You’ve gone more than a year without a period and are considered to be postmenopausal. In these years, women may begin to feel the effects of normal aging but also still may be affected by the hormone changes that came with menopause. Our experts answer your questions and will help you to figure out whether the physical changes you are experiencing are normal and suggest coping strategies.
Q. I’m finding it harder to lose weight now that I’m older. Is menopause to blame?
A. Many women gain weight during the menopause transition, although neither menopause nor menopause treatments have been shown to be responsible. Midlife weight gain appears to be mostly related to aging and lifestyle, and although the cause is not menopause, menopause may be related to changes in body composition and where fat is stored, with a decrease in lean body mass. These changes may have detrimental metabolic consequences, so it’s important to avoid weight gain during and after the menopause years through diet and exercise, which minimizes fat gain and maintains muscle, thereby reducing body size.
Q. Is there anything I can do to stop my hair from thinning?
A. Some women experience thinning of the hair on the scalp in midlife. For many, this is because of an interplay of genetics, hormone shifts and environmental factors. Known as female pattern hair loss, the hair thins mainly on the crown of the head, starting with a widening through the center hair part. Other causes of hair loss may include nutrition deficiencies (such as low iron intake), significant or prolonged stress, thyroid disease and other chronic illness, and certain medications or supplements. Women also may notice increased hair loss when stopping hormone contraceptives or estrogen therapy. Hair loss can have significant effects on body image, self-esteem, and quality of life. Treatments depend on the cause of the hair loss and may include eating a healthy diet and adding a multivitamin to support hair regrowth. Topical minoxidil also can be beneficial for hair regrowth, although it may take at least 4 to 6 months to show improvement.
Q. My eyes itch and sometimes tear. Is this something that can be treated?
A. After menopause, some women report chronically dry and scratchy eyes, often along with light sensitivity, blurred vision, or swollen or reddened eyelids—a condition called chronic dry eye. Tearing can also be a symptom, because the eye produces more watery tears to compensate, although these tears don’t lubricate the eyes the way healthy tears do. Sometimes, the condition is caused by certain diseases (such as Sjögren syndrome) or drugs (such as allergy medications and antidepressants). Consult your eye care team about what may be the cause in your case and the therapies available to help provide relief. In mild cases, over-the-counter artificial tear drops or gels can help. Drinking more water and taking omega 3 supplements may also be beneficial. More severe cases may require plugging tear ducts to keep tears in the eyes longer or prescription medication.
Q. What can I do about my aging skin?
A. Aging skin undergoes loss of structural proteins (collagen) and elasticity, which creates sags and wrinkles. It also becomes less able to retain moisture, leading to increased dryness. Hormones play an important role in skin health. In particular, for women diminished levels of estrogen at menopause contribute to a decline in skin collagen and thickness. Beyond hormone changes, a number of other factors can increase the visible signs of aging skin. In smokers, the effects of aging are more pronounced, and long-time smokers have more skin damage. Maintaining skin health is one of several good reasons not to smoke or to quit smoking. Exposure to sunlight and other sources of ultraviolet (UV) light is another significant factor in skin changes. Long-term UV ray exposure causes negative effects on skin appearance, including lines, wrinkles, rough texture, and brown spots, to build up over time. Aging skin also is more prone to skin cancer. For this reason, use of a good sunscreen is essential. For optimal UV protection, women should use a broad-spectrum sunscreen, which blocks both UVA and UVB rays. Ideally, it should be applied every day to exposed areas and reapplied every 2 to 3 hours during outdoor activities. Avoiding the sun during peak hours (11 am to 3 pm) and wearing a broad-brimmed hat and solar protective clothing are also advised. Avoid tanning to ensure healthier, more attractive skin—tanned skin means that skin is damaged. Other skin-healthy habits include eating a well-balanced diet, getting adequate sleep, and drinking adequate water. A moisturizer also can minimize water loss from the skin and make it appear more hydrated. Most cream-based moisturizers contain ingredients that boost the outer layer of the skin. Other components, such as hyaluronic acid and topical retinoids, have shown to provide skin benefits.
Q. How can I stop this aching in my knees?
A. Osteoarthritis, the most common degenerative joint disease, is predominantly a disease of aging. Typically, weight-bearing joints, including the knees, hips, and feet, are affected. Aside from aging, important risk factors are obesity, significant joint injury, and overuse. Even though there is no way to prevent or cure osteoarthritis, maintaining ideal weight and exercising to strengthen muscles have been shown to provide pain relief. A wide variety of over-the-counter and prescription therapies are also available to alleviate pain. It’s a good idea to consult your healthcare provider, however, to rule out rheumatoid arthritis, a more serious autoimmune disease of the joints.
Q. My gums are starting to recede, and it hurts my teeth to eat anything cold. Is this normal?
A. Your dental health and the health of your bones are closely related. So, although problems with teeth and gums may be more common at and after menopause, don’t think of them as normal. With bone loss, the tooth sockets in your jaw deteriorate, leading to receding gums and exposing the roots, which makes you sensitive to cold. Take good care of your teeth and your bones. Get regular dental checkups and follow your dentist’s advice about flossing, brushing, and rinsing. And talk to your doctor about bone health.
Q. Do I have to start worrying about heart disease?
A. You do. Although many women think of heart disease as a man’s disease, the number one killer of women in North America is cardiovascular disease, that is, diseases of the heart and circulatory system. After age 55, more than half of all the deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause. Be sure to talk to your healthcare team about what your risks are and how you can reduce them.
Q. What can I do to prevent osteoporosis?
A. Osteoporosis is a loss of bone strength that makes you vulnerable to broken bones. Although women start losing bone in their 30s, the process speeds up after menopause. Osteoporosis is called silent, that is, you may not know you have it until you have a broken bone. Testing for osteoporosis with a bone mineral density test is usually recommended for women at age 65. If you are younger than 65 and have what’s called a fragility fracture, that is, a bone break typical of weakened bones (often in the wrist), that indicates that you have osteoporosis. Talk to your healthcare provider about your risk of osteoporosis and what you can do to help keep your bones strong, especially with good nutrition and exercise.
Q. Ever since my periods stopped, my desire for sex has decreased. Is this normal?
A. Sexual desire decreases with age in both sexes, and low desire is common in women in their 40s and 50s, but not universal. Some women have increased interest, while others notice no change at all. There is no major drop in testosterone at menopause. If lack of interest is related to discomfort with intercourse, estrogen may help. What’s important to remember is that there is a full range of psychological, cultural, personal, interpersonal and biological factors that can contribute to declining sexual interest, so if the decline in desire is bothering you, tell your healthcare provider. A clinical evaluation can identify any underlying medical or psychological causes of low sexual desire, which then can be treated as appropriate.
Q. Is there any relationship between menopause and cancer?
A. No, menopause itself doesn’t increase the risk of cancer. Cancers are more common as people age, however. Most cancers occur in people age 55 and older. The cancer most women are concerned about is breast cancer and whether hormone therapy increases the risk. Women with a uterus, who need to use a progestogen in addition to an estrogen, have some increased breast cancer risk after3 to 5 years of taking these hormones. Women who have had a hysterectomy who can use estrogen alone show no increased risk after 7 years. Keep in mind that many other things affect breast cancer risk, including your genes, your weight, and your lifestyle. Hormone therapy can also play a role in uterine cancer. If you have a uterus and don’t take, or don’t take enough, progestogen with it, that can increase the risk. If you have any menstrual-like bleeding after menopause, see your healthcare provider about it. The risk of colon cancer, the most common cause of cancer death in women and men, increases with age, and combined hormone therapy may lower the risk for women. But for this cancer, too, many other things affect your risk, including genetics, weight, and lifestyle. If you are at average risk, you should have a colonoscopy every 10 years starting at age 50.
Q. As I mature past menopause, how can I achieve the best possible health?
A. Get the checkups you need and maintain a healthy lifestyle. The risks of osteoporosis, heart disease, diabetes, and cancer all rise after menopause. Most women visit their primary care doctor or gynecologist once a year for a well-woman visit, which insurance should now cover with no copay. Even height, weight, and blood pressure checks at your visit reveal a lot about your health risks, and you and your healthcare team can discuss other tests you might need, such as cholesterol measurements, PAP tests, and mammograms. Physical inactivity, obesity, and unhealthy eating, smoking, and excessive alcohol consumption increase the risk of heart disease, stroke, diabetes, and cancer. The evidence continues to grow that getting active, losing excess weight, and healthy habits can reduce these risks.
Q. How can I find a menopause specialist?
A. The North American Menopause Society maintains a search feature on this website for those women in the United States or Canada who are looking for an expert interested in helping them manage their health through menopause and beyond. Healthcare providers who have passed a competency examination leading to the prestigious credential of NAMS Certified Menopause Practitioner (NCMP) are noted in the displayed results.