1. How will my body change as menopause approaches?

Each woman’s menopause experience is different. The greatest differences observed are between women who have natural menopause and those whose menopause is early or induced, which typically requires specialized care. Many women who have natural menopause report no physical changes at all during the perimenopausal years except irregular menstrual periods that eventually stop when menopause is reached. In addition to irregular menstrual periods, some women experience symptoms of hot flashes, difficulty sleeping, and/or vaginal dryness. The severity of these changes varies from woman to woman, but for the most part, they are perfectly natural and normal. In fact, some experts and women prefer not to call perimenopausal changes “symptoms,” a term usually reserved to describe diseases.

2. What are hot flashes?

The most common menopause-related discomfort is the hot flash (sometimes called a hot flush). Although their exact cause is still a matter of speculation, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus mistakenly senses that a woman is too warm, it starts a chain of events to cool her down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. An increased pulse rate and a sensation of rapid heart beating may also occur. Hot flashes are often followed by a cold chill. A few women experience only the chill.

3. How long will I have hot flashes?

Good news! Hot flashes typically stop on their own over time, and may not require any treatment. If treatment is needed, hot flashes can usually be reduced or eliminated completely.

4. What are the treatments for hot flashes?

The best treatment depends on how severe the hot flashes are, how much they interfere with a woman’s quality of life, her personal philosophy and preferences, and her health profile. If treatment is needed, hot flashes can usually be reduced or eliminated completely with lifestyle changes, nonprescription remedies, and prescription therapies. Systemic estrogen therapy is the only therapy approved by the U.S. Food and Drug Administration (FDA)—and Health Canada—for treating hot flashes.

5. Is it safe to take dietary supplements to help my menopause symptoms?

Supplements and prescription drugs have a lot in common. Both are used in an attempt to improve health. But “natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) are missing something their prescription counterparts come with—a Patient Package Insert. This document, required by the U.S. Food and Drug Administration (FDA) for all marketed prescription medications, provides vital information on how to take a drug safely, identify its negative side effects, and avoid potentially dangerous interactions with other drugs.

In Canada, all natural health products require an eight-digit product license number before they can be sold. Homeopathic medicine that is approved will have a license number beginning with NPN-HM, indicating to consumers that the product has been reviewed and approved by Health Canada for safety and efficacy.

When purchasing supplements, it is preferable to choose specific brands that have been tested in clinical trials. Last but not least, proceed with caution. Consulting a healthcare provider is advisable prior to using any supplement.

6. I’m having trouble sleeping and I’m tired all the time. Is this due to menopause?

Some women experience sleep disturbances (insomnia) around menopause, especially if hormone changes provoke hot flashes during the night. Sleep is adequate when one can function in an alert state during desired waking hours. Most adults require 6 to 9 hours of sleep each night. Treatment of sleep disturbances should first focus on improving sleep routine with good sleep hygiene. When lifestyle changes fail to alleviate sleep disturbances, a clinician should be consulted to discuss other options and to rule out sleep disorders, such as thyroid abnormalities, allergies, anemia, restless leg, depression, or sleep apnea (breathing problems).

7. I’ve been having headaches lately. Can this be due to menopause?

Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around menstrual periods or when taking oral contraceptives. Hormonal headaches typically stop when menopause is reached and hormone levels are consistently low. Most headaches do not require treatment or can be treated with nonprescription pain medications. Some headaches, however, can be serious. More serious headaches, including migraines, may require prescription drugs.

8. My memory is not as good as it used to be. Is this aging or is it menopause?

There is no firm evidence that memory or other cognitive skills actually decline because of natural menopause. However, difficulty remembering and concentrating are common complaints during perimenopause and the years right after menopause. More research is needed to determine the cause of these complaints. Although studies are lacking to prove the association, sleep disturbances and hot flashes may contribute to these symptoms, as well as dealing with various midlife stressors. Remaining physically, socially, and mentally active may help prevent memory loss. Women who are concerned about declining cognitive performance are advised to consult with their healthcare provider.

9. Does menopause cause moodiness and depression?

Few scientific studies support the belief that menopause contributes to true clinical depression, severe anxiety, or erratic behavior. However, some perimenopausal women report symptoms of tearfulness, mood swings, and feeling blue or discouraged.

It is unclear whether these mood symptoms are related to the gradual decline in ovarian hormone levels, but sleep deprivation associated with night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may have an impact on these symptoms as well. During their reproductive years, most women become accustomed to their own hormonal rhythm. During perimenopause, this rhythm changes, and the erratic hormonal ups and downs—although normal—can create a sense of loss of control that can be upsetting.

Sometimes, coping skills and lifestyle changes are not sufficient to relieve symptoms of stress. These symptoms may be a side effect of medication, a symptom of a medical condition, or the result of clinical depression or anxiety. A healthcare provider can help determine the cause of mental health stressors, assess options, and prescribe appropriate treatment.

10. I need information about feminine dryness due to menopause.

During their life, at least one-third of all women will experience some troubling symptoms in the vulvovaginal area (external female genitals and vagina). These symptoms range in severity from mildly annoying to debilitating—and include vaginal discharge, irritation, burning, dryness, itchiness, and pain (both with and outside of sexual activity). There are many possible causes of vulvovaginal symptoms. Women around the time of menopause should not assume that vulvovaginal problems are due to reduced estrogen levels. Symptoms should be investigated by a clinician to identify the cause and possible treatment. A thorough, regular evaluation of vulvovaginal health is recommended to all women at menopause and beyond, regardless of whether or not they have symptoms or are sexually active