This is your brain on menopause

By Teresa “Annie” Stone, FNP, family nurse practitioner, Providence Medical Group-Tanasbourne

Menopause is called “the change” for good reason: Women go through significant changes in our bodies, culminating in the end of our monthly periods. But we also experience profound changes in our brains – changes that can carry us into a potent new place in terms of our power and self-knowledge. 

Before menopause, women's brains are influenced by “mommy” hormones that drive us to put ourselves second to everyone else in favor of nurturing relationships, bearing children and keeping the family and community together. During perimenopause – the transition between fertility and menopause – those self-sacrificing mommy hormones begin to switch to self-actualizing “me” hormones. As the ratio between estrogen and testosterone shifts and our natural production of oxytocin – sometimes called the “love hormone” – diminishes, our brains move away from their intense caretaking mode to a new kind of “you can take care of that yourself” mode.

When these changes take over in menopause, they can have an understandably huge impact on every aspect of a woman's life, from her work to her family to her relationships. About two out of three divorces in couples over age 50, for example, are initiated by women. This brain shift toward “me” mode is a big reason for that, and I think that's fascinating. 

This is a time of profound psychological and emotional change, when women can really come into their own and discover new strength and a new voice. It has the potential to be an incredibly powerful and wonderful experience for most women. But at the very time that this self-actualizing opportunity is opening up, many women are simultaneously juggling other huge priorities: trying to maintain professional lives that they've worked very hard to establish, shepherding children into adulthood and independence and taking care of aging parents. Throw in the added menopausal aggravations of intolerable hot flashes, sleep-disrupting night sweats, exhaustion-driven brain fog, vaginal dryness, painful intercourse, and decreased – or in some cases, increased – libido, and life can get immensely challenging.

A little help here?

One of the most important things a woman can do, if her symptoms are keeping her from getting the most out of this time in her life, is to connect with a skilled health care provider. Managing perimenopause and menopause symptoms and risks is very complex and has to be absolutely individualized, because it is so different for each woman. That's the glory and the challenge of assisting women through this change. 

Once you find a provider you trust, work with her or him to understand all of the changes you are going through, both physical and emotional. Discuss your symptoms and risk factors in detail to decide whether your symptoms would be better managed with hormone therapy or with nonhormonal alternatives that are backed by research. Talk about what you've read or heard, and ask for help cutting through the myths. This will take some detailed conversations, and possibly some trial and error as you explore different therapies. But help is definitely out there.

Western medicine has some good answers and support for a lot of the physical symptoms of menopause. Barring certain risk factors (a history of breast, ovarian or endometrial cancer; blood clots; stroke, or liver disease), hormone therapy is still considered a safe and effective choice for many women whose hot flashes, night sweats, insomnia and other symptoms are intolerable. We've learned over the years that the safest approach to hormone therapy is to use the lowest dose for the shortest length of time to manage symptoms. 

For women who do have risk factors or who can't tolerate hormone therapy, there are several nonhormonal medicines that also can be very effective. They include:

  • Gabapentin: an anti-seizure medication that has been proven to be just as effective as estrogen in managing menopause symptoms
  • Paxil, Effexor and Pristiq: three antidepressants that also help relieve menopause symptoms (other antidepressants don't seem to be as effective) 
  • Clonidine: a medicine usually prescribed for high blood pressure, but also helpful in reducing menopause symptoms 
  • SERMs (selective estrogen receptor modulators): estrogen blockers or simulators used to relieve vaginal dryness and pain during intercourse, or to slow the loss of bone density (SERMs may worsen hot flashes and cause other side effects, so their risks and benefits must be considered carefully) 

Finding the right medication and dosage may take several attempts, so don't be discouraged if the first thing you try doesn't work out. With Gabapentin, for example, it's best to start at very low dosages and to increase the dosage very slowly to avoid other side effects. 

All of these hormonal and nonhormonal medications can help with menopause-related insomnia by relieving the hot flashes and night sweats that wake many women up all night long. Over-the-counter sleep aids also can be effective, and have no addiction potential. Because insomnia is probably the most challenging menopause symptom to manage, I'll write more about it in a future article.

Supplements such as soy, flaxseed and black cohosh often are suggested as remedies for menopause symptoms, but if you look at the research, they don't seem to give us any advantages. The research continues, but the jury is still out.

On the other hand, we know absolutely that health-promoting activities such as meditation, yoga, regular exercise, stress management, healthy diet, adequate rest and having joy in our lives can be incredibly effective. Their value can't be underestimated. True, fitting them into our lives can be challenging – how many of us who work full time are able to get to the yoga studio three times a week? Our culture doesn't make it easy, but we have to carry on and march through this process. Doing things that bring us joy is crucial, because we give so much of ourselves all day long. It takes a lot of energy to get through the day, and restoring our emotional reserves takes concerted effort. There is not a supplement we can take for that – we have to design it and provide it for ourselves. Fortunately, as our “me” hormones take over, we're more inclined to see that as important, to insist on it, and even to get a little ticked off if it doesn't happen.

There is so much to love about being a woman! For me, menopause has been such a transformational experience that I want other women to get everything out of it that they can. I believe that if women are given permission to do that, and are given some help with their symptoms, they can transition through this time and come through it into an incredibly powerful, peaceful place that they've not known before. Because that woman you were before? She just might be gone – hallelujah! Brace yourself, because a new woman is here!

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