Approximately 10 years ago when Angie Runnels was 45, a gynecologist found a polyp on Angie’s right ovary. During surgery, the doc- tor diagnosed Angie with endometriosis, and removed the ovary because the polyp and ovary were intertwined.
After the surgery, Angie found out her right ovary had been the one ovulating each month; without it, she stopped having menstrual cycles. The operation had pushed Angie into surgical menopause, which is when a woman enters menopause due to a medical procedure.
Before this, however, she had been experiencing perimenopausal symptoms. She often experienced night sweats, disrupted sleep and weight gain.
A decade ago, however, when she first started experiencing these symptoms, she says perimenopause — the transition time from having regular menstrual cycles to menopause, which is defined as the moment when a woman has not had a period for 12 consecutive months — was not widely talked about, so she didn’t recognize why her body was going through these changes. She says the stigma surrounding menopause, although it has gotten better, has to continue to change through education and women “holding each other up.”
“I think women are scared of menopause,” Angie says. “It is scary, because it’s the unknown. You haven’t dealt with that in your 35 to 45 years growing up — you haven’t dealt with that. And so it’s a map uncharted. It’s unknown territory. So I feel like that’s why I think everyone should educate themselves as much as they can.”
Once in menopause, Angie continued to experience sleep disruption, weight gain and hot flashes. As someone who has owned, raised and trained Tennessee walking horses all of her life, she says her mom used to tell her she “burned the candle at both ends;” but in menopause, she had low energy, often feeling tired and dealing with brain fog.
Her gynecologist told her she shouldn’t do hormone replacement therapy (HRT) because Angie had a family history of breast cancer on her mother’s side. She ruled out the possibility and dealt with the worsening symptoms through continuing the strength training she had done throughout her life and through nutrition.
In Dec. 2023, however, at the encouragement of her boot camp trainer, she decided to get her hormone levels checked. She also did “deep dive” research into HRT, which her provider, Makenzie LaRose, MSN, APRN, FNP-BC, AGACNP-BC at Reviving Wellness in Cape Girardeau, was excited to discuss with her when she went in for her appointment. There, Angie found out the research she’d initially been told about was outdated and based on synthetic HRT; since her mother had not had breast cancer, she could be a good candidate for bio-identical plant-based HRT.
Angie started HRT treatments that month, and for the past six months since, she says she no longer experiences hot flashes or night sweats and doesn’t feel like she needs to take a nap every day at 3 p.m. She has also lost 12 pounds, through a combination of the treatment, walking regimen and strength training.
Angie says she feels like herself again.
“Do your research, and don’t go with the first doctor’s opinion,” Angie says. “You have to be your own best advocate, and I think that you just have to do what’s right for yourself. And I’m not saying HRT is right for everyone; I just want everyone to know how much it has helped me, in my case.”
By the time Angie began experiencing perimenopausal symptoms, her mother had passed away, so she wasn’t able to talk with her mother about her mother’s experiences with this part of life; she says she relied on talking with her friends and doing her own research about it. She believes it’s important for women to talk about their experiences with perimenopause and menopause, because if two people are having a conversation about it, that means others have questions and need information, too.
She advises women who are noticing changes within their bodies such as weight gain, night sweats, hunger, sleep disruption or difficult emotions to track those changes using a calendar, journal, notebook, phone note or Fitbit, and then share that data with their health care providers. She says if a woman doesn’t feel like herself, there’s a reason, and it’s important to advocate for oneself by asking questions and telling health care providers about symptoms such as joint pain, brain fog or repetitive urinary tract infections.
By the time women reach menopause, Angie says they have so much knowledge and have accomplished so much, working hard to get to where they are in their personal and professional lives; oftentimes, menopause works against that. She wants women to feel “great” during this part of their life; she says women still have so much to look forward to post-menopause, such as spending time with family and friends, continuing to grow in their careers, and reflecting upon all of the goodness that fills their lives.
“Menopause is the afterparty. That’s how I look at it,” Angie says. “We’re not dealing with all of the other stuff of when we were like 16, 17. And we have all the knowledge, and we’ve accomplished so much. … It’s just that portion of your life. … It’s where you want to go, and you want to live your best life and present your best self. … Menopause is not the end. It doesn’t mean you’re done.”
The three stages of menopause
1. Perimenopause
Meaning “around menopause,” perimenopause is the transition from ovulating regularly to menopause, when women cease to ovulate. Some women experience more noticeable symptoms than others during perimenopause, and the symptoms can start anytime from the time a woman is in her mid-30s to mid-40s. During perimenopause, the level of the hormone estrogen rises and falls unevenly, causing menstrual cycles to lengthen or shorten; on some cycles, the ovaries may not release an egg. The average duration of perimenopause is three to four years, although it can be as short as a few months or last as long as a decade.
Symptoms
- Irregular periods.
- People in perimenopause may also experience menopausal symptoms, such as hot flashes, sleep problems, mood changes, vaginal dryness, bladder problems, decreasing fertility, loss of libido, loss of bone density and changing cholesterol levels.
2. Menopause
Once a woman has gone through 12 consecutive months without having a period, she is in menopause, which marks the end of menstrual cycles, including ovulating and having a period, and signals the end of the ability to reproduce. Menopause is a moment in time; once a woman reaches it, she enters postmenopause. This occurs because the body no longer produces high levels of estrogen and progesterone, the hormones needed for pregnancy, ovulation and menstrual periods. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.
Menopause can occur naturally; be induced by surgery that removes the ovaries called an oophorectomy; as a side effect of chemotherapy or radiation therapy; or due to primary ovarian insufficiency, or premature menopause before age 40, which approximately 1% of women experience. Menopause occurs most often between the ages of 45 and 55; the average age of menopause is 51 or 52 in the U.S.
Symptoms
- Vaginal dryness
- Hot flashes
- Chills
- Night sweats
- Sleep problems
- Mood changes
- Slowed metabolism and weight gain
- Thinning hair and dry skin
- Loss of breast fullness
Management and Treatment
- Hormone therapy or hormone replacement therapy: Natural or synthetic hormones are given via patch, pill, cream, vaginal ring, gel or spray form, to make up for the decreasing amounts of hormones the body makes on its own. There are risks to hormone therapy and hormone replacement therapy; talk with your health care provider to see if the benefits outweigh the risks for you and your circumstances.
- Nonhormonal treatments: Adding phytoestrogens to your diet such as soybeans, chickpeas, lentils, grains, beans, flaxseed, fruits and vegetables; avoiding hot flash triggers such as spicy foods, caffeine and nicotine; regular physical activity; joining support groups; prescription medications; cognitive behavioral therapy and hypnotherapy
3. Postmenopause
The time after menopause, a phase a woman stays in for the rest of her life.
Symptoms
Mild menopausal symptoms may continue to occur for several years during postmenopause, although most menopausal symptoms lessen and disappear. There is an increased risk for osteoporosis and heart disease during this part of life due to low estrogen levels.
Frequency
All people who menstruate will go through menopause, although the type, frequency and severity of symptoms at each stage varies from woman to woman.
Sources: Cleveland Clinic, Harvard Health Publishing, Mayo Clinic, National Institute on Aging
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