What’s “Normal” for Menopause and Why Do Women Experience It Differently?

One writer’s search for answers amid her perimenopausal hot flashes

Doctor writing on clipboard while sitting across from woman

 

In my 20s, a hot Friday night meant cheap dinners, bars, and dancing with friends, hoping the nights would never end. 

In my mid-40s, a hot Friday night is sweating on my bathroom floor, my naked flesh pressed against the tile, praying for a particularly wicked hot flash to end. 

When my physician told me I’d likely joined the ranks of 27 million women in the United States each year on the journey to menopause, I didn't know whether to be happy or utterly depressed. Would I be forever relegated to bathroom floors around town, wondering if I could set up my laptop on the toilet seat and do some binge-watching while I sweated it out? 

I wanted answers. I wanted to know if I really had to just “suck it up” and deal with this sweaty, insomnia-riddled, where-did-my-waistline-go, new normal. I also wanted to understand why no two women have the exact same, or even predictably similar experience. Why was menopause such a mystery?

That’s why I tracked down two leading experts on menopause to fill me in on what I didn’t know. Here’s what I found out:

“The Talk”
“Women are taken aback by menopause because it’s really not spoken about and there’s no guidebook,” says Dr. Stephanie Faubion, Medical Director of the North American Menopause Society and the Penny and Bill George Director at the Mayo Clinic Center for Women’s Health. “We don’t get ‘the talk’ when we go through menopause and there’s no one talk that applies to all women.”

Menopause comes in two parts: perimenopause and menopause. As for which phase you’re in: “It comes down to whether you’re still menstruating or not,” says Faubion.

Perimenopause is the hormonal transition where a woman's ovaries decrease estrogen and progesterone production. It’s the year (or years) leading up to menopause, which is where the body stops menstruating. 

Perimenopause is basically the time where everything a woman could mark on a calendar goes out the window. This is when the hot flashes and mood swings might begin. It’s when we wonder why we keep gaining weight even though we haven’t changed anything in our diets or physical activity. There’s also no single answer as to why women experience this time differently.

“Some women just have their last menstrual period and that’s it,” says Faubion. “The other end is women in my office in their 70s asking when [their menstruation] is going to end.”

The critical thing that makes perimenopause and menopause so stressful is for most women, there is no “what to expect when you're not expecting” talk.

This lack of education and information means that women are left wondering why other women are sweating through their mattresses at night and they just “felt a bit warm once or twice.” There’s simply no gauge for what’s normal on the road toward menopause.

Which is, of course, exactly what I wanted to know: What is normal, or at least common? Surely someone could lay out the most common symptoms and changes I could expect as an official member of the Perimenopause Club. 

Common symptoms
Faubion shared that she’s found a little education can go a long way to help women understand their bodies in this new hormonal stage.

First and foremost, the most common perimenopausal symptoms are:

  • Hot flashes
  • Irregular periods
  • Insomnia
  • Night sweats
  • Vaginal dryness
  • Weight gain
  • Thinning hair

 

Faubion says it’s as though “someone changed the rules of your body and they forgot to tell you.”

There’s also a misconception that perimenopause and all its symptoms last only from 12-18 months and then, voilá! A woman is in menopause. Faubion was quick to counter with some surprising statistics.

“The mean duration of hot flashes is around seven to nine years,” she says. “One-third of women will hot flash moderately to severely for a decade or longer.” She also explained that people lose muscle mass as they get older (3% to 8% per decade). Loss of muscle mass also explains why we gain weight when we haven't changed anything in our activity or diets, since muscle burns more calories than fat. “When we’re not burning as many calories sitting, we’re not burning as many calories,” she says.

Which led me to wonder: If someone has changed the rules of my body, why does it seem every body gets a different set of rules for menopause?

Results may vary
“Looking across the globe, Asian women typically have fewer menopausal symptoms than Caucasian women,” Faubion says. “African-American women tend to have symptoms that are worse.” The exact reason why? Medicine isn’t quite sure.

Certain environmental factors can impact the severity of a woman’s symptoms, too. Faubion explained that eating spicy foods, living in hot climates, drinking warm liquids and stress all impact symptoms. Stress, however, was singled out as one of the highest-impact factors that made the menopause journey worse across the board.

Dr. Anna Barbieri is a board-certified gynecologist and Certified Menopause Practitioner by the North American Menopause Society. She noted that, by the time women begin their menopause journey, they’ve likely hit a high-stress time in their lives. 

“There’s a perfect storm of different demands on women in their 40s and 50s,” she says.  “Children are still at home, our parents get older and women find themselves handling care for two generations. Women are also at a career peak and there’s a high level of work demands, or reassessing what they want to do with the rest of their lives.”

I felt as if Barbieri had peeked into my mind and seen the later-in-life career shift, cross-country move and stress eating I’d indulged in as a result. Life stress causes body stress. Perimenopausal and menopausal women already have a significant amount of pressure, and Barbieri recommends women take a hard look at what’s causing stress and take steps to address those factors.

A lack of sleep, a common perimenopausal complaint, causes a domino effect on the rest of our lives. “A lack of sleep can cause a lot of anxiety,” Barbieri says. That anxiety can affect our moods, skipping the gym, stress-eating and more. Stress also makes women search for ways to “wind-down” at the end of a long day. If you’re a glass-of-wine gal, you might want to rethink that strategy when you’re having bothersome menopause-era symptoms.

Studies show that any alcohol consumption reduced the amount of restorative sleep in a night. Even one drink reduced sleep quality. Heavy drinking showed a nearly 40% decrease in restorative sleep. “It’s not that you can’t have that glass of wine to unwind,” says Barbieri. “But women can consider alternative ways to relax. There’s also a ton of sugar in alcohol, and if you’re worried about weight gain, the alcohol likely isn’t helping.”

It turns out that nutritional changes can also have a significant impact on a woman's menopausal symptoms. “Many women find that making the shift to a whole-food, plant-based diet with less processed food and less sugar is the first step toward fewer symptoms,” she says. She’s also quick to add that she’s not advocating cutting out animal-based proteins. It’s more about cleaning-up the diet overall and understanding that we only get out of our bodies what we put in. Better food in can help to ease the symptoms bodies put out, especially during menopause.

The next step
I’d wrangled two experts and discovered that there was a lot I didn’t know about menopause. From how long symptoms last to how stress can have a significant impact, I was definitely feeling better with a bit of information in my pocket.

Yet, I wondered, did I really have to take my physician’s word for it that this delightful array of symptoms was my new normal? Did I really have to just “deal with it”?

“Any time you feel you’re not being heard by your physician, it’s time to find another physician,” she says. Treatments for a woman’s menopausal journey should be just as personalized as the woman herself.

“Like puberty, menopause is another one of life’s hormonal transitions,” she says. What two women experienced puberty the same way? Exactly.

And when it comes to treating the symptoms that might come along with menopause, she’s a proponent of individualization. “I want to sit down with my patients and understand their symptoms, medical history, goals and beliefs. This helps me meet patients where they’re at while practicing rational, intelligent, evidence-based medicine.”

That last sentence left an impression on me. 

And my next step is to seek out a physician that won’t just tell me to “suck it up” as my body goes through this hormonal transition. Because I want my Friday nights back. 

Maybe not the ones from my 20s, but perhaps new ones that don’t revolve around sweating in bathrooms.

E. Napoletano is an award-winning journalist and the recipient of the 2019 Illinois Women’s Press Association first-place prize for her feature on the traumatic effects of family separation policies at the border.