All you need to know about menopause

Womenopause: Stop Pausing and Start Living by David C. Miller and Lovera Wolf Miller is a handbook about modern menopause. The authors provide quizes and concrete suggestions as to how women can attain the best quality of life for the rest for their lives. The book covers diet, exercise, supplements, and hormone replacement. Every woman over 40 should put this book on her must-read list.

 
DD: Why did you write this book?
Doctors: Menopause is our passion. Lovera has been lecturing about menopause since she began private medical practice in California 30 years ago. It is an enduring medical topic with tons of new research every month. How women navigate through their midlife has tremendous long-term health consequences. The majority of information available to women through popular media is incomplete at best, and often, presents views not shared by the leading menopause experts. Our book reflects both the latest medical research and our professional experience.
 
DD: What is the difference between menopause and peri-menopause ?
Doctors: Menopause is the “pausing” of “menstruation” or more simply, the final menstrual period. Many use the term loosely to refer to the menopausal transition years but we always use it to denote the final menstrual period. The 10 or so years leading up to the final period are defined by irregular periods (early, late, heavy, light, skipped) and are called perimenopause. By convention, because the periods are irregular, a woman cannot easily know her final period. Therefore, there has to be one full year of no periods before one can say that the “final” one occurred a year ago. “Peri” means around so perimenopause surrounds menopause — several years before menopause and exactly one year after the menopause. All of the years (hopefully many!) following menopause are termed post menopause. We don’t like the term post menopause very much; therefore, we usually call it the UpSide. During perimenopause, the ovaries lose their rhythmic cycling and secrete estrogen erratically. It is the dramatic high and low blood levels of estrogen that triggers the common menopausal symptoms: hot flashes, hot flushes, hot dreads, night sweats, drenched nightgowns, insomnia, meno-fog, mood matters and the like. These problems may recede during post menopause — but not always. Twenty percent of women suffer from hot flashes indefinitely.
 
DD: How does menopause – or perimenopause – affect mood and concentration? Can you explain the term menofog?
Doctors: Estrogen has immense effects on brain. The withdrawal of estrogen that occurs during perimenopause gives rise to several distinct problems. Estrogen influences important neurotransmitters such as serotonin and dopamine that have important roles in mood regulation. The usual perimenopausal mood changes are like PMS only not predictable any more, and persistent. It is not exactly depression that most menopausal women have (although certainly some women who have had problems with depression in the past are significantly more likely to suffer from recurrent depression during perimenopause). We refer to it simply as mood matters.
Estrogen also strongly affects the area of the brain called the hippocampus. The hippocampus is intimately involved with memory formation. Post menopausal women who choose to take estrogen retain a normal volume of hippocampal neuronal cells, whereas women who do not take postmenopausal hormone therapy have a demonstrated shrinking of the hippocampus. This correlates with the incidence of dementia in older women. Women who take postmenopausal estrogen have over a 60 percent reduced risk of developing Alzheimer’s disease. We refer to the mild memory lapses that many perimenopausal women experience as “menofog.” Menofog is walking into a room and forgetting why you went there.
 
DD: Does menopause cause weight gain?
Doctors: It is a well established fact that American women gain weight as they age, beginning in their mid-20s. It accelerates during perimenopause and beyond. Weight gain, however, is not an inevitable consequence of menopause, and menopause per se cannot solely be blamed as the cause. The cause, as everyone ought to know by now, is consumption of uncompensated calories — eating more than we burn. Reducing caloric intake and increasing physical activity can control this. In our book we hit those very important topics with both medical science and practical advice. As an example, we recommend not dieting. We recommend putting real food into the diet instead. It’s not rocket salad — it’s not complicated; real food is anything God put on the planet for us to eat. Real food does not have any kind of label on it. We recommend everyone ask themselves two questions before they eat anything: 1) Am I hungry? 2) Did my great grandparents eat this kind of food? We recommend committing to a life-long habit of physical exercise. Exercise is better for mood than Prozac, better for sleep than Ambien, and better for the waistline than liposuction.
Estrogen is not a weight loss miracle. Estrogen does, however, reduce belly fat, which turns out to be the most metabolically-destructive kind of fat. If two women eat and exercise exactly the same way, the one who uses postmenopausal estrogen will have a trimmer waistline. If anyone thinks they can be healthy by taking estrogen and just sit on the sofa, sip soda, and eat chips, while watching TV, then they will be sadly disappointed. It won’t work.
 
DD: Can bone loss be avoided or is it inevitable?
Doctors: Bone loss dramatically accelerates at menopause and is a significant public health issue. It turns out that more women die from complications of fractures due to weak bones — 50,000 per year — than die from breast cancer — 40,000 per year. No one seems to take bone health seriously enough. Bone strength is maintained by activity (walking), diet (calcium, and vitamin D), and estrogen. Osteoporosis is completely avoidable.
 
DD: Do women often experience symptoms during peri/menopause that interferes with their quality of life, but because the symptoms are not classic hot flashes, they do not think to seek help?
Doctors: Yes! It never ceases to be amazing how women interpret their menopausal symptoms differently. That is why in our book, we include a “wScore” to get a better handle on bothersome menopausal symptoms that many women do not think to relate to their perimenopausal hormone changes. Many women do not experience what would traditionally be called a “hot flash,” but do report drenched nightgowns. Some women just feel a flush, or an unpleasant warmth across their neck and face, while others experience an emotionally driven hot dread, others just feel the sweating and not the hot part, while still others are not annoyed so much by the heat but rather by the cold crash that follows. Some women are flashing only at night while they are sleeping and only notice insomnia as their menopause symptom. All of these symptoms are part of the vasomotor dysfunction that occurs when estrogen production is erratic. For many women, these symptoms can be quite debilitating, destructive, and greatly interfere with their quality of life.
 
Many other symptoms of estrogen withdrawal (perimenopause) and estrogen deficiency (UpSide) are linked to menopause: particularly vaginal dryness. Estrogen is required for the vagina to retain its’ elasticity, lubrication, and sensory feedback for sexual arousal. Menopause can, through a lack of estrogen, disrupt a woman’s sexual satisfaction and hence disrupt couples’ relationship. Estrogen is a major factor in arthritis, wrinkles, hair loss, urinary bladder dysfunction, and belly fat.
 
One might still say that hormone therapy is not “necessary” because no one ever died from hot flashes or mood swings. However consider the evidence: hormone therapy for menopause, begun during the “window of opportunity” (ages 40 to 60) significantly reduces the risk of heart disease by 40 percent (the #1 killer of women); hormone therapy for menopause reduces stroke, dementia, osteoporosis, and depression. In fact, compared to women who choose not to take hormone therapy, those women who do take menopausal hormone therapy have a 40 percent reduction of all cause mortality. Women who choose menopausal hormone therapy have a greater quality and quantity of life. When hormone therapy is combined with optimal lifestyle commitments, then wow, the best chance of healthy aging occurs.
 
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