Think back to when you first got your period. What was your perspective? Did you consider it an honor as you confidently stepped into womanhood? Or did you view it as terribly embarrassing—always having accidents and being unable to go in the water at the beach for fear of bleeding through?
What is your perspective on menopause? Do you fear aging and the onset of menopause? Is it a time of distress and discomfort? A signal of aging? Are you afraid the best years are behind you? Are you focused completely on your menopausal symptoms? Or do you see this menopause transition as a rite of passage, a season of freedom and confidence, and a time to discover or rediscover your power, purpose, passion, and authenticity?
Educate Yourself on Menopausal Transitions
The Natural Progression of Menopause
According to the Mayo Clinic, the average age of menopause in the United States is 51. The onset of menopause can begin as early as your 40s, but I have friends who are athletes who didn’t have menopausal symptoms until they were in their late 50s.
I speak with women in their forties or younger who complain about fatigue and suspect they might be fighting a cold. Others describe experiencing migraines or bitchiness at certain times of the month. Some have instances of vaginal dryness. What these women have in common is that they don’t always put together that their symptoms are hormonal. They are in a state of premenopause or perimenopause but may not recognize it if hot flashes/hot flushes are absent.
What’s the difference between these life stages?
Premenopause arrives first. We may not even notice the effects in our bodies, minds, or moods, but our levels of estrogen and progesterone are beginning to drop.
Perimenopause is next. Estrogen levels continue to drop, and symptoms begin to arrive for the “party.” Our period becomes irregular. Night sweats and hot flashes/hot flushes begin.
Menopause officially arrives when the ovaries stop releasing eggs.
The Suddenness of Surgical or Premature Menopause
When I used to hear the word menopause, I thought of hot flashes and older women. When I heard the words surgical menopause, I thought of hot flashes that start at an earlier age than normal. This was a very simplified version of what goes on with surgical menopause. These images were the only version of what might happen to me that I was aware of with my limited knowledge and perspective before my hysterectomy and oophorectomy.
To clarify, a hysterectomy does not include the removal of ovaries and will not send a woman into surgical menopause. An oophorectomy removes the ovaries and causes sudden surgical menopause due to hormone drops, especially estrogen.
The main difference between surgical menopause and natural menopause is the timeframe and intensity of the symptoms related to the transition. During natural menopause, symptoms appear gradually and are sometimes so subtle that we barely notice the changes; and when we do, we can tackle one or two symptoms at a time as they pop up.
My friend Tracy has been undergoing the process of natural menopause for the past couple of years. Her symptoms are not always consistent from month to month. Tracy recognizes that the severity of her menopausal symptoms depends on how well she’s taking care of herself. Her stress levels, workload, sleep patterns, yoga practice, and even her relationship with her son all factor in.
By contrast, sudden menopause begins when the ovaries are surgically removed (oophorectomy) or are damaged by disease, radiation, chemotherapy, or other medications. This damage to or removal of the ovaries causes a sudden drop in estrogen and a deficit that will not be replenished due to missing ovaries and causes an immediate plunge into menopause.
If your ovaries were removed after menopause, you will not be in surgical menopause or feel any hormonal difference. If your ovaries were removed before menopause, then symptoms can show up abruptly, sometimes as soon as you wake up from surgery.
That is what happened to me. Once my ovaries were removed, a flood of symptoms appeared. I got hit all at once while I was recovering from major surgery. I had no time to adjust to the difference in my hormone levels, and I suddenly felt off balance in my body and life.
Whether you go through menopause naturally or suddenly/surgically, your symptoms will vary. Some women have severe symptoms, while a certain percentage of women barely notice the transition. They can include
- vaginal dryness
- hot flashes/hot flushes
- night sweats
- emotional symptoms like sadness, irritability, anxiety, and depressive symptoms
- psychological symptoms such as loss of memory or focus
- weight gain [ transform ]
- loss of bone density
Quality of Life for Postmenopausal Women
Our perspective plays a large part in viewing life during and after menopause. And this is the one area we have control over. We can choose the agony and fear of aging, or we can decide to embrace this season of our life as a time of freedom and renewed confidence. We can give ourselves grace and make room for more self-love and self-care.
I love that the Chinese refer to menopause as the second spring. They consider it a time to reflect on life and turn their focus inward to nurture themselves. That rings true for me, as this season of my life already has had an ongoing theme of self-love, self-care, and self-reflection.
Just like surgery may have the benefits of alleviating pain or risk of disease, the season of menopause transition can be wonderful, with positive side effects such as:
- No more periods, cramping, tampons, or pads. Uterine bleeding is nonexistent, as is abnormal bleeding. No more irregular periods.
- We can finally wear white pants again, any time of the month.
- Sexual intercourse may be more enjoyable without the risk of pregnancy.
- We may have greater confidence and self-assuredness.
- We don’t have to schedule our sex lives, athletics, or vacations around our periods.
After my surgery, it took time for my body to heal physically. It took even longer for my mind and emotional health to stabilize.
There were times when I felt broken. I had to constantly remind myself that I was in a state of healing and change. Even though I felt broken, I told myself I was whole, strong, and valuable. I had to remind myself that menopausal symptoms would pass. They wouldn’t last forever.
In my personal experience, surgery and surgical menopause were both frustrating and exhausting. The last thing we need to do is to beat ourselves up. And isn’t that one of our greatest strengths as women? We think we should heal faster, not cry for no reason, and be able to do it all… even right after surgery. We only need to cut ourselves some slack and remind ourselves that this, too, shall pass.
That’s a perspective I can embrace.
Regardless of your age at menopause, healthy women are embracing the positive effects of menopause.
Menopausal Hormone Therapy as Treatment
I have been fortunate enough to benefit from bioidentical hormone replacement therapy (BHRT). Not all menopausal women can take HRT. For me, it eliminates hot flashes/hot flushes and night sweats. It has improved my quality of life. For others with a family history or risk of breast cancer, it may not be an option. Talk to your doctors and decide if it is right for you.
My primary guide and partner with HRT is also my gynecologist. Internists, family practitioners, and endocrinologists may also be in your toolbox to help balance your hormones. I view my relationship with my hormone specialist as a partnership. They are patient and open to listening to my concerns while assisting me to feel my best. We meet regularly, approximately every three to four months, and we fine-tune my hormone levels based on blood work and symptoms. While there may be standard doses of hormones to treat menopausal transitions, my doctors and I believe in optimizing levels for an effective treatment.
Whether synthetic or bioidentical, hormone replacement therapy commonly includes estrogen, progesterone, testosterone, or some combination of the three. HRT is used to replace or support the body’s natural hormone levels. It is not just for surgical menopause or exclusive to women. My friend Natalie improved her libido in her thirties by taking testosterone, while my friend Tony began estrogen therapy after his diagnosis and treatment of prostate cancer.
Synthetic Hormone Therapy vs. Bioidentical Hormone Therapy
Synthetic hormones have been around for years in the form of Premarin, Provera, and even low-dose birth control pills. Synthetic means humanmade from chemical sources. I was surprised to learn that Premarin is produced from the urine of pregnant horses or mares. Who knew? The goal is to create hormones that are similar, although not necessarily identical, to what your body naturally makes to alleviate symptoms. Many doctors prescribe synthetic hormones, and many insurance companies cover the cost.
I was introduced to hormone, sexuality, and nutrition expert Camille Lawson, R.N., M.Ed., through a mutual friend. In a blog post entitled “Hormones: The Key to Vibrant Health and Sexuality for Women” she writes: “All bioidentical hormones originate from either soy or diosgenin (wild yam) plant sterols that are put through steps in a lab to become a hormone that is identical to the hormones manufactured by the body. Compounding pharmacies are key to correct formulation of your hormones, after a thorough hormone panel is done.”
Bioidentical hormones are humanmade and plant-based. They have identical chemical structures as the hormones made by our ovaries. Bioidentical hormones are prescribed by a doctor and filled through a compounding pharmacy. The cost is most likely not covered by insurance.
Bioidentical hormone therapy was my choice and has caused no adverse effects. I use a combination of estrogen, progesterone and testosterone for balance, returning me to a premenopausal woman’s hormone state. I liked the idea that the hormone receptors in my body would recognize the yam extracts as familiar. My daily dose of BHRT ended up having a positive effect on my quality of life as a postmenopausal woman.
Even within wellness circles, there is a lot of controversy over the use of both synthetic and bioidentical hormones. Taking hormone replacements must fe
el right for you, your belief system, and your knowledge of health and safety.
If you require HRT, BHRT, Ambien, Lexapro, or something else to eliminate night sweats, insomnia, anxiety, or depressive symptoms, talk to your doctors. Explore your options and make an educated decision for this point in time. Then, go to work on lifestyle changes that help to alleviate your symptoms naturally and rebalance your health so that, under the guidance of your medical team, you eventually may not require pharmaceuticals.
Get a New Perspective
I am technically postmenopausal; however, I still have symptoms that may continue for months or years. It helps me to remember that no matter how bad my symptoms get, they will not kill me. They are just uncomfortable. It is up to me to learn to live in balance, health, harmony, and freedom. It is up to me to control and empower myself to remain the confident, healthy, joyful woman I know myself to be. When I do this, I find myself with a whole new outlook. My symptoms may not change, but my perspective does. And that has a positive, beneficial effect overall.
Another perspective to examine is our beliefs about menopause and aging. As women, we fear being sidelined from the mainstream of life, put out to pasture. Yet there are so many tremendous examples of women in midlife and beyond who are doing remarkable things. They write books, rescue children, serve in the Senate and House of Representatives, and inspire future generations. They are purposeful and contribute so much value to their families and communities. We can too.
Our expectations during menopause require managing as well. There were times during my recovery from hysterectomy when I started to think that maybe I was imagining things. I wondered if, somehow, the plethora of physical symptoms and emotional fluctuations I felt were all in my head. Maybe, menopause doesn’t really exist. After all, I spoke with other women who returned to work within days of their surgeries and who appeared to have escaped surgical menopause altogether. Meanwhile, it seemed to take forever for me to feel normal again.
As I contemplated where this thought came from, I examined my expectations. Fifteen years prior, I stayed with my parents when my mom had a hysterectomy. The first days after she came home from the hospital, she was in physical pain, but aside from that, she escaped the added symptoms of menopause. Perhaps age played a factor: My mom was fifty-four when she had her surgery; I was forty-three. She had most likely already entered perimenopause, where the decline in hormones manufactured by her ovaries had already taken place gradually, so there wasn’t such a sudden drop and change in her energy levels and emotions.
Being a sports nutritionist and having studied wellness for almost a decade, I also know how much our world has changed. The nutrient and toxicity levels of the foods my mom grew up with differ from those I’ve been exposed to. My generation has also been surrounded by more technology and radiation than any other generation in history.
It could simply be that everybody, even women within the same family, is different. My mother was lucky enough not to be affected by premenstrual syndrome, whereas my PMS symptoms had always been quite severe. I had endometriosis, which was not diagnosed until surgery.
Some of us are prone to anxiety and worry and even have tendencies toward negativity and cynicism. In my experience, worry never resulted
in anything good. In fact, it elevated my stress levels, made things worse, and slowed healing. I eventually changed my expectation to positive optimism, and things began to improve. What I focused on grew. As I focused on the good things in my life with gratitude, I found more in life to appreciate.
Premenopausal women and menopausal women are healthy women.
There have been observational studies that suggested that hormone therapy not only has beneficial effects on menopause but it can also be beneficial against diseases such as osteoporosis, coronary heart disease, dementia, and all-cause mortality. It can increase bone strength and decrease the risk of fractures.
Whether you choose hormone therapy or not, choosing the right perspective and managing your expectations can go a long way toward releasing the agony and fear of aging and embrace this season as a time of freedom, passion, purpose and renewed confidence.
From my blog:
- Read my story about my journey through a setback of an unexpected hysterectomy.
- Learn how to prepare for surgery and initial recovery.
- Define wellness and the challenges of menopause.
- Discover complimentary medicine that can help menopause symptoms.
- Find out about lifestyle changes that can improve the quality of your life during all stages of menopause.
- Discover how your thoughts and words directly impact your feelings.
- Uncover and embrace your passions, purpose, and next chapter so you, too, can come back strong!
- Bonus: Questions You May Wish To Ask Your Doctor when facing hysterectomy/oophorectomy.
Prefer the video version? Check out my online course: BALANCED WELLNESS DURING MENOPAUSE.
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I have been blessed and humbled to partner with the following authors on my own journey through menopause. Together, we all hope to empower YOU to live a life of true health, love, laughter, and freedom, especially during your menopause transition.
With love, gratitude, and kindness,