Menopause is natural, inevitable…and potentially a very unpleasant experience.
While almost every woman will experience menopause in later life, it doesn’t always go the way it’s supposed to. Sometimes, it comes earlier or later than expected. In others, it causes a whole host of issues, from unpleasant sex to heart problems.
Even in healthy, “regular” menopause, women are told to expect an increased risk of cardiovascular problems, hot flashes, and cancer. And though it’s a natural result of aging, it seems to make the process harder than it should be.
So, we’re here asking the hard questions: What gives? Is there a link between menopause and aging? And what can we do to slow down the wheel of time?
From Peri-menopause to Post-menopause: A Time of Transition
When you think about menopause, you probably picture Grandma tearing off her coat in the middle of a hot flash. But many symptoms we associate with menopause actually occur in the younger years – the so-called “menopause transition”.
Step 1: Peri-menopause
Peri-menopause is the first step in the menopause experience. It can hit anywhere from your mid-40s to your mid-50s, sometimes a full decade before you reach “true” menopause.
The menopause transition begins in your ovaries. These reproductive glands store and release eggs every month and produce hormones like estrogen, progesterone, and testosterone. You need these hormones to regulate your menstrual cycle, calcium use, bone health, and even blood cholesterol levels.
But in peri-menopause, your ovaries start producing less oxygen. Ovulation (egg release) tends to become erratic, starting and stopping at random. Your menstrual cycle will shift, too, lengthening, shortening, or varying in blood flow. You may also experience some of the classic symptoms of menopause:
- Hot flashes and night sweats
- Mood swings
- Heart palpitations
- Vaginal dryness
- Libido changes
- Trouble with concentration or memory
- Insomnia or shifting sleep patterns
- Joint and muscle aches
Because menopause is caused by hormonal shifts, the symptoms can be incredibly varied and unpredictable. While some women experience only mild symptoms and discomfort, others may require medical intervention to wrangle discomfort or health risks.
Then, in the 1-2 years before you hit true menopause, your estrogen production falls off a cliff. While you’re still fertile, you’ll soon cease to have periods altogether. (Unfortunately, your other symptoms probably won’t cease – in many cases, they get worse.)
Step 2: True Menopause
“True” menopause occurs when you’ve gone at least 12 months without a single period. At this point, your ovaries cease releasing eggs or producing estrogen. In other words, you’ve officially passed reproductive age and moved into the next biological stage of life.
Soon, you’ll move into your post-menopause life. Hopefully, your symptoms will ease up, though some people suffer hot flashes for another decade or more.
Surprise! When Menopause Comes Early
We generally associate menopause with a woman’s late 40s or mid-50s. But some women get to “enjoy” menopause in their 30s or earlier.
Premature menopause (menopause before 40) can happen for a few reasons, including:
- Primary ovarian insufficiency. In half or more cases, premature menopause has no known cause – the ovaries simply cease estrogen production. In others, an undiagnosed genetic or autoimmune disease comes into play.
- Surgery. When a woman has an oophorectomy (ovary removal), her body enters immediate menopause due to lack of estrogen.
- Chemotherapy and radiation therapy. Certain cancer and autoimmune treatments can induce menopause due to hormonal and organ changes. However, these changes aren’t always permanent – or guaranteed.
Unlike regular menopause, premature menopause usually requires hormone treatment for at least 10-20 years. If you don’t replace the prematurely lost estrogen, you’re at higher risk of developing age-related conditions like heart disease, cancer, osteoporosis (brittle bones), and cognitive decline.
Risks of Menopause and Postmenopause
Even when menopause goes right, you’re still at risk of developing conditions such as:
- High cholesterol
- Heart disease or cardiovascular disease
In some cases, a few small lifestyle changes can stave off the worst impacts. In others, medical intervention may be required.
Menopause, the Body, and Aging
When you enter menopause, your body reduces the estrogen available for basic functions. However, the impacts extend far beyond just your reproductive system.
Menopause and the Body
Your body relies on estrogen for several essential functions, including:
- Building and maintaining strong bones
- Keeping your skin properly oiled, thick, and plump
- Boosting your metabolism
- Keeping muscles (particularly around the vagina and bladder) tight and elastic
But when your estrogen production drops off, your body can’t fulfill many of these roles.
As a result, you may be at risk of weak bones and fractures, urinary incontinence, and rapid weight gain. Lack of estrogen leading to decreased moisture in the skin also leads to dry, papery-thin, wrinkled skin. Not to mention, you may have to exercise more and eat less just to maintain your weight.
Menopause and Aging
Modern science suggests that aging and reproduction are evolutionarily linked. Your reproductive longevity (your number of childbearing years) impacts your post-menopausal healthspan. And that’s no coincidence: recent studies show that when hormone production ceases, your biological clock speeds up.
Menopause hits your cardiovascular system particularly hard. A 25-year longitudinal study of 3,300 women found that menopause and post-menopause can cause hormonal, cellular, and DNA changes that lead to:
- Hardened arteries
- Thicker arterial walls
- High blood pressure
- Increased cholesterol
- A higher risk of heart disease
- And early death
Each of these is a known risk factor that contributes to faster aging. Menopause literally speeds up your clock from the inside-out.
Brain imaging studies suggest that the menopause ages your brain faster, too.
For instance, your brain may change its structure, connections, and energy usage. There may also be increased deposition of amyloid plaques in the brain, which is associated with a higher risk of Alzheimer’s disease.
There’s also evidence that menopause’s vascular risks increase the rate of cognitive decline. Vasomotor symptoms like night sweats have been linked to more lesions in the brain, poor word recognition, and altered brain activity during memory tasks.
Experts believe that menopause itself drives these transitions, as ovarian aging – perhaps via decreased hormone production – has been found to set off certain age-related conditions like dementia.
Decreased estrogen production has also been found to increase the risk of another age-related comorbidity: osteoporosis.
Osteoporosis occurs when bones demineralize, becoming porous and brittle. As calcium leaches from your bones, they become less dense, which makes them easier to break.
Because estrogen normally helps stop the demineralization process, decreasing estrogen levels allows your body to steal calcium from your own bones. Without hormone replacement therapy, women can lose up to 25% of their bone density between menopause and age 60.
Sleep and Aging
Sleep – or lack thereof – is a known trigger for aging and age-related conditions like heart disease and cancer. Because menopause shares a strong correlation with sleep disturbances and insomnia, it’s likely that menopause, via sleep changes, could trigger accelerated aging.
Menopause Treatment and Slowing the Aging Process
Unfortunately, there’s no “cure” for menopause. However, several treatments exist to help manage the symptoms. And if you start them at the right time, some can even minimize the impacts of aging.
Non-Hormonal Treatments for Menopause
For women who want to steer clear of hormonal therapies, there are several alternatives.
Some of the best include a healthy diet, plenty of exercise, and quitting smoking, all of which promote better cardiovascular health and relieve oxidative stress. Limiting caffeine and alcohol intake may also reduce instances of hot flashes. And cognitive behavioral therapy has proved useful in assisting with symptoms like insomnia and mood swings.
Studies have found that a few non-hormonal prescription meds may also help:
- Low-dose antidepressants: Some SSRIs and SNRIs, such as escitalopram and venlafaxine, have been shown to decrease hot flashes, depression, irritability, and mood swings.
- Gabapentin: This seizure medication shows promise to reduce hot flashes in women who can’t tolerate hormone therapy.
- Clonidine. Aside from treating menopause-related high blood pressure (its intended purpose), this medication may provide relief from hot flashes.
Some women may also require medications to prevent or treat osteoporosis. Prescriptions aside, your doctor may recommend supplements like calcium, vitamin D, and vitamin K2 to promote stronger bones and decrease cardiovascular risks.
Hormonal Treatments for Menopause
Despite these alternatives, one of the most effective treatments for menopause symptoms is still hormone therapy.
Studies show that hormone replacement therapy (HRT) can decrease symptoms like hot flashes, night sweats, and insomnia.
Most women also find that estrogen treatments positively impact their moods, while estradiol treatments can improve vaginal dryness and lead to less painful sex.
Hormone Therapy and Aging
Two decades ago, an enormous women’s health study found that hormone therapy increases the risk of cancer, heart disease, and death in postmenopausal women. However, it had one major flaw: the data was primarily sourced from women 10 years post-menopause.
More recent evidence suggests that beginning hormone therapy within 3-5 years of menopause – when the risk for these co-morbidities is far lower – not only doesn’t cause these events, but can protect against them.
Taken at the right time, hormone replacement therapy fights aging by reducing the risk of osteoporosis, decreasing insulin resistance, and lowering the risk of cardiovascular events. Plus, by introducing estrogen back into your system, your skin may stay plumper and firmer for longer.
Don’t Let Menopause Phase You
Menopause is a time of big changes, not all of them to your benefit. From an increased risk of heart problems to drier skin, it’s a lot to get used to. (Not to mention the havoc it wreaks on your biological clock.)
But with the right therapies and a positive mindset, you don’t have to let menopause win. In fact, you can approach menopause with a smile on your face – and come out the other side feeling strong, healthy, and confident.