Coping With Menopause

There is no one-size-fits-all approach to coping with menopause (more precisely, perimenopause)—the period of time for women during which hormonal shifts usher out the childbearing years and usher in the postmenopause stage. There are women who have very few symptoms or problems as they pass through menopause. But most have at least some temporary symptoms, and some struggle with problems that really disrupt their lives. Hot flashes, mood swings, weight gain, insomnia, and other characteristics of menopause can be challenging.

Hormone therapy can alleviate many of the symptoms of menopause, but there are many strategies that can be used alone or along with medication to help smooth the way through premenopause. Keep in mind that menopause is a life stage rather than a disease or medical condition. Just like adolescence, with a few tactics, you can get through it to the adventures that lie ahead.

Emotional

For many women, emotions are heightened during menopause. Periods of irritability, crying at the drop of a hat, lashing out for seemingly no reason, or otherwise overreacting are common during menopause. Hormones play a role, of course, but it's also a time of reflection and the realization that one important phase of life is giving way to another.

The emotional repercussions of menopause depend largely on an individual woman's personal history and life circumstances but increased and stress and mood swings are nearly universal. Regardless of your personal set of emotional responses to menopause, there is a multitude of strategies you can try to deal with them, many of which may also contribute to improving your overall mental, physical, and emotional health and well-being.

  • Meditation. A mere 15 minutes a day of meditation can effectively alleviate stress and make it easier to cope.
  • Exercise. Any sort of physical activity can reduce stress. The important thing is to do it regularly—at least three times a week or more.
  • Goal-setting. Do a life inventory. List things you'd most like to accomplish, hobbies you're interested in, or skills you'd like to hone. Consider any obstacles that might be in your way—even if it's simply a negative mindset. Make a plan to begin pursuing at least one goal.
  • Social support. This is a healthy response to stress because it helps establish a social support network. When you're overwhelmed by stress, anxiety, or worry, call a friend or see a counselor.

The National Center for Complementary and Integrative Health says research has not clearly shown any herbal supplements to be effective for menopausal symptoms. As well, custom-mixed (compounded) bioidentical hormones have not been shown to be safer or more effective than conventional hormone therapy. If you are any medications, check with your medical provider or pharmacist before adding herbal supplements since they can interact with other drugs.

Physical

You may need tactics to cope with the physical symptoms of menopause. These symptoms can interrupt your day or keep you from having the best quality of life.

Hot Flashes

Your thermostat may be very touchy around menopause. Many women find that they have a very narrow range of comfort, and it doesn’t take much to set off the alarm that tells your body to “cool off now!” Try some of these ways to deal with flashes:

  • Dress in layers. Be prepared to “take it off” if you feel yourself flushing.
  • Use breathing techniques. Breathe slowly and deeply. This sort of controlled breathing just as you start a hot flash can shorten and lessen it.
  • Drink water. If you are flashing, you are sweating. Water helps replenish your stores and it also seems to help regulate your internal temperature. Try to get 48 ounces in a day.
  • Turn down the thermostat. Whenever possible, keep your environment under 70 degrees in the daytime and under 65 degrees at night.
  • Avoid hot places. Don’t sunbathe or sit in a sauna if you are prone to flash.
  • Don't eat hot and spicy foods. Even if you have always been able to eat them, they may trigger you to flash. Stay away from the spices if you find they trip your thermostat. You will be able to eat them again someday.
  • Take estrogen. It's still the most effective treatment for hot flashes. It does carry some risks, so talk it over with your medical provider. Sometimes a short course of a very low dose is enough to get you over the hot flash bump, and then you can phase it out.
  • Use other medications. Some blood pressure medications, anti-seizure medications, and antidepressants have all been shown to improve hot flashes in menopausal women. Check with your medical provider if you think medication is something you’d like to try.
  • Try flaxseed or flaxseed oil. It may decrease hot flashes and have the added benefit of reducing joint and muscle pain for some women.
  • Consider vitamin E, yam phytoestrogens, and black cohosh. These have all been used for many years to combat hot flashes. Studies on these alternative remedies usually show them to be only as effective as a placebo. There are plenty of women who swear by them, but so far no hard research bears it out.

Insomnia

Insomnia is very common just before and after menopause. Sometimes it is due to night sweats which are hot flashes. But sometimes women seem to have a hormone shift that makes them wakeful at the same time each night. It can be hard to turn your brain off, and then you will go into your day sleep deprived. This can be frustrating and exhausting. Here are some things to try:

  • Cool your bedroom. Try to keep your nighttime bedroom temperature below 65 F.
  • Take estrogen. A short course of estrogen—less than a year—can sometimes help you re-establish your sleeping pattern. Check with your medical provider about your risks.
  • Meditate. Just before bed, meditate for a bit. This can put you in a calm state of mind and help you fall asleep—and stay asleep.
  • Take a bath. This can regulate your temperature and send you off to dreamland comfortable and relaxed.
  • Try sedatives. These can sometimes help you regulate your sleep cycle. It’s not a long-term solution, so talk it over with your medical provider.
  • Discuss antidepressants. If you are on an antidepressant that makes you wakeful, talk to your provider about changing to one that has a more sedative effect and takes them at bedtime.
  • Consider CPAP. If you snore, or if you are having periods of not breathing in your sleep (sleep apnea), you may need a sleep study to determine whether you would benefit from a continuous positive airway pressure (CPAP) device. Sleep apnea can cause damage to your heart, so if your partner tells you that you are snoring, or if you suspect sleep apnea, get a referral for a sleep study.

    Vaginal Dryness and Urinary Incontinence

    Vaginal dryness or pain with intercourse is very upsetting for women who experience it during menopause. These symptoms can disrupt your sex life, which may affect your relationships. Incontinence is embarrassing and disheartening for women. Both symptoms can be caused by the change in vaginal and urethral tissue that occurs when estrogen drops.

    • Apply vaginal estrogenWhen applied in the vagina, estrogen does not affect your system the way estrogen pills or patches do, and the effect is right there where it is needed. If you use local estrogen for vaginal symptoms, it may take three or four weeks to see the effect.
    • Use lubricant. Because your vaginal wall is becoming thinner, it is easier to tear or damage. Using lots of vaginal lubricant during sex will help prevent damage. Water-based lubricants feel natural and wash off easily. Silicone-based lubricants last longer, but more women report being sensitive or allergic to them.
    • Incorporate vitamin E and flaxseed oil. These can sometimes offer some relief from vaginal and urinary symptoms. Usually, women take them as oral supplements, but there are creams that contain them as well to be applied directly to the vagina.
    • Do Kegel exercises. Strengthening the pelvic floor muscles can improve sensation during intercourse and can reduce urinary incontinence. If you do them several times a day, you will probably see results in two to four weeks.

      Weight Gain

      Any time women tend to gain weight, it can be distressing to them. Since metabolism slows down as you age, menopause is a common time to begin adding pounds. This is frustrating because it comes at just the time when you are wanting to preserve your youth, and when your health risks begin to climb. Weight loss in menopause requires the same approaches that it does at other times in your life, but don’t set unreasonable goals for your target weight. 

      • Weight train. It not only helps you get stronger, but it also has the benefits of increasing androgen levels for better libido, stepping up your resting metabolism and preventing osteoporosis. Even if you’ve never tried strength training or weight training before, consider it now.
      • Walk. This is good for just about everything that ails you in menopause. It is easy on your joints, requires no special equipment except good shoes, and it burns calories reliably. Try varying your walking speed to improve the calorie burn, with spurts of power walking along with brisk walking. It not only burns more calories, but it also revs up your metabolism and builds bone mass.
      • Diet. This is always important, and never more than in menopause. If you want to lose or maintain weight, look for a diet that includes all food groups and is made for the “real world.” Successful weight loss diets are not the ones that require a lot of specialized foods, but ones that work with everyday foods and situations. Now is a good time to realize that you don’t need as many calories as you used to, and revamp your ideas about how much food is “enough.”
      • Manage stress. When you are stressed, you release hormones like cortisol that tell your body to hang onto fat. This may have served our prehistoric ancestors when they had to travel around all winter looking for food, but it only raises your risk factors for heart disease and stroke. So keep the stress down and your body will turn off its “keep-the-fat” button.
      • Eat more fruits and veggies. This will add fiber to your diet and give you many antioxidants and micronutrients that you need. Try to get five servings a day of the most colorful fruits and vegetables.

      Memory Problems

      Memory problems are very annoying and sometimes disturbing. They may begin in menopause, and women are sometimes alarmed when they find they are forgetful. Although some memory loss is part of aging, there may be some transitory loss that comes with the dip in estrogen. Here are some suggestions for relief:

      • Eat right. Keep your brain in good form. Get plenty of colorful fruits and vegetable for antioxidants and vitamins. The real memory villains are alcohol, sugar, and caffeine. Try cutting them way down, or out altogether and see if it improves your ability to remember.
      • Explore memory strategies. Use acronyms to remember names or streets, associating one thing with another (cue words to remind you of errands or tasks you want to do).
      • Implement external supports. Leave paper and pencil where you can easily jot down lists and reminders of what you want to remember. Hang your keys in the same place every time you come into the house. Keep a grocery list on your computer and print it out to make your shopping easy. Put information into a personal digital assistant (PDA) so you can easily carry the information you need. Set up your environment to make remembering easier.

      Social

      Menopause often arrives at a time when your social role and support network are in transition. You are sending your kids off to college or out into the world, experiencing an empty nest. You may be newly single or in a strained relationship. Your friends may be preoccupied with being grandparents and no longer easily available for activities. Meanwhile, you may be called upon to give increasing assistance to your aging parents.

      Through these changes, it can help to nurture your existing relationships as well as make new ones. Groups such as the Red Hat Society and Meetup groups for empty-nesters are one way to look for those in the same stage of life. Weight loss and exercise groups can help you tackle those concerns as well as being a good way to meet new friends going through what you are.

      But don't restrict your social life to only those in your life stage. Hobbies and activities that you can do with your children, grandchildren, younger relatives, and elders will let you see life through their eyes.

      Practical

      This new life stage is often a wake-up call that you should be doing more planning for retirement. A large home stuffed with belongings might not be ideal as your household is reduced to one or two people. It's never too early to start thinking about simplifying your lifestyle, downsizing, and where you want to spend your retirement years. This stage of life is excellent for traveling and exploring your options.

      Look into your financial security and how to maximize your retirement savings in the next few years. If you have always allowed your life partner to handle the finances, this is a good time to learn some basic skills. Knowing your assets, liabilities, and budget can help you choose the best options.

      Ensure you have the right medical insurance for ongoing and new health conditions. You may have put off drafting legal documents such as a will and advance directives, but doing so now can bring peace of mind that your wishes will be known and honored.

      Focusing now on your health, wellness, and practical matters will reap benefits for the many years to come.

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      Additional Reading

      • National Center for Complementary and Integrative Health. Menopausal Symptoms: In Depth.

      • North American Menopause Society, (NAMS), Menopause Guidebook: Helping Women Make Informed Healthcare Decisions. North American Menopause Society, 2015.

      • Office on Women's Health. Menopause.

      • The American College of Obstetricians and Gynecologists. The Menopause Years.