Menopause Symptoms Vary in Scope, Duration

Q:  I am a 51-year-old female who has not had a period for 15 months. I have gone through the moodiness, sleeplessness and hot flashes, most of which have passed, although I still do have hot flashes a few times a day.

How long after menopause should I expect to still get these hot flashes? Shouldn't I be done with this?

A:  Menopause is a highly individual process. Some women have no symptoms whatsoever, while others might have them for five years or more. During menopause a woman's body slowly produces less of the hormones estrogen and progesterone. Between the ages of 45 and 55 years old women who are nearing menopause might experience:

• Changes in the menstrual period - variation in flow or in the amount of time between periods.
• Hot flashes or hot flushes - sudden, and sometimes intense, heat in the face, neck and chest.
• Night sweats and sleeping problems that can lead to feeling tired, stressed or tense.
• Vaginal changes - the vagina may become dry and thin; for some women sex may become painful.
• Thinning of the bones, which may lead to loss of height and bone breaks (osteoporosis).

A woman has reached menopause when she has not had a period for 12 months in a row. In some women, the hot flashes never seem to go away, but then again, 10% of younger, pre-menopausal women also have hot flashes.

Part of the problem of continued hot flashes may simply be an increased awareness of them, particularly after going through the hard part of menopause when hot flashes were frequent. And certainly, our American culture encourages us to dread any sign of growing older.

There are other causes of hot flashes, too, including some medications, infections and hyperthyroidism. If you have other symptoms that don't fit with those typical of menopause, you may want to talk to your doctor.

To stay healthy, you can make some changes in the way you live. The National Institute on Aging offers the following suggestions for women entering or already in menopause:

• Don't smoke.
• Eat a healthy diet that is low in fat and cholesterol and moderate in total fat. Your diet should aim to be high in fiber and include fruits, vegetables, and whole-grain foods. It should also be well balanced in vitamins and minerals, including calcium.
• Lose weight if you are overweight.
• Take part in weight-bearing exercise, such as walking, jogging, running, or dancing, at least 3 days each week.
• Take medicine to lower your blood pressure if your doctor prescribes it for you.
• For vaginal discomfort, use a water-based vaginal lubricant (not petroleum jelly) or an estrogen cream.
• If you frequently feel an urgent need to urinate, ask your doctor about techniques such as pelvic muscle exercises, biofeedback, and bladder training that can help you improve muscle control.
• Be sure to get regular pelvic and breast exams, Pap tests, and mammograms. Contact your doctor right away if you notice a lump in your breast.
• If you are having hot flashes, keep a diary to track when they happen. You may be able to use this information to help find out what triggers them.

Try these tips to help manage hot flashes:

• When a hot flash starts, go somewhere cool.
• If hot flashes wake you at night, try sleeping in a cool room.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin "breathe."
• Have a cold drink (water or juice) at the beginning of a flash.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column also appears in the Milwaukee Journal-Sentinel.