The Basics 

Although every body is different, approximately 80 percent of people with a cervix experience physical and emotional symptoms as a result of menopause.

So what exactly is menopause?

Clinical professor in the Department of Obstetrics and Gynecology and Reproductive Sciences at the Yale University School of Medicine, Dr. Mary Jane Minkin, explains “menopause is the cessation of ovarian production of eggs-and attendant estrogen and progesterone. In general, it is defined as no menstrual periods for a full year--so if you get a period 6 months after your last one, it resets the clock.”

This phase of fluctuating, erratic cycles that precedes menopause is known as “perimenopause” and begins when periods become irregular--like “being off on a cycle by more than 7 days,” Minkin explained.

The flux of hormones estrogen and progesterone in the body can cause an array of symptoms, including hot flashes, night sweats, sleep troubles, memory issues, difficulty urinating, vaginal dryness, and changes in sexual desire or satisfaction. These symptoms often appear between the ages of 45 to 55, but for some, menopause can begin as early as 30, with varying duration. Some report experiencing such symptoms for up to ten years.

Medically Induced Menopause

Tara Mandarano, 41, a Canada-based writer and editor, was in her twenties when she went into induced medical menopause after six months of taking the drug Decapeptyl for her endometriosis treatment regimen.

“The symptoms I experienced from Decapeptyl were harsh” Mandarano reflects, citing night sweats, hot flashes, weight gain, and joint pain as several of her symptoms. She reconciled these conditions with the comforting thought that they would subside when she stopped the pill.

“I just thought I would be on it for six months,” Mandarano said, “and then hopefully my endometriosis would go away. But it came back. For many years, I managed with regular birth control pills, but they no longer keep my pain at bay.”

Today, Mandarano faces medically-induced menopause while taking a new drug, Orlissa, which she says doesn’t cause as many menopausal symptoms. Still, she takes preventative measures during the occasional hot flash. “Now I dress in layers and make sure to bring t-shirts and socks if I’m going out in case my hot flashes end suddenly and I feel freezing.”

Those with endometriosis commonly take birth control pills or intrauterine devices (IUDs) which prevent cyclical fluctuation of the oestrogen hormones by inhibiting ovulation. Some even undergo surgical treatments to remove endometriosis lesions, but all of these methods can be ineffective. Completely eradicating a menstrual cycle with medication that induces menopause is the final option for many suffering with endometriosis. The dramatic fall of oestrogen levels that accompanies menopause has been known to improve pain, as it has for Mandarano.

When asked about the various medications used to induce menopause, Mandarano listed several. “Decapeptyl seems to be more popular in Europe as an endometriosis treatment to turn your hormones off and give your body a rest from all the fluctuations,” she said. “In North America, Lupron is the drug of choice. Orlissa is made by the same company as Lupron, but it works differently. There are two doses available, 150mg and 200mg. I am on the lower dose for three months to see if it helps reduce my pain. If not, I will try the higher dose for three months.”

In addition to endometriosis, Mandarano also copes with bipolar 2, PMDD, and generalized anxiety disorder. As such, she must pay careful attention to which drugs she uses to treat her endometriosis, as her emotional and mental wellbeing are impacted variables. “Orilissa in particular,” she notes, “comes with some potential severe side effects, like bone density loss and suicidal thoughts.” Mandarano manages the mental health risk by staying vigilant with her moods and keeping both her psychiatrist and husband in the loop.

Mandarano’s story is a reminder that the long-held perception of menopause as something that happens in the late forties, causes several years of physical discomfort, and ends with no lasting repercussions is only one representation of the condition.

Through trial and error, Mandarano continues to seek a comprehensive approach to endometriosis pain and the subsequent conditions of induced menopause while staying on top of her mental wellbeing. It’s vital to note that emotional shifts are just as common among women coping with menopause as the well-known physical symptoms.

Emotional Impacts

Jane Nriapia, 42, a mother living in the UK, began to note emotional shifts and increased fatigue two years ago. “I really started to think something was happening when the night sweats came. I could literally wake up in the middle of the night freezing, as my body would have heated up, I would have sweated profusely and then cooled down leaving me in a cold wet pool.”

While coping, Nriapia left her job. “I got to the point were I didn’t feel I could work anymore,” she reflects. Finally, she went to the doctor and demanded attention for her severe symptoms.

Now, she takes a pill called “Milienette” and feels significantly better, noting, “I can only conclude that I was missing the oestrogen and progesterone that I am now getting from this pill. I still regularly take my iron tablets and this combination has meant that I no longer spend days in bed sleeping and wallowing in self pity. My moods and general well-being have improved vastly.”

Nriapia’s experience speaks to the importance of discussing menopause-related health concerns with a doctor. One in three women have serious issues with menopause—one in twelve will suffer from depression. It’s imperative that patients discuss their symptoms and their mood changes rather than suffering in silence.

The Science Behind Hormones

Many are all too familiar with the loathed question, “Are you on your period?” after a particularly notable emotional outburst. While this question can often offend the addressed party, there is a correlation between menstruation and erratic emotional shifts. The science behind that relies on a single word: hormones.

Period menstrual syndrome, more commonly referred to as “PMS” often manifests emotionally. In the week leading up to one’s period, estrogen levels drop and rise more erratically, which often leads to mood swings and other menstrual symptoms. 

During perimenopause, estrogen levels decline and drop in an irregular pattern. The American College of Obstetricians and Gynecologists explain that this “constant change of hormone levels during this time can have a troubling effect on emotions,” which, consistent with PMS, can lead to irritability and mood swings. 

It’s easy to glean how estrogen plays a role in emotional wellbeing. In addition to shifts in estrogen levels, however, a person experiencing menopause also faces changing levels of hormones progesterone and testosterone.

So, what is the impact of each fluctuating hormone?

Low levels of estrogen can result in hot flashes, night sweats, palpitations, headaches, insomnia, fatigue, bone loss, and vaginal dryness.

Lack of progesterone in the perimenopause phase causes periods to become irregular, heavier, and longer. During menopause, progesterone production stops entirely during menstrual cycles.

Testosterone production also declines during menopause, but production persists after menopause. Also commonly referred to as the “male” hormone, testosterone plays a significant role in libido. Some women report a decline in sexual desire after menopause.

In addition to these three hormones, ovarian activity also changes. As explained by the Women’s Health Research Institute, “during menopause, the number of ovarian follicles declines and the ovaries become less responsive to the two other hormones involved in reproduction Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSHS).” Brain chemistry is impacted when these two hormones no longer regulate estrogen, progesterone, and testosterone.

Those experiencing extreme hormonal impacts from menopause may benefit from speaking with a doctor to ensure that the body remains functioning optimally and that all potential health risks are mitigated.

Treatment Options

Physical conditions, hormonal shifts, and emotional changes are relevant to be aware of when considering those with menopause. If you are among the one in three women who experiences issues with menopause, know that while there is no one blanket solution for all women, there are many treatment options to explore for managing your symptoms.

Those taking an alternative medicine approach might benefit from look into evening primrose for breast tenderness, ginseng for sleep and mood, and soy supplements which contain phytoestrogens for combatting hot flashes. Some of these products are even available over the counter.

Dr. Minkin advised, “for hot flashes, products like Remifemin (German black cohosh), Relizen (Swedish pollen extract), or Femarelle (an Israeli soy extract) can be helpful. And there are many medications available to help as well, which are quite safe.” She also recommended a product called Replens, which is a vaginal moisturizer inserted vaginally two to three times a week for those suffering from vaginal dryness.

Lifestyle changes including reducing stress, staying physically active, practicing a healthy diet, and regular acupuncture can also support a more peaceful, less symptomatic menopause.

Jane Nriapia stands by regular use of essential oils, which she combines with her regular doses of iron and Milienette, as a believer in both homeopathic remedy and science. She even began her own blog in 2019, called All Over The Drop, where she chronicles her personal experiences and connects with others who are interested in oils.

Regardless of which approach one takes, it’s always important to consult with a medical professional as some supplements or practices may pose concerns, depending on existing health record.

Education and Dialogue

Learning about menopause will be a unique experience for everyone.

For those who lack foresight and haven’t yet experienced the bodily transition, Dr. Minkin says it can be helpful to get information from mothers and sisters, who can supply insights on their own experiences. Family history with menopause can inform how the condition manifests itself -- whether physically, emotionally, or both.

For those who have already experienced menopause, it’s important to remember that the impacts aren’t limited to the menopausal phase. Those with a cervix are at a higher risk of heart disease, osteoporosis, and obstructive pulmonary disease after menopause. These risks, however, are a good reason for those with a cervix to check in on their health regimen.

Professor Roger Lobo, an extensive researcher in various areas of reproductive endocrinology and menopause, sustains this belief. “Menopause,” he says, “provides women with an opportunity to review their health and lifestyle and to make changes which will benefit their future wellbeing.” So those currently in menopause can find a silver lining in that their body's natural process is calling them to give their wellness a little love.

Menopause is not a disease nor a disorder. Hormonal shifts that hail the end of fertility are not the end of womanhood. Being aware of the changes that take place and ways to navigate potential complications, whether pre, present, or post menopause can make the topic a lighter one for all. So, go with the flow (or lack thereof) and stop the stigma surrounding menopause.

We all know someone with a cervix. Why not be an ally for half of the global population?

Learn how you can get involved with World Menopause Day here.