Ask the Experts - Symptoms of menopause

Margery Gass, MD is professor of obstetrics and gynecology and
Director of the University Hospital Menopause and Osteoporosis Center at the University of Cincinnati.

Q. How can a woman be sure she’s really in menopause?

A. By definition, a woman is officially in menopause if she has not had a menstrual period for a full year--and if the loss of her period is not due to medications, such as certain hormonal or psychiatric drugs and some forms of chemotherapy.

Q. I’ve heard that after menopause, a woman’s “thermal comfort zone” shrinks. What does this mean, why does it happen and, most important, what can women do to stay comfortable?

A. As women get older, we feel hot more easily and get cold more quickly. We don’t know for sure why this happens. Our temperature-regulating center, which is in the brain, may change over time. To stay comfortable, the most practical thing to do is control your environment.Dress in layers so you can always take a layer off or put one on. Be aware of lighting. Bright lights from any source, even if they are 15 feet above you,can trigger hot flashes, as can bright lights on makeup mirrors. If you start to feel warm, look at the lights that are on near you and try to get farther away from them.

Q. Why do so many menopausal women complain of feeling irritable and “down” – and what can they do to boost their moods?

A. Many women who are going through the menopausal transition experience unpleasant or uncomfortable moods. It’s really very similar to premenstrual syndrome (PMS) in adolescents, but it’s often more chronic and pervasive because women often don’t have regular cycles around the time of menopause. But it’s temporary; I always tell women that they’re not going to feel this way forever. Within a couple of years, hormones will generally stop fluctuating and most women will feel that they’ve reached a new plateau. If a woman is really feeling bothered by negative and irritable feelings, she may want to consider going on low-dose selective serotonin reuptake inhibitors (SSRIs). That class of drugs was a wonderful break through for PMS. Women with PMS can use them for a week or 10 days before their period.At menopause, because symptoms are not so predictable, women should simply take them every day. Most women will not need to take them forever, and
low doses often
work just fine.

Q. Vaginal dryness and discomfort during lovemaking
are common at and after menopause. How can women keep sex enjoyable?

A. One of the most important things women can do is to keep having sexual intercourse on a regular basis. In some ways, sex is like a sport–because you need to stay in condition in order to participate without discomfort. If a woman hasn’t had sex for a while, she may develop vaginal dryness and tightness. If she doesn’t have a partner and is not taking hormone replacement therapy but wants to keep sexual options open for the future, she should mention this to her doctor.There are ways women can stay in shape for sex. Vaginal estrogen creams and non-hormonal moisturizers can help. So can vaginal dilators. A dilator is a cylinder or tube, most often made of plastic or rubber. It is used to stretch vaginal muscles to make them more pliable. It’s important to follow your doctor’s advice regarding the use of dilators.