Many of our mothers didn’t dare speak about "the change," even to their doctors. Today, information about hot flashes and night sweats flows freely from the press, and it’s a relief — it’s fun, actually — to share our experiences of menopots, insomnia, and other hormonal annoyances. MORE asked two experts to have a talk about menopause and let us listen in.
Hilda Hutcherson, MD, 52, is an ob-gyn and a professor of obstetrics and gynecology at Columbia College of Physicians and Surgeons, in New York.
Donnica Moore, MD, 46, is a women’s health expert and advocate, and president of Sapphire Women’sHealth Group, a multimedia women’s health education and communications firm.
MORE: What was your mother’s menopause like?
HUTCHERSON: My mother’s generation did not say menopause.
MOORE: The few times my mother broached the subject, she called it the change of life. She wouldn’t utter the word to me — and I was already a full-fledged doctor when she was going through menopause. She would ask me for help with her symptoms without ever saying it. Today, women are quite open and well-informed. The word is on the covers of magazines; it’s on TV and in ads; it’s everywhere.
HUTCHERSON: This openness is emblematic of how women in midlife handle other life events now too. We educate ourselves and are empowered by knowledge, we share experiences with our peers, and we make our choices.
MORE: Some women even talk about menopause as a rebirth. Do you agree?
HUTCHERSON: Oh, I agree. It is a rebirth. You finally wake up and say, I’ve spent my entire life taking care of everybody else. Now it’s time to focus on me. Also, we are more confident. We know what we want and don’t mind asking for it. My patients who are in their 50s have said that even though going through this transition can be difficult at times, it’s still better than being in their 40s.
MOORE: Many women I talk to get what Margaret Mead called the postmenopausal zest. I once heard a woman say, "The blood is no longer going down, so it’s going up to your brain," which is not biologically correct but is metaphorically pretty accurate.
MORE: But do you find there can be a sadness about the finality of it, particularly for women who never had children?
HUTCHERSON: I do find that with patients, and with friends, who did not have children. Often their reason for not having children was not finding the right partner.
MORE: The perfect guy never came along.
HUTCHERSON: So take Mr. Almost Perfect! My best friend fits this picture — she’s single and really regrets it and has gone though menopause. After she met my husband, she said, "How in the world could you fall in love with a man who wears polyester pants?" I said, "Honey, I can buy him different pants." She’s looking for perfection and, of course, not finding it. But once your period stops coming, reality sets in. And it can be very depressing for women, except for the ones who decided years ago that they didn’t want a baby. Women can do technological stuff now and get somebody else’s eggs and have a baby. But eventually, the realization that motherhood is not going to happen comes along. I have four children, and when my menopausal symptoms started, even I felt a sense of sadness. It’s the finality of it.
Hot Flashes and Mood Swings
MORE: Do women have realistic expectations about menopause?
HUTCHERSON: My patients say they’ve read scary stuff about it, and then it’s not as bad as they thought it would be.
MOORE: About one in three women has no symptoms that interrupt her quality of life. So a significant number of us sail through.
MORE: But for those who do have pesky symptoms?
MOORE: Well, each hot flash usually lasts a few seconds — up to about a minute. But a minute can be a long time when you’re acutely uncomfortable. Labor pains last less than a minute too. Most women find that their hot flashes resolve in a few years.
HUTCHERSON: But I have heard of them lasting as long as 20 years!
MOORE: Symptoms vary among women and vary by the day or moment.
HUTCHERSON: Some symptoms are intense enough to need medical treatment. Others can be controlled with home remedies, such as ice packs.
MOORE: There are women who get symptoms so intensely that they say, "I cannot live like this." For them, luckily, there are now many options — estrogenic or nonestrogenic medications, and acupuncture, soy products, and more.
MORE: How do you handle yourself in public while having a hot flash?
HUTCHERSON: Most people don’t notice unless you lose your cool. Just take it in stride — remove your jacket or find a tissue and blot your forehead. But if you huff and puff and start to panic, then people will notice. And most people aren’t going to say anything — especially men. Men are going to turn their heads. They get kind of embarrassed by it.
MOORE: Women have been embarrassed until recently.
HUTCHERSON: I tell men that the number one thing they need to know about menopause is that joking about it can be hazardous to their health. Menopause causes an increased fracture rate in men.
MORE: We’re allowed to joke about it; you’re not.
MOORE: Right. It’s one of those kinds of things.
MORE: To talk a bit more personally, Dr. Hutcherson, you’re in menopause, and Dr. Moore, you’re starting perimenopause. So how is it going?
HUTCHERSON: I feel very good. I expected to have a lot of hot flashes and night sweats and not be able to sleep and be depressed — the things my patients complain about. I get some hot flashes, but I just ignore them. I say, okay, this is only going to last a little while. I take a few deep breaths and keep going. Once in a while I’ll have a hot flash in a meeting, and I will blot my forehead and it’s done. The bottom line is, I really don’t care at this point whether somebody sees me have a hot flash or not. I don’t care what they think.
MOORE: I feel the same way.
HUTCHERSON: I’m alive, I’m healthy, and this hot flash is going to pass. Attitude helps me a lot. Sure, sometimes at night I’ll wake up and I’ll throw the covers off, and a few minutes later I’m cold and I’ll put the covers back on. But I just keep going. And I’m happy because I know that there are women who really do suffer. I’ve treated some of them.
MORE: Are you experiencing the increased energy that people talk about?
HUTCHERSON: Hell, no.
MOORE: I’m sorry, did you miss the part where she’s an ob-gyn with four children?
HUTCHERSON: There are nights when I have to stay up late because I’m writing a book and have so many jobs. And I’m exhausted. When I was in my 30s, I could stay up all night and work into the next afternoon and be fine. I don’t have that same energy. I work out with a trainer twice a week and try to get in some aerobics at least another couple of times a week so I don’t fall apart and can get through my very, very busy day. But I haven’t had a big energy boost. No.
MOORE: I am not worried about menopausal symptoms. For one thing, my mother had hardly any. But I’m also not afraid to get treated if I have bothersome ones.
MORE: What about mood swings?
HUTCHERSON: Mood changes lean towards depression for women who have them. Most women don’t get an increase in mood swings with menopause, but I’ve seen more depression than anger. Women just feel low.
MOORE: Depression is not associated with menopause except in women who have had previous depression, previous severe PMS, or some kind of major negative life event simultaneous with menopause. Also, I think some low feelings — crankiness and bitchiness — stem from sleep deprivation.
HUTCHERSON: Definitely. Another life stressor that happens at this time is relationship issues. This may be the first time a woman steps back from a long relationship and realizes that there is something wrong here. That often happens around menopause.
MORE: One of the downsides of being a patient these days is that there is so much confusing, contradictory information out there.
MOORE: I like to quote Mark Twain, who reportedly said, "Be careful about reading health books. You may die of a misprint." It’s very important not to base decisions on the study du jour. The findings may not apply to you. For example, in the Women’s Health Initiative study that showed an increase in breast cancer among women taking hormones, the average age at which the women had begun taking the hormones was 63, which is much older than many of the women who were on hormone therapy who panicked.
HUTCHERSON: There are a lot of half-truths floating around. The best way to get at what’s best for you is to talk to your own doctor. Everyone is different. Your doctor knows you and knows your history. Every woman with breast cancer, for instance, now thinks she can never use estrogen products again; that may not be the case.
MOORE: I agree. Your healthcare provider knows best. Everything else is background. Also, women should always write a list of questions for the doctor. We have no problem bringing a list to the grocery store — why won’t we bring one to the doctor’s office? Prioritize the questions in case time is limited, but absolutely bring them, and ask them. Some women see more than one doctor — an internist and a gynecologist, let’s say — and get conflicting advice from the two. It’s okay to speak up about that. Say, "My other doctor told me something different; would you mind calling her and discussing it?" Doctors are bound to know the most information about their own specialty and less about other fields. Your gynecologist may know more about hormones, for instance.
HUTCHERSON: Yes, get your doctors talking to each other. That’s part of their job.
Menopause and Sex
MORE: What about having sex during menopause?
MOORE: This generation of women has dashed the myth that menopause is the end of your sexuality.
HUTCHERSON: Yes, there’s a huge difference between the generations. In my mother’s day, women weren’t talking about sex, and no one would admit to masturbating. Today, women are having sex-toy parties.
MOORE: And this openness is a boon in many ways. I believe that the number one factor in a healthy sex life is good communication with one’s partner.
HUTCHERSON: Yes, but as men age they may start to have erectile dysfunction or what have you. And when men have trouble, they may not want to talk about it. They may withdraw. Then women may start to take it personally: I’m not attractive enough; he doesn’t want to have sex with me. Meanwhile, the women may be running into issues — vaginal dryness may make sex painful, or they begin to have less intense orgasms and are getting, understandably, angry about that. It’s really unfair: We need our orgasms! But for some women, sex after menopause is better. They’re not worried about getting pregnant anymore. The kids are out of the house. There’s more time and opportunity.
MOORE: And we have treatments if you lose desire — we can do something about that most of the time.
HUTCHERSON: Lots of sex — with or without a partner — is a great treatment for vaginal dryness! It also helps headaches, depression, arthritis, cramps. It’s great aerobic exercise — good for flexibility and circulation…
MOORE: ...and great for sleep problems…
HUTCHERSON: So it’s worth pursuing and keeping up with — with or without a partner.
MORE: Menopause seems to be a real boon for marketers. What do you think about these menopausal products — wicking pajamas, the Chillow, and so forth?
MOORE: These people wouldn’t be in business if women weren’t buying their products. And I’d like to think that consumers are benefiting from them. I’m all in favor of capitalism. Having said that, wicking pajamas use the same technology as high-performance athletic training wear. So it’s not as if somebody invented a new material just for menopausal women; they just put a cute name on it. I’m personally in favor of sleeping in the nude, which has the same benefit and is far less expensive.
MORE: And your husband probably appreciates it. What about herbal treatments for symptoms?
MOORE: I put things like wicking pajamas in a whole different category from herbs.
HUTCHERSON: I wouldn’t suggest women just go out and buy herbs without speaking to their doctor, because herbs are medicine.
MOORE: If something is strong enough to have an effect, it’s strong enough to have a side effect. And when you buy herbal preparations, you may be buying several different products mixed together. So with many herbal products, you may be double — or triple — dosing.
Estroven, for example, which is one of the most commonly sold herbal products for menopause, is not one ingredient. Its main ingredient is black cohosh, and while either product may work for many women, I’m concerned about people who are taking both Estroven and black cohosh. You’re getting a double dose. If an alternative treatment works for you, most doctors are going to say that’s great. I don’t fix things that aren’t broken. Starting with an herbal preparation for hot flashes, especially for women who have mild to moderate hot fl ashes, is a reasonable approach.
HUTCHERSON: With direction from a professional…
MOORE: Exactly. Talk with your doctor, and it needs to be in your medical record. But I never argue with somebody who tells me that something works for her. Can I prove whether it’s a biological effect or a placebo effect? No. Do I care? No.
Originally published in MORE magazine, March 2008.