This is your brain on menopause

By the care providers at Providence Medical Group-Tanasbourne

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

Before menopause, women's brains are influenced by “mommy” hormones that drive them to put themselves 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 a woman's natural production of oxytocin – sometimes called the “love hormone” – diminishes, her brain moves away from its 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 could be a big reason for that. 

Menopause 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. Insomnia can be such a challenge that it deserves an article of its own. To learn more about it, read Menopause and sleep…or not, written by our colleague Alison Mitchell, M.D., at Providence Medical Group-Cascade.

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 provide 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 your life can be incredibly effective. Their value can't be underestimated. True, fitting them into your life can be challenging – how many of women who work full time are able to get to the yoga studio three times a week? Our culture doesn't make it easy, but things that bring joy is crucial, because women give so much of themselves all day long. It takes a lot of energy to get through the day, and restoring your emotional reserves takes concerted effort. There is no supplement you can take for that – you have to design it and provide it for yourself. Fortunately, as the “me” hormones take over, women are more inclined to see that as important, to insist on it, and even to get a little resentful if it doesn't happen.

Menopause has the potential to be a very positive transformational experience. If women are given some help with their symptoms, they can transition through this time and come through it into an incredibly powerful, peaceful place.

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