Your 6 Most Pressing Questions About Menopause and Vasomotor Symptoms, Answered

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All women go through menopause, and 1.3 million of us enter this realm every year. And yet very few people are ready and willing to chat openly about it. But if you're between the ages of 45 and 55, you're among the many experiencing this transition, as your monthly menses slow down and eventually cease. Once you've gone without a period for 12 consecutive months, you have hit menopause.

While you might be overjoyed to discontinue your forced donations to the menstruation industry, this transition also comes with plenty of challenges. Symptoms such as weight gain, insomnia, moodiness, depression, hot flashes, and vaginal dryness plague many—and even worse, discussing this natural course of aging is still somewhat taboo.

But we've got you covered. Here, experts answer five of the most pressing questions readers like you have about menopause, and offer both practical solutions and a modicum of hope, so you can move into this next stage of life with grace.

1. Why does menopause make women hot—like, sweating-temperature hot?

When people think about menopause, the symptoms they most commonly associate with the transition are hot flashes and night sweats, collectively known as vasomotor symptoms (VMS). About 80 percent of women experience VMS in midlife. If you're among this group, you know all too well the sudden onset of intense heat in your face, neck, and chest that can happen randomly at any time, day or night. Science has not pinpointed the exact cause of VMS, but researchers theorize that they're triggered by a decline in estrogen levels, an inevitable part of both aging and menopause.

"What happens normally is that you have a feedback loop between the hypothalamus [a region in the brain], the pituitary gland, and the ovaries," says Stephanie Faubion, MD, an internist specializing in women's health issues in Rochester, Minnesota. "That loop gets disrupted when the ovaries stop making estrogen, and certain neurons in the brain that control temperature—KNDy neurons—become overactive." When these neurons fire, they signal your body that it's hot, even if it's not. Your body then responds by trying to cool itself down, increasing blood flow to the skin (hence the flushing), sweating, and increasing its heart rate. You literally become a hot mess.

2. Is there anything I can do about hot flashes? And how long will I have to deal with them?

Though each hot flash lasts only a couple of minutes, they can occur several times per day or night. VMS that happen at night are called night sweats, and you may wake up having soaked through your pajamas or even your sheets. This interrupted sleep pattern can lead to insomnia, and can have an impact on your energy, mood, and cognitive function.

However, every woman is different, and while some women have several hot flashes per day, others may never experience a single one. "Unfortunately for those who have VMS, it can last a long time," says Dr. Faubion. "On average, women flash for 7 to 10 years, but for some it can be more."

Many women experience VMS during perimenopause, the years leading into the menopause transition, as early as their 30s, even while they're still having their period, according to Dr. Faubion. "And though many women like to 'tough it out,' there are things you can do to reduce or alleviate the symptoms of VMS," she says.

Lifestyle changes such as exercising regularly, avoiding alcohol, eating a balanced diet, quitting smoking, and losing weight can help reduce the severity and frequency of VMS. But if you’re not having luck with those, consider speaking to your doctor about treatment options.

3. How does menopause affect sex?

"The most common question I get is 'Why does sex hurt?'" says Laurie Mintz, PhD, a psychologist specializing in sexual health and the author of Becoming Clitorate. "For these women, sex—meaning penetration—never hurt before, but now it does. And even though women have been misguided into thinking that painful sex is normal, sex is never supposed to hurt."

Vaginal dryness is one reason that sex can be painful for perimenopausal and menopausal women, and this is again due to those declining estrogen levels. "We need estrogen for many things, including vaginal elasticity," says Dr. Mintz. "When it declines, the vaginal tissue is affected."

"The good news is that the majority of women who had a good sex life before menopause will likely have a good sex life afterward, and dryness is easily correctable with hormone therapy," adds Dr. Faubion. "Even low-dose estrogen therapy, as found in rings, creams, and gelcaps, can be an effective local treatment, as can DHEA, an over-the-counter compound that can be administered vaginally."

But physical dryness aside, menopause can also shrivel your libido. "Desire is a biopsychosocial event—mental, physical, and cultural—and every woman will be different in terms of what works for her," says Dr. Mintz. To rekindle your desire-fire, she has several suggestions. "First, are you engaged in cognitive distraction during sex—for example, are you going over your to-do list?" she posits. "You need to make sure your head and body are in the same space, and to be mindful of yourself and your partner." She also recommends scheduling "trysts" with your partner, taking time to build arousal.

And finally and most importantly, don't wait until you're horny to get sex. "Get sex to make you horny," Dr. Mintz says. "Responsive desire is when our mind wants it, but our body is not craving it yet. But as you get into it and become aroused, you get desirous, and it all works out."

4. My emotions and thinking are all over the place. How does menopause affect my mental health?

Mood swings, anxiety, and irritability are classic signs of perimenopause and menopause, and combined with other symptoms such as VMS and insomnia, they can take a real toll on your mental well-being. According to the North American Menopause Society, for example, women with night sweats reported higher incidence of depression.

"Depression can certainly be triggered by hormones, as anyone who has been crabby around her period can attest," says Dr. Faubion. "If you've had an issue with hormone-related depression before, such as postpartum or severe mood swings around your period, you're at greater risk of having a similar issue when you become perimenopausal."

Another big complaint during this transition is brain fog, she notes: "Of course, memory and concentration could be impacted, because you're flashing all night and aren't getting any sleep and are in a terrible mood. So I suggest treating the other symptoms you're having and seeing if the brain fog gets better, because it might. If not, studies have shown that cognitive function often rebounds after the menopausal transition." In other words, wait it out.

5. Can menopause cause other health problems?

When it comes to your heart, yes. According to SWAN (the Study of Women's Health Across the Nation), those with frequent VMS have a 50 to 77 percent increased risk for a cardiovascular event, such as a heart attack or stroke. Another study found that severe hot flashes were associated with the accumulation of belly fat and a higher incidence of obesity—both risk factors for other health conditions, such as type 2 diabetes and heart disease.

Insomnia that results from a decrease in estrogen, night sweats, or both may also mean bad news for your heart: Research published in the Journal of the American Heart Association revealed that stress and insomnia may cause irregular heart rhythms (atrial fibrillation) in 25 percent of menopausal women, putting them at a higher risk for stroke, blood clots, and heart failure.

"There's also a relationship between cholesterol and menopause," says Dr. Faubion. "Estrogen works to keep LDL (bad) cholesterol in check, so when you lose estrogen, total cholesterol and LDL rise, and HDL (good) cholesterol decreases. It also appears that HDL is less functional in post-menopausal women, meaning it is less protective of your heart." Again, hormone therapy is a viable option for rejiggering your estrogen levels, helping normalize your system and putting your heart at ease.

6. How do I find menopause care?

The treatment you choose to help with menopausal symptoms is an individual thing, and not every woman will, or should, take the same course of action. But the key takeaway here is that if your health and happiness are being affected, there is something you can do about it.

"Not a lot of OB-GYNs or primary-care physicians have a solid understanding of menopausal women, so it's worth seeking out a qualified physician," Dr. Faubion says. "The North American Menopause Society (NAMS) has a portal on its website where you can search by zip code for a seasoned practitioner who is well versed in menopausal patients."

For those with persistent sexual concerns, Dr. Mintz recommends finding another kind of specialist. "Look for a physician who specializes in sexual medicine for menopausal women," she says. "There are many kinds of sexual pain, and yours may or may not be related to menopause. Seeing a specialist can help you determine your exact issue." She also recommends NAMS as a good resource for this sort of practitioner.

Either way, though, the time for action is now. Get help, get healthy, and get happy!

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