Welcome to midlife

“The change.” Any woman knows what those two little words mean.

While most women dread the changes that can come with midlife, Sheila Koone, a community health educator at Novant Health Forsyth Medical Center, relishes the opportunity to speak with women in midlife about their health and well-being.

“There are so many things that women don’t talk about publicly with regard to their health,” Koone said. “Whether that’s dealing with depression or anxiety, urinary incontinence or the menopause transition, women have suffered in silence for too long. It is time to bring these issues out of the closet and into the conversation.”

What is menopause?

Menopause refers to the period of time after a woman’s hormone levels have decreased, and it signals the end of a woman’s fertile years. Perimenopause is the time before menopause when the supply of mature eggs in a woman’s ovaries diminishes and ovulation becomes irregular. The production of the hormones estrogen and progesterone decreases, and it is this drop-off that causes many of the symptoms commonly associated with menopause.

Menopause occurs when you stop having menstrual periods, usually around age 51 but it can begin earlier or later, depending on your body and unique health factors. Women who smoke and are underweight tend to experience menopause earlier in life, while overweight women often experience menopause later. A woman generally tends to experience menopause around the same age that her mother did. Other factors also can influence when menopause occurs, such as surgical removal of the ovaries or premature failure of the ovaries due to smoking, radiation exposure, certain medications and more.

Menopause is said to be complete when menstrual periods have ceased for one continuous year, a process that can take many years.

What symptoms can be expected?

No two women’s experiences with menopause are the same. Symptoms may be minor or severe and may last for one to two years or longer.

Physical symptoms you may experience can include the following:

• Irregular menstrual periods.
• Hot flashes.
• Dry skin.
• Night sweats and disturbed sleep patterns.
• Vaginal dryness.
• More frequent urination or leakage of urine.
• More frequent minor vaginal and urinary infections.
• Cardiac issues, such as dizziness, heart palpitations and more.
• Hair growth, including thinning scalp hair and an increase in facial hair.

Psychological symptoms can include:

• Mood swings.
• Anxiety.
• Depression.
• Tearfulness and irritability.
• Less desire for sex.
• Lack of concentration.
• More trouble remembering things.

When are things not normal?

“Many of the symptoms that are considered a normal part of menopause have an abnormal side to them as well,” Koone said. She noted that one of the biggest myths she routinely dispels is the idea that any symptom a woman experiences is attributable to aging or menopause.

“Women tend to disregard the fact that there are other things that could be going on,” she said. “To me, the biggest myth in midlife is that so many women believe that everything they’re concerned about is related to menopause or is a normal part of getting older. And in some cases that just isn’t true.”

• Weight gain

“We know that as women’s hormones transition, their bodies begin to deposit fat more in the midsection and that is the worst kind of body fat to have when it comes to a risk for cardiovascular disease,” Koone said. She said that while hormones certainly play a big role in weight gain during midlife, things such as staying physically active – including strength training – and eating a healthy diet with adequate protein can help women lose or maintain an ideal weight, even during menopause.

• Sleep

“If women have hot flashes, night sweats and potentially poor sleep hygiene anyway, it isn’t abnormal to have disturbed sleep,” Koone said. “But women can also begin to experience sleep disorders that have nothing to do with menopause.” She noted that women who experience sleep apnea and restless leg syndrome may report waking up several times a night, wake unrefreshed, have headaches upon waking, have higher blood pressure and are a little overweight. “Anyone who may be exhibiting those extra symptoms should be evaluated further,” she said.

• Irregular heartbeats

“Some women may experience irregular heartbeats, palpitations or the sensation that the heart is beating out of control – all of which can be attributed to fluctuating hormones,” Koone said. “However, it’s definitely something you want to alert your doctor to. You should never automatically assume a heart-related symptom is related to the menopause transition.”

• GI distress

“Some women may have an increase in gastrointestinal (GI) distress, whether it’s constipation, diarrhea or an increase in heartburn,” Koone said. She encouraged women not to dismiss symptoms and simply increase over-the-counter treatments. “You could have an ulcer, a hernia, gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS). If you notice any changes to your GI system, follow up with your doctor instead of treating it yourself long term.”

• Forgetfulness

“Some women are very concerned about getting Alzheimer’s disease because they forgot something on the counter, can’t recall names or walk into a room and don’t know why they’re there,” Koone said. “Some of that can be attributed to being stressed, busy and distracted and that’s normal. I often tell women, ‘If you lost your car keys and then found them, OK. That’s normal. If you don’t know what your car keys are for, you may have a problem.’”

• Urinary incontinence

“Lots of women think, ‘I just leak a little when I cough or sneeze and because it’s not a big amount it must just be because I’m getting old,” Koone said. “Urinary incontinence is not a normal part of aging and we have lots of resources and different therapies available to treat everything from urinary and fecal incontinence to gas.”

• Drastic sex drive changes

“Whether it’s erectile dysfunction, medication side effects or just an increasing lack of mobility, there are a lot of physical reasons why your sex life can change, but it’s not necessarily normal to go from having a very active sex life to not wanting one anymore,” Koone explained. Hormone imbalances, emotional and relationship issues, and pain from menopause-related vaginal dryness also can affect your sex drive. “It’s important to talk to your doctor about what is going on so they can help determine the best course of treatment for you. A drastic change in sex drive is not normal, even in midlife and as we age,” she said.

Treatments and a team approach

Often, menopausal symptoms can be managed through nonmedical means, such as avoiding hot and spicy foods, exercising regularly and adjusting the thermostat to cope with the body’s fluctuating temperatures. Hormone therapy may help moderate to severe symptoms, and is available in a wide range of doses and delivery methods, such as pills, patches, rings and creams.

Talk to your doctor about the risks and benefits of hormone therapy, what impact it may have on your individual situation, and what the right treatment plan is for you. Nonhormonal treatments, including prescription medications, herbal supplements and lifestyle changes, also can be used to treat menopausal symptoms.

“If women are concerned about any symptoms they are having, they need to see a practitioner who can help them determine if what they are experiencing is normal or not,” Koone said.

She added, “You need a team on your side to help you navigate through the menopause transition. You don’t have to walk through this transition alone, and at Novant Health we have multiple resources to help you figure out what’s normal, what’s not and to come up with a strategy to manage your symptoms.”

Find a Novant Health provider who is the perfect fit for you.

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