book, “Is It Hot in Here? Or Is It Me?,” explores this change of life.
/ Source: TODAY

In the second part of our special series, “Not Your Mother’s Menopause,” we take a look at a survival guide for menopause. If you are a woman in your early 50s, your body is most likely going through a hormonal balancing act: You’re hot, you’re cold, you’re cranky, and you’re itchy. But you can be prepared for these changes. TODAY talked with two Newsweek writers, Barbara Kantrowitz and Pat Wingert Kelly, about their book, “Is It Hot in Here? Or Is It Me? : The Complete Guide to Menopause.” Read an excerpt:

Chapter 1
What’s Happening?
Your last period was shorter than usual. Or maybe it was longer. Somehow, the flow seemed a little different. It could be nothing — or it could be the first sign that you’ve entered perimenopause, the years before your last menstrual period. A few lucky women have regular periods to the end and then, almost overnight, no more tampons. But for most of us the transition takes four to six years. The journey may be marked by subtle changes that only the most attuned woman would notice, or it can be a bumpy ride. If it’s the latter, you may struggle with a variety of symptoms: irregular bleeding, hot flashes, sleep problems, moodiness. You may wonder if you’ll ever feel like your old self again. Understanding what’s going on with your body is the first step toward being back in control.

What You Need To KnowRemember when you were 13 and your girlfriends shared their complaints of menstrual aches and pains with you? Around that time, you probably realized that not everyone’s periods were the same. After the initial shock of menstruating passed, some of your girlfriends hardly noticed a thing. Some got on a regular schedule pretty quickly, while others were so erratic they never knew when their “friend” would surprise them. Others were constantly popping aspirin for cramps, while a few of your pals were really troubled by premenstrual syndrome and were difficult to live with for about a week each month. Lots of other girls fell somewhere in between. In some respects, menopause is back to the future, because it often includes many of the same experiences in as wide a variation as menstruation. Just look at the chart on the facing page, and you’ll see how little difference there is between the cycles of early menstruation and those of the menopause transition.

Natural menopause starts without your intervention; that’s why it’s sometimes described as “spontaneous.” You might detect the first subtle hints of what’s coming (slight changes in menstrual duration and flow) 10 or more years before your periods stop. As you get closer to the end of your reproductive years, the timing may become more unpredictable and the level of flow may be unusually heavy or almost nothing at all. Some women experience problems like hot flashes (overwhelming waves of heat), night sweats, sleeplessness, less lubrication when sexually aroused, and moodiness as their hormone levels become increasingly erratic. All of these experiences are considered normal. You won’t know for sure that you’ve reached menopause until you go a full year without a period. This can happen at any age from 40 to 58, although the average age is 51.4 years.

A few women don’t reach menopause until they’re in their 60s.

Induced menopause, which can occur at any time after puberty, describes what happens to a woman whose periods have stopped because of some outside intervention such as chemotherapy, pelvic radiation, or the removal of both ovaries (sometimes as part of a hysterectomy). With chemotherapy and radiation, the perimenopausal transition can last for months. Sometimes fertility ends immediately. The most common type of induced menopause is surgical menopause, which occurs when both ovaries are removed. As a result, your body’s main source of natural estrogen disappears immediately. This abrupt drop in hormones increases the likelihood that you’ll experience menopausal symptoms such as hot flashes and verbal memory problems.

Premature (or early) menopause refers to any type of menopause (natural or induced) that occurs before age 40. While rare, premature menopause puts women at greater risk for bone loss.

Timing Is EverythingQ: I was surprised to learn that natural menopause typically occurs between the ages of 40 and 58. That seems like a really wide time span. What determines whether it happens early or late?

A: How many follicles (egg sacs) you were born with and the rate at which they deteriorate play a role. So does your lifestyle. Heavy smokers, longtime smokers, and current smokers reach menopause approximately a year and a half earlier than average. The same is true for women who have been treated for depression, epilepsy, or childhood cancer (specifically with pelvic radiation and certain anticancer drugs called  alkylating agents) or who have been exposed to certain viruses or toxic chemicals. According to a few studies, heavier women and women with higher childhood cognitive test scores may reach menopause later than the average age. Women who have used supplemental estrogen (in oral contraceptives, for example) in the previous five years also tend to reach menopause later. The length of your menstrual cycles may give you a hint of what’s coming. Women between the ages of 20 and 25 whose cycles are completed in 26 days or less tend to have an earlier menopause than those whose cycles last 33 days or more. If you’ve been pregnant more than once, you may have a slightly later menopause. If you’ve never been pregnant, you may have an earlier menopause. Here are some things that don’t appear to affect the timing of your last period: the age when you started menstruating, race, marital status, and socioeconomic status.

When to See the DoctorIf you experience any of these symptoms, check with your physician:

  • Very heavy bleeding with clots, or periods that last a week or more
  • Frequent spotting between periods
  • Bleeding with pain or fever
  • Blood in your urine or pain when urinating
  • Abrupt cessation of periods
  • Symptoms like hot flashes, night sweats, and erratic bleeding that are interfering with your ability to function
  • A missed period that could indicate pregnancy
  • Any bleeding that occurs after one year of no menstrual periods

The Stages of MenopauseFor a long time, doctors talked vaguely about different stages of menopause. Then, in 2001, a panel of experts from the National Institutes of Health, the North American Menopause Society, and the American Society for Reproductive Medicine convened the Stages of Reproductive Aging Workshop (STRAW) to develop a more formal description of female progression from puberty all the way to postmenopause.

While the STRAW model seems to imply a predictable transition from the reproductive years through perimenopause to postmenopause, women’s real-life experiences actually vary tremendously. Soon after these stages were announced, the TREMIN Research Program on Women’s Health (the oldest ongoing study of menstruation in the country, now based at Penn State) examined the menstruation diaries of 100 of their participants to test the assumptions put forward by STRAW. After reviewing up to 12 years’ worth of records for each woman, the researchers found that the women followed 23 different patterns as they approached menopause. While most did follow the basic linear progression outlined by STRAW, many women flip-flopped between stages, stalled in one stage for a long time, or skipped a stage. Some skipped several stages. Others continued to have regular periods until one day when they stopped for good. A few postmenopausal women even crossed back over into perimenopause. So if your progression through perimenopause doesn’t look like the STRAW model below, you’re far from alone.

Excerpted from “Is it Hot in Here? Or Is it Me?” by Barbara Kantrowitz and Pat Wingert Kelly. Copyright 2007 by Barbara Kantrowitz and Pat Wingert Kelly. Permission granted by