illustration of woman experiencing hot flashes in bed

After 34 years spent educating women about hot flashes, hormone therapy, and menstrual disorders, Dr. Patricia Sulak — OB/GYN at Scott & White Hospital/Clinic and Texas A&M College of Medicine, author of “Should I Fire My Doctor?” and founder-director of the Living WELL Aware conference — is still surprised by how little women know about menopause.

“They’re not really aware of even common symptoms like hot flashes and bone density loss as much as they need to be,” says Sulak. “Some women are having hot flashes and thinking there’s no treatment for them, or maybe it’s just them having them. Women don’t know about osteoporosis. Women aren’t aware of a lot of things. And even though there’s a lot of information out there, they’re not applying it to themselves or their health.”

To get a handle on menopause, here are nine things Sulak says women should know about this stage in their lives.

What is menopause?

Menopause is defined as having no menstrual periods for one year, secondary to declining hormone production from the ovaries. The symptoms of menopause are due to the decreasing production of estrogen from the ovaries.

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When will I go through menopause?

The average age of menopause is between 51-52. The majority of women stop having periods somewhere between ages 45–55, but the beginning stages of declining ovary function can begin years before that in some women, while others will continue to have menstrual periods into their late 50s.

The age of menopause is genetically determined, but such things as smoking or chemotherapy can accelerate ovary decline, resulting in earlier menopause.

What symptoms do the reduced levels of estrogen in the body cause?

The most common symptom experienced by 80 percent of women during the menopausal period is hot flashes, which can occur day and night. Approximately 50 percent of women will experience moderate to severe hot flashes, which interfere with their daily activities. Some women may also experience muscle and joint pain (arthralgia) and mood swings.

It may be difficult to ascertain whether these symptoms are due to hormonal alterations, life circumstances, or the aging process itself.

What are the “invisible” consequences of menopause that women do not “feel”?

The decline in estrogen production from the ovaries during menopause can parallel the loss of calcium from the bone, leading to bone thinning. If severe, this can cause significant decreases in bone density (osteoporosis), increasing susceptibility to hip, spine and other bone fractures. An accelerated rate of bone loss can occur in many women during the first few years after the last menstrual period.

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Will I experience the same symptoms as my mother, sister, girlfriends, etc.?

The symptoms of menopause vary greatly from one woman to another — even in the same families. The age and rate of decline of ovary function differ tremendously, necessitating the importance of individual management.

If I have had a hysterectomy, when will I know if I am going through menopause?

If your uterus was surgically removed or if you had an endometrial ablation (removal of the lining of the uterus performed as treatment for heavy menstruation) and your ovaries were not removed, you may not know you are going through menopause unless you have the onset of hot flashes.

If you are not having any symptoms, after the age of approximately 50, a blood test can be performed to determine if the ovaries are still functioning. This may be beneficial in women who are at risk of osteoporosis. So knowing estrogen status may be important in determining the need for bone density assessment.

If you have a total hysterectomy where your uterus and both ovaries are removed, menopause will start almost immediately. Your periods will stop and you will likely experience hot flashes and other symptoms of menopause, which can be more intense since hormonal changes will happen suddenly instead of over several years.

Is hormone replacement a safe option for management of menopausal problems?

Several hormone therapies are FDA-approved for treatment of hot flashes and prevention of bone loss. The benefits versus risks vary depending on the severity of hot flashes and bone loss and the health status of the patient. Estrogen is not the “fountain of youth,” and women should be cautious of claims often made by those that promote non-FDA approved “bio-identical hormones,” where safety and efficacy have not been established.

Are there non-hormonal options for management of menopausal symptoms?

Some women may have medical disorders that preclude the use of hormone replacement or elect not to choose that method of treatment. Lifestyle alterations including weight loss, exercise, room temperature reductions, avoidance of foods that aggravate symptoms, and light cotton clothing can all be beneficial in many women. Other treatments such as herbal therapies, self-hypnosis, acupuncture, certain low-dose antidepressants, and other medications may be helpful in decreasing hot flashes. Several FDA-approved medications can be used for prevention of bone loss.

What’s the most important issue I should be concerned about at this stage of life?

If health is not a major priority, it’s important to pursue optimal wellness at this critical stage of a woman’s life. In addition to the consequences of estrogen decline, multiple life circumstances such as work demands, raising children, and assisting with needs of elderly parents, along with the aging process itself, necessitate the importance of pursuing personal health. We all need to be Living WELL Aware™ and searching for the best in wellness information, implementation, and inspiration from reputable sources.

But be cautious! Wellness is a multi-billion dollar industry, and numerous miracle claims for supplements, non-FDA-approved hormones, and other products are not backed by scientific data. For the best possible outcome, connect with a knowledgeable physician.