The Unbearable Heat On Menopause: Part 1

Boris JIVKOV, Obstetrician and Gynecologist

It is a pleasant afternoon in late summer, at a kid’s birthday party in a lovely middle-class suburban home. I am in the kitchen with the host, my close friend and colleague, a brilliant gynecologist, demon in the kitchen, sexy mid-forties mother of two. She is looking frazzled, and says, I have hit menopause, I cannot handle the heat…

I am startled. Not as much by her sudden confession, but by the feeling in my gut that something has changed forever. I am a “mancipated”, metrosexual, liberal feminist. I am her age, we have been as thick as thieves for almost 20 years, and in an instant a statement on human physiology changed my sense of her? Indeed, I have cast her into the category of older people.

This event in women’s lives, called menopause, or the climacteric, is inevitable, irreversible and undeniably, a sign of aging. For centuries humans have been grateful to their Maker for surviving, and aging.  In the last 150 years medical science revolutionized the child-bearing years of women: life expectancy in Victorian times was 42 years due to pregnancy and childbirth complications, while girls born in the eighties in the industrialized world will probably live to 120. As far as menopause is concerned, science has explained a lot, yet common knowledge is sporadic, understanding poor and multitudes of myths thrive.

It is the period of time in a woman’s life, when over 12 months the menstrual period has ceased. It can occur naturally anytime between the ages of 45 and 54.  It happens after a period of time, which can last up to four years, called the perimenopause. The ovaries have permanently stopped producing both eggs and the hormone Estrogen. A woman can no longer get pregnant.

Estrogen has a multitude of effects. It maintains a favorable lipid balance in the blood, therefore reducing the risk of vascular and heart disease. It supports bone strength, thus preventing osteoporosis, bone loss. It assists the elasticity of the pelvic floor muscles and the production of natural discharge in the vagina and the cervix. It promotes the function of the brain centers for heat regulation, responsible for steady body temperature.

Over the perimenopause, the levels of estrogen, since puberty had been secreted in a predictable monthly pattern, become erratic, and steadily decrease.

The effects on the body temperature regulation leads to the most notorious symptom of menopause: hot flashes, the night sweats. That leads to lack of rest and the domino-effect of fatigue, irritability, forgetfulness, poor self-esteem, anger. Sometimes even in the absence of night sweats sleep problems occur. Mood changes and the tendency to develop depressive disorders increase

As the estrogen support over pelvic floor muscles and the genital tract wanes, vaginal dryness, loss of full control over bladder, lack of libido occur: a recipe for relationship problems.

While it shows no immediate signs, the bone loss rapidly increases the risk of fractures, even from minor falls. The changes in the blood lipids dramatically raise the risk of heart attack and other cardiovascular problems. The reduction of these two substantial health risks   is at the core of menopause management in the long term.

Yet, in the daily experiences of menopausal women what matters most is quality of life. The management and prevention of hot flashes help with sleep and mood disorders, dealing with pelvic floor issues and sexual health will be the topic of our next article on menopause.