Her Body: Your Menopause Questions, Answered

Last month, we asked readers to send in menopause-related questions to go along with NEWSWEEK's excerpt of our new book, "Is It Hot in Here? Or Is It Me? The Complete Guide to Menopause" (Workman). In this column, we answer questions that represent some of your most common concerns. Keep writing to us on menopause or any other women's health issue. Our e-mail address is Herbody@newsweek.com.

Q. How can you tell when the menopause transition begins?
That really depends on the individual. Some women go directly from regular menstrual cycles to a year without periods—the technical definition of menopause. Other women know something's happening because their menstrual cycles begin to vary in length and timing. Hot flashes are another common sign. If you have these two symptoms and you're in your 40s, most doctors will conclude that you're in perimenopause as long as you have no other physical problems. Some physicians will test your level of follicle-stimulating hormone (FSH). If it's elevated, that could be an indication that your body is working extra hard to continue your monthly cycles. However, it's an imperfect indicator because it's only a snapshot of how your body is working at one particular moment. FSH levels can vary widely within the course of a month.

How long should a woman stay on hormone therapy once it is started?
The current recommendation from major medical organizations is to take the lowest effective dose for the shortest possible time. What that means depends on your goal in using hormone therapy. If you want to relieve hot flashes—the most common reason women take hormones during the menopause transition—then you should reevaluate your decision regularly with your doctor (at least once a year). Most women find hot flashes subside within a year of reaching menopause. At that point, you might try getting off and see what happens. One tip: don't do this in the midst of a heat wave. It will be much harder to tell whether you're sweating because of a hot flash or simply suffering from soaring temperatures outside. Also, you should know that studies show that many women get hot flashes as they're getting off hormone therapy. You should talk to your doctor about possibly tapering your dose; that has helped many women stop without dramatic side effects. Others go "cold turkey" and are fine. There are no clear guidelines on this.

I am 50 and have noticed that I am beginning to get more yeast infections at this time in my life, plus my vaginal area is drier. What can I do to resolve these issues?
Yeast infections are common in women of all ages; menopause might not be the culprit here. Yeast is actually a fungus (the scientific name is Candida albicans) that is normally present on your skin and in moist areas of your body such as your mouth and your vaginal area. A dry vagina could exacerbate this condition, but many other factors might cause it, including injury to the vagina, using douches or vaginal hygiene sprays or even taking antibiotics (which can eliminate the protective bacteria in your vaginal area.) Try over-the-counter medications first. If these don't fix the problem, you need to see your doctor. A number of other, more serious infections can also cause symptoms of mimic yeast infections.

To prevent yeast infections, pay special attention to hygiene. The only delicate way to say it is: always wipe from front to back. Also, avoid nylon panties and tight jeans. Don't use perfumed soaps in the vaginal area; they can cause irritation or even hide an infection.

As for the dryness in your vaginal area, if this is causing discomfort or pain during sex, you should try vaginal moisturizers or lubricants. If you're still uncomfortable, talk to your doctor about trying local hormone therapy—rings or creams. These come in relatively low doses and therefore presumably carry less risk than higher-dose systemic hormone therapy. You don't necessarily have to stay on it for years. Some women find that if they use vaginal estrogen for just a few months, their problem is resolved.

Can a woman start going through menopause as early as her 30s?
Yes, she can. Premature ovarian failure (POF) refers to the cessation of periods over several months or years anytime before age 40. Sometimes it's a temporary condition caused by drastic weight loss, eating disorders, excessive exercise or stress. Once the aggravating cause is eliminated or reduced, menstrual periods may resume. But for about 1 percent of American women, POF is a permanent condition. In these cases, it's also called early or premature menopause. It's not clear why it happens, although researchers suspect that it's related to a genetic abnormality or some autoimmune diseases. Understandably, early menopause can be emotionally difficult for a woman who hasn't had all the children she wants. Grief is a natural reaction to finding out at 27 or 30 (the average age of premature ovarian failure) that you may never give birth to a child that's genetically yours. These women are also at greater risk for health problems such as osteoporosis or heart disease when they're older.

Early menopause generally causes the same symptoms seen in women whose fertility ends in their late 40s or 50s: hot flashes and night sweats, irregular periods, dry vagina. In some cases, however, a woman may experience no symptoms and continue to have what may appear to be normal periods. In these cases, blood tests that confirm consistently elevated levels of the follicle-stimulating hormone (FSH) help make the diagnosis. Sometimes doctors will also do an ultrasound of your ovaries to determine if your supply of follicles (egg sacs) is depleted. Hormone therapy helps alleviate bothersome symptoms and can provide some protection against bone loss and perhaps heart disease. In this case, your doctor would probably prescribe it to you until you reach the age of natural menopause, around 51.

I'm 54 and my periods are still going strong. I know that since I started my periods later (at 13) I will continue to have them longer, but this is ridiculous. How long does "peri" last?
Actually, the age at which you started menstruating doesn't make a difference. Neither does race, marital or socioeconomic status. However, women who have smoked, as well as those who suffered from depression, epilepsy or childhood cancer tend to reach menopause on the earlier side. Women who have had multiple pregnancies or who are heavier seem to experience it later. If you had longer-than-average cycles in your 20s (33 days or longer), that could also explain the delay. The biggest determinants seem to be how many eggs you were born with and the rate at which they have deteriorated. Perimenopause typically lasts 5.8 years, but it can last 12-15 years. Most women reach menopause between ages 40 and 58, but for some, it doesn't happen until they're 60. Typically, perimenopausal women will experience ever-shorter periods coming closer together, as well as missed periods. But it's also normal to have a period every month during perimenopause, until the day they suddenly stop and never appear again. Maybe that will be your experience.

My sex drive has always been high. Getting aroused was not a problem until now. At 49, I'm in better condition than most women 10-20 years younger and I have always eaten healthy. I have just begun my trek into menopause and my sex drive is nowhere to be found. Will I ever be a sexual creature again?
Very likely, the answer is yes, but it may take some time, patience and persistence to find your answer. There are a lot of things that can affect sexual response, and menopause may have nothing to do with it. Studies have not found a spike in sexual problems during the menopause transition years. It may just be a coincidence that you're experiencing this problem now. Your first thought may be to try supplemental hormones, but because hormone therapy is associated with increased risks, most doctors would recommend that you first consider other possible causes. It's a good idea to start with a physical. Your ovaries, adrenal or pituitary glands should be checked to make sure they are not malfunctioning. Your doctor will also consider whether a prescription medication, undiagnosed depression, a sleep disorder or stress are to blame. If there's no physical cause, consider a consultation with a certified sex therapist, who can help you sort out whether a partner or aging issues could be to blame, or if you're just in a sexual rut. If nothing else helps, your doctor may suggest trying a shot of testosterone to see if it makes a difference. While natural menopause doesn't prompt testosterone levels to fall, aging does. (Between the ages of 20 and 45, a woman's testosterone levels drop by about 50 percent.) While this doesn't deflate most women's libidos, it might have a noticeable effect on yours. Fluctuating hormone levels during perimenopause might also be to blame. Since most testosterone products on the market are designed for men, getting the dosing right can be tricky. Working with an endocrinologist or doctor who specializes in sexual issues may help you find a good solution faster. Make sure to ask about the risks of any hormone treatment you decide to try. While finding solutions to sexual problems is rarely easy, the good news is that there are more experts available to help than ever before.