Menopause is the normal journey all women make marking the end of their reproductive years. There is no definite starting or endpoint, with diversions existing along the way, and an estimated time of arrival that could span years.
“One of the common things that women come to see me about are hormonal problems, and one of the most common issues are menopausal symptoms,” says LaReesa M. Ferdinand, M.D., a board-certified obstetrician and gynecologist at Heart of Florida OB/GYN Associates.
“The technical definition of menopause is the absence of a menstrual cycle for a year. However, there are a certain array of symptoms that can come along even before you have an absence of your period. There can be irregular bleeding, and there can be on and off hot flashes or night sweats.”
What Causes Menopause?
A woman is born with all the eggs she will ever possess—an astounding one to two million eggs, which are stored in the ovaries. By puberty, she’ll be down to 200,000 to 400,000. The ovaries also produce estrogen and progesterone, hormones which control menstruation and ovulation. Menopause occurs when the ovaries no longer release an egg every month, and menstruation stops.
Menopause is considered a normal part of aging when it happens after the age of forty. However, some women can experience early menopause, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that occurs before 40, regardless of the cause, is called premature menopause.
Natural menopause is a gradual process not brought on by any type of medical or surgical treatment that typically consists of three phases:
Perimenopause – This stage usually begins several years before menopause, when the ovaries produce progressively less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the final one to two years of perimenopause, a woman’s dip in estrogen accelerates. At this point, many women experience menopause symptoms.
Menopause – When one year has passed since a woman had her last menstrual period. At this stage, the ovaries have stopped releasing eggs and producing most of their estrogen.
Postmenopause – These are the years following menopause. During this stage, menopausal symptoms such as hot flashes ease for most women.
According to Dr. Ferdinand, as a result of unevenly changing levels of ovarian hormones in the body, in the months or years leading up to menopause (perimenopause), women might experience the following signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood swings
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
Symptoms, including changes in menstruation, are different for every woman. Skipping periods during perimenopause is common and expected. Often, menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months.
Decreased Sexual Desire
Lower estrogen and testosterone levels beginning in perimenopause can affect sexual function through vaginal dryness and decreased libido. Hot flashes and night sweats can also drain a woman’s energy and undermine the desire for sex as a result.
“Sometimes, my husband says he can’t stand being in the room with me anymore because my mood is so erratic,” Dr. Ferdinand laughs. “Often, patients don’t want to talk about sex or lack of sexual desire when they come to see me. But sexual function and sexual health are very common and very important.”
“One of the things that can happen too is that women realize they’re not lubricating normally or it’s more painful with sex,” Dr. Ferdinand continues. “There are millions of variations of menopausal symptoms, and there are different ways to treat them.”
A Unique Therapeutic Approach to Menopause
Dr. Ferdinand understands that every woman is unique and that there is no “cookie-cutter” approach to treat menopause effectively. Some women may respond well to specific treatments, while other women may resonate with different treatment methods.
“I consider myself a doctor who likes to practice conventional methods, but at the same time, all women are not the same,” she says. “We have the same makeup, per se, but there’s a common thread between all of us despite us being so different. And I’ve recognized, over my 15 years of practicing, that you can’t put women in one box.”
“I offer complementary medicine: my conventional background from my extensive education, but I’ve learned along the way that I need to treat women as who they are, that you can’t put them all in a box. Therefore, we have to open up to many options for therapy, including hormone therapy or herbal therapies. A lot of women may choose pellet therapy or bioidentical hormone therapy, or it could be improving their lifestyle.”
Dr. Ferdinand is quick to point out the success many of her patients have had easing the effects of menopause by making modifications in their diet and lifestyle.
“I’ve had many women have a significant change of their hormones or their menopausal symptoms just by lifestyle changes with nutrition, diet, and exercise,” she continues. “And all those things come together to help you live your best life. That’s exactly why I decided to go into medicine, to allow women to live their best lives.”