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The One Thing You Might Not Know About Menopause

Buckle up, baby. This may take a while.

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Kiersten Essenpreis
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Whenever I’m feeling warm in a room full of other people, I like to look around and ask, “Is anyone else hot? Or have I started?” Most women over 45 tend to chuckle. “Sorry,” I’ll say. “Just doing a menopause check!”

I’m 47 years old, and at least four or five times, I’ve been convinced that I’m in menopause.

Everyone has their own unique collection of come-and-go symptoms … hot flashes, difficulty sleeping, super-fun-and-not-at-all-awkward-vaginal dryness, irregular menstrual cycles, emotional highs and lows, and night sweats akin to what some of us experienced after childbirth.

(My daughter was born during one of the coldest Decembers on record and during the first weeks of her life, I can remember spending many a late night with my head stuck out the window like a dog on the freeway. I can’t imagine what my neighbors must have thought.)

I’m not going to share my own personal warning signs here, but have you heard that women of menopausal age might experience weight gain or the occasional chin hair? Asking for a friend.

But every time I begin to dramatically proclaim, “The change has come!”, I get my period, five pounds fall off of me and my chin suddenly looks like a baby’s bottom. It’s false alarm after false alarm. And that led me to consult with Rebecca C. Brightman, M.D., a board-certified ob-gyn in New York City with expertise in the areas of perimenopause and menopause.

Brightman is an active member of NAMS (North American Menopause Society) and a certified NAMS provider, and she explained the one thing many women don’t realize about menopause. “Menopause is a transition,” she said, “not a moment.” The official onset of menopause is when a woman has gone a full year without having a period. But the big misnomer about menopause is that it’s just that moment. Women can actually be symptomatic as early as seven years before they are officially menopausal, and for years after.

“When we refer to perimenopause, we are talking about a transitional period that can last years, and everyone is different,” Brightman said.

The most common symptom is getting warm in the middle of the night, but according to Brightman, the most concerning symptom is sudden changes in mood, or emotional highs and lows.

According to me, the most inconvenient symptom is how menstrual cycles can get closer together before they ultimately space out.

“Believe it or not, this is the time to pay more attention to birth control,” Brightman advised. “Many women in their late 40s may believe they can’t get pregnant, or that the chances are so low that contraception is low-priority.” It’s those erratic periods that make us unsure of where we are in our cycle, and pregnancy can easily be confused with the onset of menopause.

This brought us to the issue of birth control pills vs. hormone replacement therapy. Both may not be for everyone, but it’s important to know the difference between these two ways of making the symptoms of perimenopause and menopause more tolerable.

Hormone replacement therapy (HRT) can give women back the hormones they are losing by balancing estrogen and progesterone, helping to provide some relief from the night sweats, hot flashes and other symptoms.

“But it’s not enough to prevent pregnancy,” warned Brightman. “Birth control pills are like hormone therapy, but the higher dosage suppresses ovulation.”

According to Brightman, perimenopausal women on birth control pills often avoid the emotional highs and lows that women not on hormones experience.

“For women in perimenopausal transition, hormonal contraception can provide a hormonal neutrality until they are done ovulating,” she said.

Of course, many women cannot take birth control pills for myriad reasons, from a history of breast cancer to having a clotting risk. For those women, there are nonhormonal ways to treat symptoms. Brisdelle (low-dose paroxetine), a medication approved by the Food and Drug Administration (FDA), has been shown to decrease symptoms. There are also other FDA-approved medications that may be used off label for the treatment of menopausal symptoms. (Before you take anything, consult your physician.)

But ultimately, taking good care of yourself is a great way to both prepare and survive the extended transition into menopause. Brightman urges women to maintain a healthy body weight and live a healthy lifestyle. “Women need exercise, regardless of where they are in their transition,” she explained. “But women who practice healthy eating, maintain normal body weight and use alcohol in moderation tend to have an easier time.”

There’s no on/off switch or a single test to predict if and when you will officially be in menopause, and it doesn’t happen in a single moment. It’s an extended rollout. So, if you’ve already started waking up in the middle of the night wondering if you took a night swim, buckle up, baby. This might take a while.