Getting the Jump on Menopause

Here's what to expect

Lorraine Dennerstein, AO, MBBS, PhD, DPM, FRANZCP

February, 2004

Menopause is not a single, dramatic event, but a gradual winding down. Researchers are now paying more attention to this transitional period when a woman's menstrual cycle phases out and her periods become erratic. At this time, she may start to experience night sweats, hot flashes and sleep disturbances. She may also have mood shifts or a decline in sexual functioning.

The menopausal transition can begin anytime between the ages of 31 and 54, though most women enter this stage between 44 and 48. It usually lasts from 4 1/2 to 5 1/2 years.

Hormone replacement therapy (HRT) is often prescribed to treat hot flashes, disrupted sleep patterns, fatigue and urogenital symptoms at this time of life. However, findings from the 15- year, ongoing Women's Health Initiative study indicate that HRT should only be given short term, for three to five years.

Other drugs (such as clonidine and SSRIs) can be also used to manage hot flashes. And women choosing to "tough it out" may try over-the-counter remedies – calcium, herbs, phytoestrogens and dietary supplements.

For many, stress is the real enemy. Marital difficulties, problems at work, an illness in the family, a move or financial problems can mean more hot flashes, mood swings, and sleep disorders. Consulting a psychiatrist who specializes in perimenopause can help, for many symptoms abate with the use of anti-depressants or anti-anxiety medications.

Who gets stressed and why?

The Melbourne Women's Health Project found that women are more vulnerable to stress during the late menopausal transition; i.e, - once they had skipped two periods. Why? Perhaps because the late menopausal transition happens at the same time as maximal hormonal change marked by a decline in estradiol.

Loss of a partner and ill-health also had a greater impact on this group than on those with more regular periods or those who were post-menopausal.

A Canadian study shows that women between 35 and 44 are the most stressed of all. After 45, life seems to become more manageable, perhaps because the children are older and leave home, there is less domestic responsibility, and the career ladder has been scaled. Until then, women in mid-life are generally trying to balance too much, and "be what everyone wants them to be" while getting little in return from their dependents and their busy mates.

Stress levels were higher among women with more education and bigger households, according to the Canadian report. Single parents, and those with paid employment, especially in the professions, were the most affected – and even those who had the resources to pay for outside help complained of not being able to manage the many demands on their energy and emotions.

Chief sources of stress were worrying about children's health, trying to be good parents, relating to a husband, partner, or other family members, caring for sick and elderly relatives, balancing career and family, not having enough money, fearing unemployment, having trouble sleeping, and having a general lack of confidence.

Women in high-status occupations reported high levels of stress, but little depression. Women without partners and single parents with low incomes reported increased anxiety. Those with the least education and with a tenuous foothold in the job market, and who spoke English as a second language, had the highest levels of depression.

For more information on perimenopause, contact The National Women's Health Information Center

General References

Alexander, J. L, and K. Kotz, K. Manuscript in progress. Best Practice for the Diagnosis and Treatment of Mood Disorders during Perimenopause.

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