This is Your Body on Menopause

It's called "the change" for a reason. Not only does menopause signal the end of your reproductive life but it can also come with a whole host of side effects, which range from annoying to serious.

sweating-butterly
Photo by Gracia Lam

Temperature troubles: Doctors say that hot flashes and night sweats are the biggest complaint they hear from perimenopausal and menopausal women—not surprising, since 75 percent of women experience them. It's not clear exactly what causes hot flashes, but it's believed that hormonal changes make the brain's "thermostat" more sensitive to perceived changes in temperature, causing it to overcompensate with a surge of heat, says Margery L. Gass, M.D., the executive director of the North American Menopause Society.



To keep your cool, keep breathing. A recent Mayo Clinic study found that menopausal women who practiced paced breathing (taking six deep breaths a minute for 15 minutes) twice a day saw a 52 percent reduction in hot flashes. Researchers think that relaxation through deep breathing may improve the brain's ability to regulate temperature. Cognitive behavioral therapy, which helps identify and shift negative, distorted thoughts to change behavior and positively influence mood, has also been proven to reduce the frequency and length of hot flashes, because it helps you cope with triggers like stress.

Eating more soy may improve hot flashes, but recent research suggests that's true only if your body produces the soy metabolite equol. And many women, especially those of European descent, do not. Research is divided on whether herbal supplements like black cohosh and licorice extract work, and many experts, including Gass, are doubtful that they provide benefits.

If you're suffering severe or constant heat waves, your doctor may recommend Brisdelle, the first nonhormonal prescription drug approved by the U.S. Food and Drug Administration (FDA) to treat hot flashes. It contains the selective serotonin reuptake inhibitor (SSRI) paroxetine (which is marketed for depression and anxiety at much higher doses under the name Paxil). "The lower dose isn't linked to weight gain or sexual dysfunction, and it affects the way the neurotransmitters in the brain work on your internal thermostat," says Holly Thacker, M.D., the director of the Cleveland Clinic Center for Specialized Women's Health and the author of The Cleveland Clinic Guide to Menopause.

Vaginal dryness: Lower estrogen leads to less natural lubrication in the vaginal tissues. You can use an over-the-counter lubricant if the dryness is an issue only during intercourse, but a longer-acting over-the-counter vaginal moisturizer (like Replens) is a better solution if you're dealing with daily discomfort. Or opt for a prescription estrogen cream, vaginal suppository, or vaginal ring. All three deliver low doses of estrogen directly to the vagina without raising estrogen levels throughout the body, which means side effects and risks are minimal. Bear in mind that dryness makes it easier for bacteria to travel to the urinary tract, so bringing back moisture also reduces the risk of painful urinary-tract infections.

Bone loss: The National Osteoporosis Foundation says that women can lose up to 20 percent of their bone density during the five to seven years following their last period—and again reduced estrogen seems to be the culprit. To keep your bones strong, load up on calcium and vitamin D—whether through dietary sources, like dairy products, leafy greens, and salmon, or through supplements. (The current recommendations for postmenopausal women ages 50 and older are 1,200 milligrams of calcium and 800 to 1,000 international units of vitamin D daily.) Make a point to do regular weight-bearing and muscle-strengthening exercise, like jogging, jumping jacks, and lifting weights a few times a week, since stressing bones spurs them to strengthen and also build new muscle mass.

Weight gain: Estrogen influences where your body stores fat, so when its level wanes, you may notice extra inches around your midsection. To minimize weight gain, step up your exercise intensity and eat healthfully—especially foods like salmon, nuts, and avocados. The healthy monounsaturated and polyunsaturated fats they contain are linked to a reduction in stubborn belly fat. Need extra incentive to fight back? A 2014 study published in the journal Menopause found that losing weight decreased the number of hot flashes women experience.

Thinning hair: When estrogen levels are high (as they are during pregnancy), your locks are at their fullest. But when those levels drop during menopause, hair follicles go into the resting phase, which can cause hair to thin and fall out. Topical minoxidil (like Rogaine for Women) can minimize loss by reactivating the hair follicles and stimulating regrowth.

Skin problems: Shifting hormones can bring on an unfortunate trifecta of dry skin, wrinkles, and pimples, says Doris Day, M.D., a clinical associate professor of dermatology at the New York University Langone Medical Center, in New York City. To tackle breakouts, look for a low-concentration benzoyl peroxide wash (2 to 5 percent) instead of the harsher benzoyl peroxide leave-on gel you used as a teen. Day also recommends topical Clindamycin lotion or Renova (which contains Retin-A in a moisturizing base), which can eliminate acne while preventing and treating wrinkles. During menopause, sebaceous glands slow down oil production, leaving skin visibly drier. Day suggests looking for a moisturizer containing hyaluronic acid. "It's a humectant that pulls water into the skin and holds it there," she says.