In the TV series “House of Cards,” when Clare Underwood (Robin Wright) put her head inside the fridge to cool off from a moment of menopausal madness hot flash, anyone over 48 (or thereabouts) could relate.
“Hot flashes” as they’re often called (or “personal summer” if we’re being coy) don’t happen for every woman going through menopause. But they’re a common feature of the end of fertility in what used to be called (in hushed tones) “The Change.”
The sudden surge in heat that can happen as the body tries to regulate estrogen and progesterone levels which drop precipitously at this time is overwhelming when it first happens. After a while, like Underwood, you peel off a layer of clothing, head for a nearby fridge, and start carrying fans.
As we’re beyond being bashful about health matters here, let’s take a look at what menopause is:
What is menopause?
The name is actually a misnomer – there’s no “pausing” happening here. It’s when a woman’s periods have ceased for a year. Up until that point, she’s considered to be in “perimenopause”, and periods can be patchy, lighter (or a lot heavier), and generally irregular. After menopause a woman is considered “postmenopausal.”
Then the eggs have run out?
That’s exactly it. Female humans are born with about 1 – 2 million (tiny, tiny) eggs in their ovaries when they’re born. They do not make any new ones during their lifetime. Then, when reaching puberty, an egg a month (generally) gets discharged from the ovaries (which alternate egg delivery each month2) into the fallopian tube, waits to get fertilized (or not) and then head to the uterus where the uterine lining plus unfertilized egg is released via a tiny hole in the cervix and out through the vagina as blood. This is a menstrual cycle.
Here’s what the Cleveland Clinic reports: “During fetal life, there are about 6 million to 7 million eggs. From this time, no new eggs are produced. At birth, there are approximately 1 million eggs; and by the time of puberty, only about 300,000 remain. Of these, only 300 to 400 will be ovulated during a woman’s reproductive lifetime. Fertility can drop as a woman ages due to decreasing number and quality of the remaining eggs.”
So by the time a woman is between 45 – 53, the egg stores are definitely dwindling. When a woman hasn’t had a period for a year – the eggs are gone. As an aside, that’s why “egg freezing” has become popular with younger women who would like more options in their life regarding career/family. Earlier in their fertility they can freeze their eggs (fertilized or not) and then know they’ve got a supply to draw on later.
What else happens during menopause?
Everyone’s menopause is different. Some people get hot flashes as the hormones surge and dip; others get night sweats for the same reason. Sore, or swollen, breasts are a common complaint (cue: softer bras, lose the underwire, bigger sweaters). Weight gain (especially belly fat) can pile on. Vaginal dryness can make sex more painful (stock up on lube). Basically, whenever the body is learning to cope with a new set of chemical levels, it’s going to provide symptoms until it finds a “new normal.”
Are there any treatments?
This is a contentious area. One school of thought is that menopause is just the reverse of puberty – and no one considers that a “disease,” it’s just part of the natural flow of life. It’s a stage – you go through it – and then you’re on the other side by approximately age 55.
Understandably, others are keen to ameliorate the irritating symptoms of this stage of development. To do this, some medical professionals prescribe Hormone Replacement Therapy (HRT) or Menopausal Replacement Therapy (MRT).
You can read more about HRT here. The most popular “natural” replacement for falling estrogen levels used to be a product called “Premarin” – until many women found out that the ingredients are in the name – pre (pregnant) mare (female horse) in (urine) – and didn’t want to ingest horse pee or have the increased risk of breast/ovarian cancer, stroke or cardiovascular disease. The Pfizer product was also cited in this lawsuit.
Diet & exercise
The North American Menopause Society has many useful recommendations, including regular weight-bearing (brisk walking is best) exercise to keep muscles supple and bones strong (calcium levels also drop at this life stage leading to brittle bones, so a supplement is helpful). Step up the vegetable portions (five a day is optimum) and stick to unrefined foods, avoiding high fat foods, caffeine and sugar. If you drink alcohol, embrace moderation. Still smoking? Maybe it’s time to quit to reduce inflammation and extend your lifespan.
There are few serious medical studies done on the various alternative therapies, so proceed with caution. But some women report feeling less flushed or bloated using herbal therapies such as dong quai, evening primrose, St. John’s Wort and bee pollen extract. We couldn’t find any National Institutes of Health reports on the efficacy of these though.
Many things can make menopause worse. If there’s embarrassment and/or shame concerning (female) health-related issues at home, or at work, that’s an unnecessary stressor. Many women feel they have to hide symptoms, or pretend nothing’s wrong. Considering 50% of humans will go through menopause, this is irrational.
This is where celebrities are a great help in dispelling myths and being brave out there in the world today. Viola Davis explaining the menopause to Jimmy Kimmel (and his 6 million viewers) is worth watching – and kudos to Kimmel for asking her to do so.
The actor Gillian Anderson (“The X-Files”) told People magazine that she was inspired by Angelina Jolie who talked openly about what happened when she went into menopause, after elective surgery to tackle her genetic predisposition for both breast and ovarian cancer.
“Perimenopause and menopause should be treated as the rites of passage that they are. If not celebrated, then at least accepted and acknowledged and honoured,” Anderson said.
Across the Pond, writer and performer Jennifer Saunders, who went into medical menopause during chemotherapy for breast cancer, told the BBC presenter Kirsty Wark that it affected everything from skin and hair to energy levels and metabolism. “It was quite astonishing,” Saunders told her. Then, as befitting the person who created “Absolutely Fabulous,” she admitted: “I had a large glass of Champagne and then got on with it.”
On the plus side – and perhaps this is thanks to celebrities being open about their health journeys – many women say menopause gives them a new surge of confidence and lease on life. With child-bearing years behind them, they can focus on other things.
As Kristin Scott-Thomas told Phoebe Waller-Bridge in “Fleabag,” “After the menopause – you’re FREE! You’re just a ‘person,’ in business [yes] it’s horrendous – and then it’s magnificent. Something to look forward to.”
As more and more women are living longer, and so having up to three decades of life post-menopause, it’s hoped that this stage will become something everyone can talk openly about. As more medical research about how to help with some of the more pesky symptoms is done, like hot flashes, we’ll update this article to reflect that.
Until then, build up your fan collection, wear layers, up your hydration levels and stay cool, lady.