By the time they reach menopause, most women are done with riding roller-coasters – at least the amusement park variety.

Menopause can put women on a whole new and unexpected roller-coaster ride, however, without the thrills of the amusement park. This time it is hormones that are providing the ups and downs, taking women along for a ride that can throw their physical and emotional well-being for a loop.

Technically, menopause – the end of a woman’s period of fertility – begins when it’s been 12 months since a woman’s last menstrual period. In fact, perimenopause, the time leading up to full menopause can last from four to eight years.

The average age of menopause for a woman in the United States is 51, although it can occur much earlier or later. A natural process, menopause usually occurs gradually, with hormone levels fluctuating over a number of years.

Estrogen, the prime female hormone, governs multiple bodily functions including reproduction, the menstrual cycle, the immune system and metabolic processes. When estrogen production goes through a number of ups and downs, it can affect multiple body systems:

Hot flashes are perhaps the most common and one of the most frustrating symptoms of menopause. An estimated 75 percent of women report hot flashes, usually over a period of two to five years. Less commonly, others report hot flashes 10 years or more post-menopause.

Hot flashes come on suddenly, causing a rapid rise in body temperature, provoking discomfort, sweating, and flushing. In work and other public settings, this can provoke anxiety and discomfort. One strategy is to wear layers of clothing that can be quickly removed and to have a small fan available that can be turned on for relief.

At night, hot flashes can interrupt sleep and often are accompanied by sweating, sometimes to the point of requiring a change of nightclothes. Multiple hot flashes during the night seriously interfere with sleep. 

Mood changes also can affect women more during these years with fluctuating hormones contributing to mood swings, memory problems, and irritability. Small annoyances that you may have coped with in the past might trigger a stronger reaction.

Keeping stress under control is one way to help offset mood swings. One study found that women who participated in organized relaxation had 30 percent fewer hot flashes and also reported a significant drop in tension, anxiety, and depression.

Sleep problems are common in menopause, affecting the quality and quantity of sleep. Insomnia occurs even in the absence of hot flashes and night sweats. Having trouble falling asleep and also waking up in the night and not being able to get back to sleep is more common during menopause.

It’s important to practice good sleep habits. Limit caffeine late in the day, keep devices with screens out of the bedroom, and develop a calming routine before bedtime.

Loss of bone density can occur. A woman reaches peak bone density by age 30; after that, she experiences a very gradual loss each year until menopause, when the rate of loss increases.

Estrogen plays a significant role in bone formation. Although replacing estrogen can slow bone loss during postmenopause, women need to consider the very real risks of hormone replacement therapy.

Vaginal changes. Lower estrogen levels cause vaginal walls to thin and become drier, which can create discomfort and pain during intercourse. Lubricants can provide some relief and topical estrogen products are sometimes prescribed.

Hormone replacement therapy (HRT) was routinely prescribed for postmenopausal women for decades until results of the Women’s Health Initiative showed that that long-term use of HRT increased the risk of heart attacks, blood clots, stroke, breast cancer and gallbladder disease.

Although HRT still is prescribed for women with severe hot flashes and vaginal atrophy, the general consensus is that it should be used at the lowest possible dose for the shortest possible time.

Women in the United States enjoy a long lifespan, with one-third of their lives lived after menopause. However rough the ride might be, menopause represents a new life stage where women have the opportunity to pursue new directions and define who they will be moving forward.

To learn more about OB/GYN services, contact Dr. Wayland Billings of Mercy Clinic Women’s Health, 10 S. Treaty Road, Miami, at 918-238-3074.