Rough transition into menopause

I’m 46, and there are days when it feels like I’m completely losing my mind. I misplace my car keys, struggle to remember details of recent conversations, and can’t recall seemingly anybody’s name. To help cope with my mental cloudiness, I always keep an extra set of keys nearby, write endless sticky notes to myself, and frequently opt for the generic “hello” over more personalized greetings.

Strategies like these may help me get through my day, but they fail to calm the nagging concern that something is seriously wrong with me. They also do nothing to combat the other “symptoms” that have developed over the last year or two, namely trouble sleeping and a vague sense of doom and gloom.

Talking with friends my age tends to make me feel better — not their comforting words so much as the knowledge that they’re experiencing many of the same things that I am. For lack of a better explanation, many of us believe that what we’re going through must be related to menopause and the hormonal changes that accompany it.

Although most of us still have fairly regular menstrual periods, emerging evidence suggests that our theory may not be far off the mark. “Women experience some very real symptoms during the menopausal transition,” says Dr. Gail Greendale, research director at the UCLA Women’s Health Center. “And they begin earlier than anyone ever thought they did.”

Exactly when women begin the menopausal transition — or perimenopause — isn’t black and white. Menstrual irregularities such as longer or shorter intervals between periods or significantly heavier or lighter periods mark its beginning; menopause itself is reached only after periods have ceased for a year. Some women have no symptoms other than altered menstrual patterns. For those who are more symptomatic, however, symptoms can last anywhere from just a few years to a decade.

To get a better handle on all of this, Greendale and a group of researchers from across the country have been monitoring thousands of women as they progress through menopause as part of the Study of Women’s Health Across the Nation (or SWAN study). As the scientists examine the physical, biological, psychological and social changes that these women go through, their work is shedding a whole new light on what the “middle years” hold in store for women.

It used to be that everything that happened to women between ages 40 and 60 was blamed on menopause. Then, in the late ‘80s and early ‘90s, the pendulum swung in the opposite direction and people — medical professionals included — began to shy away from attributing anything untoward at all to this midlife change.

The truth probably lies somewhere in between, Greendale says: Women don’t fall totally apart, but the years leading to menopause, as well as menopause itself, clearly can affect the way they feel and function.

Symptoms extend well beyond hot flashes. A study published last year in the journal Neurology found that perimenopausal women have more difficulty with learning and memory. “You’re simply not as fast on the uptake,” Greendale says.

Sleep difficulties are also extremely common — it’s estimated at least nearly 40% of women between ages 40 and 55 report trouble getting a good night’s rest. A 2008 study published in the journal Sleep found that falling asleep becomes progressively more difficult for women as they transition through menopause; so does sleeping through the night and staying asleep until the alarm goes off. Hot flashes certainly contribute to the problem, but they’re only partly to blame, and other factors related to the menopausal transition — such as hormonal changes themselves — seem to be at play as well.

Perimenopausal women are more likely to experience psychological distress than those who haven’t started the transition. An early SWAN study appearing in the American Journal of Epidemiology found the prevalence of mood symptoms such as irritability and nervousness to be higher during the menopausal transition. A more recent study published in the Journal of Affective Disorders showed that the likelihood of depressive symptoms like loss of appetite and feeling “blue” rises as well — by as much as 30% to 70%.

Many women find a certain level of comfort in findings such as these. “Learning that they’re not alone helps them cope with their menopause,” Greendale says. “It validates the way they’re feeling. It makes them feel like it’s not all in their head.”

The next step is figuring out what can be done for women who are symptomatic, beyond simply telling them that what they’re experiencing is real. Unfortunately, treatment options are extremely limited. Though hormone therapy has proved effective for hot flashes, it may increase the risk of heart disease, stroke and cancer and has never been proved to alleviate most other types of symptoms.

The bit of good news in all this: For many women, the months or years leading to menopause can be more troublesome than what they experience later. “Symptoms during the transition into menopause may be transient — they may or may not persist,” Greendale says. Studies of cognitive function, for example, suggest that women’s capacity to learn rebounds after menopause is finally reached; the brain fog ultimately lifts, in other words.

Our understanding of menopause is still rudimentary, and it’s likely that I’ll be well through this transition before there are any good answers or treatments. It seems I’ll have to rely on my extra set of keys and Post-its. That and commiserating with my friends.

Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. The M.D. appears once a month.