What Is Menopause?

Dr. Susan Love's Menopause and Hormone Book: Making Informed Choices
by Susan M. Love, M.D., Karen Lindsey

In the first edition of this important bestselling book, praised by Newsday as "the bible for a whole generation of menopausal women," renowned physician and pioneering women's health advocate Dr. Susan Love warned about the potential dangers of the long-term prescription of hormone replacement therapy. Her insightful words of caution have been backed up by the stunning results of the recent studies on hormone replacement.

In this revised edition, Dr. Love offers a remarkably clear set of guidelines as to what the studies have shown about the risks regarding heart disease, breast cancer, stroke, and other conditions, and what effect hormone therapy has on osteoporosis. She offers definitive expert advice about whether or not to go on hormone replacement therapy and, if so, for how long, as well as how to taper off hormones; and she introduces the alternative methods for treating the symptoms of menopause.

Dr. Love stresses that menopause is not a disease that needs to be cured - it is a natural life stage, and every woman ought to choose her own mix of options for coping with symptoms. A questionnaire about your own health history and life preferences helps you develop a program that will best fit your unique needs. With clarity and compassion, she walks you through every option for both the short and the long term, including:

• lifestyle changes (diet, exercise, and stress management)
• alternative therapies (including herbs and homeopathic remedies)
• available medications other than hormones

Chapter 1

Before we can discuss how to deal with menopause, we need to have a clear understanding of what it is. If menopause means "the time after your periods stop," why are you having hot flashes while you still have periods? What if you have had a hysterectomy-does that count as menopause? What if you never go through menopause: your doctor just puts you on hormones and you still get your periods?

Stages of Menopause

Some of this confusion exists because there are two different stages of the menopausal process. During perimenopause, your hormones are winding down, fluctuating, and often creating the mass of symptoms we think of, incorrectly, as "menopausal." (I'll discuss those symptoms in detail in Chapter 3.) In most cases these are self-limiting and will go away in a few years.

Then there's menopause itself-which is, strictly speaking, your last period (the permanent "pause" of your menses). In the aftermath of meno-pause, you may also experience some symptoms, but these are typically different from the symptoms of perimenopause. (Menopause itself, by the way, probably lasts for only a few days, and you can never be absolutely certain when it's occurred. Menopause is usually identified retrospectively, when it's been a year since your last period. Everything afterward is, strictly speaking, "postmenopause"-though for some reason this term has never existed as a noun.) To avoid ambiguity, in this book I'll comply with popular custom and continue to speak of menopausal women, menopausal symptoms, etc. Keep in mind that I'm referring to the time after that elusive moment when your last period ends.

The reason I'm making such a fuss about semantics is that terminology can cause a lot of needless fear. One of the reasons many women dread menopause is that they confuse the lesser, often nonexistent symptoms of menopause with the symptoms of perimenopause-and so they think that the most difficult, confusing symptoms will last the rest of their lives. In reality, the vast majority of women experience these two stages very differently.

A study done in 1965 found that, with the exception of hot flashes, the symptoms of perimenopausal women were closer to those of adolescents entering puberty than to those of postmenopausal women.1 When adolescent girls experience weight gain, bloating, and mood changes, doctors assume it's because of high estrogen levels. When women around menopause get the same symptoms, the assumption is that it's caused by low estrogen. Yet it has seemed obvious to me for quite a while that the time right before menopause is the mirror image of puberty. During puberty, this mechanism is starting up. Then, at the other end, when the process is gearing down, the same things happen again. What these two life stages have in common is big hormonal shifts.

Times of hormonal shifts and changes are times of symptoms. Remember the highs and lows of puberty? Your face broke out. You slept half the day. Your brain didn't seem to work the way it used to. You didn't know what was going on with your body. Well, with perimenopause it happens all over again. This, too, is a time of symptoms in many women-hot flashes, mood swings, fuzzy thinking, insomnia, and, most of all, unpredictability. Fortunately, just as with puberty, these symptoms do end. The hot flashes dry up, just as the acne did. Your sleep patterns return to normal; your brain becomes able to focus again. Nothing lasts forever. Overall it takes about three to six years for each transition, until your body is balanced at a new place. (God help those of you who have teenage daughters going through puberty while you are going through perimenopause!)

Acknowledging the parallels between puberty and perimenopause makes the whole process less strange and scary. You've been through puberty. It may not have been fun, but you survived it. And you did it without any of the wisdom and coping skills you now have. Most of you also experienced the enormous hormonal shifts that accompany pregnancy and childbirth, and you got through those as well. There's no reason to fear perimenopause or menopause. It's just hormones again, and we all know how to deal with them.

Biology of Perimenopause: Puberty in Reverse

What exactly is going on in your body, bringing about all this change? In order to clearly define the phases of the menopausal transition, we need to review a little biology. Okay, I know there are those of you who want to skip the technical stuff-"I don't want a biology class-just tell me what to do!" Feel free to skip the next several paragraphs and pick up again on page 16. For those of you who want to know how it works, read on.

It's amazing to realize how little we actually know about the way a woman's body works. We do know, however, that hormones work together in a wonderful and intricate dance.

At birth your two ovaries contain all the eggs you'll have throughout your lifetime (Figure 1.1). The eggs sit there comfortably for several years; then you hit puberty and the beginning of your years of menstruation. Your hormone levels begin fluctuating wildly before settling down as you reach maturity. The major hormones involved in this process of puberty are follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which come from the pituitary gland (a small gland that lives near the brain, between the eyes); and estrogen and progesterone, which come from the ovaries. In addition, the hypothalamus (part of the brain) produces gonadotrophic-releasing hormones (GnRHs). (Are you still with me? One friend who read this chapter said it was great until she saw FSH, and then her eyes glazed over. And she was a doctor!)

Copyright © 2003 by Susan M. Love, M.D., with Karen Lindsey.

About the Author

Susan Love, M.D., is an adjunct professor of surgery at UCLA and the president of the Susan Love, M.D., Breast Cancer Foundation, a nonprofit organization dedicated to the eradication of breast cancer. She is the author, with Karen Lindsey, of the renowned Dr. Susan Love's Breast Book. She lives in Los Angeles.

Karen Lindsey is the author of Divorced, Beheaded, Survived: A Feminist Interpretation of the Wives of Henry VIII.