Facing change: Menopause

August 02, 2010|By CHRIS COPLEY
  • Registered nurse Barbara Hendershot urges patients to have a positive attitude about going through menopause. Some women see it as the end of their best years. Others see menopause as the beginning of a freer time of their lives. Attitude, Hendershot says, is important.
By Ric Dugan/Staff Photographer,

When a person catches a cold, nearly everyone has the typical symptoms, such as sneezing, runny nose and a sore throat.

Nearly all boys going through puberty grow body hair and develop a deeper voice. That's normal.

But when a woman passes through menopause, the range of typical and normal conditions is quite broad. Take hot flashes, one of the most visible symptoms of menopause.

"About 10 percent of women never have a hot flash," said Mitesh Kothari, an obstetrician-gynecologist with Capital Women's Care, in Robinwood Medical Center, east of Hagerstown. "Fifteen percent have them for the rest of their lives. About 70 percent have them for one to five years."

All of this is considered normal, Kothari emphasized. Due to genetics and other factors, different women will experience menopause in very different ways. But that's normal.

Lisa Miller, another OB-GYN at Capital Women's Care, agreed.

"There're women who suffer from night sweats and hot flashes and some women who don't experience that at all," Miller said. "No one really has a good explanation for this."


Barbara Hendershot, 54, is a registered nurse with Tri-State Community Health Center. She has also passed through menopause herself.

It happened abruptly, when she had a hysterectomy about eight years ago.

"It's not the same, because if you have all your body parts, it's gradual," Hendershot said. "When they do it surgically, it throws you right into it."

For years, Hendershot had experienced pain with her menstrual cycle. She had one ovary removed when a cyst was found on it, but her cycles continued to be severe.

"I can put up with a lot," she said.

But, she said, she knew that following month her cycle could be worse.

Finally, she scheduled an exploratory surgery to look for other problems. She authorized the surgeon to conduct a hysterectomy if he found anything of concern. She came out of surgery and soon went into menopause.

But she said she had no regrets leaving her child-birthing years.

"It was a relief. And I was happy with my two kids," she said.

Basics of menopause

Menopause is the time of a woman's life when she completely stops menstruating, according to Rebecca Hulem, a registered nurse and certified menopause clinician who works on the north side of Los Angeles. She is the author of "Feelin' Hot? A Humorous, Informative and Truthful Look at Menopause."

"Technically, menopause means you've gone one full year with no menstrual bleeding, no spotting," Hulem said by phone from California. "The average age of menopause is 51.4 years, but it normally occurs in women from their mid 40s through their late 50s."

The early, first signs of menopause are called perimenopause, Hulem said. This typically begins in the early 40s as hormone levels begin to change. Progesterone levels decline and women get irregular periods - lighter, heavier, more time in between or other patterns.

But progesterone also plays a part in other body functions, Hulem said, such as sleep and mood. These can be affected by hormone levels.

"A lot of women will feel moody, like they have PMS," she said. "They'll experience sleep disturbances, mood swings, irregular periods."

The other primary hormone that varies in levels during menopause is estrogen. Estrogen plays a role in regulating internal temperature, appetite, sleep and sex hormones.

"Estrogen is going to wax and wane. More estrogen - more hot flashes," Hulem said. "Many women also have a drop in libido. Estrogen also decreases in the vaginal tissue - leading to less lubrication, perhaps painful intercourse."

Hulem said most women will experience a slow progression through menopause. There's a physical aspect and there's an emotional aspect. On their own, the physical symptoms can be a challenge to deal with. When Hulem went through menopause, she struggled.

"I was a runner, I had a healthy lifestyle," she said. "But when I had menopause, I had hot flashes, irritability - the classic case. So I thought, 'If I'm having a hard time with this, how can I expect my patients to understand what's happening with them?'"

This led to writing her book. Hulem also speaks to women and to corporations about women's health issues.

Emotional reactions

Emotionally, for some women, menopause is a sign that their best years are over. They experience a serious case of the blues or worse.

"We don't know that menopause causes depression," Kothari said. "It may be that passing through menopause means something to a woman. Their bodies are changing. Sexual intercourse becomes more uncomfortable. They need to use lubrication, or they need to take a pill. There's a lot of women when they hit menopause, they think they're over the hill."

Research doesn't conclusively link menopause and depression, according to, the website of the North American Menopause Society. But there's a widespread belief that menopause causes depression.

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