Menopause symptoms and treatment are losing their hush-hush status

Not long after her 50th birthday, Nicola Beckles started to wonder “who turned up the heat?”

The psychologist with a private consultation practice in Amityville often found herself feeling warm but did not wake up in the middle of the night sweating — a symptom that often signals the onset of menopause.

“There was never changing of nightgowns or embarrassing hot flashes with perspiration,” said Beckles, now 64. She did notice other signs: cramping, tender breasts and weight gain.

Menopause, the period of life when a woman’s menstrual cycle stops, is a uniquely individual experience that is starting to be shared on a more public level in books, on talk shows and through podcasts. It officially begins when a woman has gone 12 months without having a period.

The growing public dialogue is all part of a larger effort by women to advocate for themselves and shed the secrecy around menopause and its symptoms, which can include night sweats, sleeplessness, depression, brain fog, painful sex and mood swings.

These changes can have a daily impact, but many women say they aren’t taken seriously or even addressed by their doctors. And studies have shown Black patients, who have faced a history of unequal treatment in health care, especially feel they are not heard or are disproportionately denied treatments, such as hormone therapy.

On average, women reach menopause in the United States at the age of 52, according to the Bethesda, Maryland-based National Institute on Aging. For some, the transition to menopause — called perimenopause — can be the most difficult stage of this life change. The transition can take place over years, generally when women are between 45 and 55.

Menopause isn’t a disease that requires treatment, but a normal life stage when women come to the end of their childbearing years

- Dr. Jill Maura Rabin, vice chair at Northwell Health

“Menopause isn’t a disease that requires treatment, but a normal life stage when women come to the end of their childbearing years,” said Dr. Jill Maura Rabin, vice chair of education and development, obstetrics and gynecology at Northwell Health. “The fact is, in 1850 the life expectancy for women was 43 . . . now a baby girl can expect to live until almost 90. Women are spending up to half their lives in menopause, so it’s very important not to pathologize it.”

The number of women entering menopause continues to grow.

Women age 50 and older were 26% of all women across the globe in 2021, according to the World Health Organization — an increase from 22% in 2011. At the same time, women are living longer. The average life expectancy of women in the United States went from 79.3 years in 2021 to 80.2 in 2022, according to the Atlanta-based Centers for Disease Control and Prevention.

In May, a bipartisan group of women senators, including Kirsten Gillibrand of New York, introduced the Advancing Menopause Care and Mid-Life Women’s Health Act, which would have appropriated $275 million to research menopause and support women’s midlife health. The bill did not make it out of committee.

Still, women are finding power in their numbers, with celebrities including Drew Barrymore, Halle Berry, Michelle Obama and Gwyneth Paltrow sharing their own experiences.

BIOLOGICAL TURNING POINT

Beyond the physical signs, menopause can also impact a woman’s mental health and outlook.

“Unlike in their 20s and 30s, when the years ahead felt endless,” women can feel that they now face a “more limited future,” said Laurie Sloane, a psychotherapist with offices in Manhasset and Manhattan. “Time is important.”

Sloane said some women find menopause is an “opportunity to raise questions about how you want to live this next chapter and reframe where you are and where you might be heading.”

For Beckles, the biological turning point fueled lifestyle changes.

She became determined to lose the weight she’d gained due to menopause and her sedentary job.

“I still had teenage boys at home, and they could eat, and I lacked discipline and motivation to get to a healthy weight,” Beckles said.

She found success in group training classes and at her gym, dropping 50 pounds. Beckles decided to retire two years early from her school psychologist job and started traveling, visiting destinations from Mexico to Morocco.

“I needed to take care of myself,” she said.

HORMONE UPS AND DOWNS

Menstrual cycles can veer off monthly patterns during perimenopause as a woman’s ovaries produce less estrogen and progesterone, two hormones vital during her reproductive years.

Women may have longer, heavier periods during this time or go months without a period. They can have sleep problems, night sweats and mood swings.

Artist and educator Margarita Espada, who founded Teatro Yerbabruja, an arts organization in Bay Shore and Puerto Rico, waited for the hot flashes that never came.

Instead Espada said she was fatigued and had pain in her legs, fingers and pelvis.

Traditionally, one way of easing these symptoms is hormone replacement therapy (HRT), where women receive estrogen and progesterone as a substitute for the hormones that had been produced by their ovaries.

HRT rode a wave of popularity in the 1960s through the 1990s, as not only a way to ease symptoms but to also protect women against some chronic conditions that are more common as women age, such as osteoporosis.

However, HRT is not without its risks. In 2002, a Women’s Health Initiative study linked HRT with an increased risk of heart disease and breast cancer, which led to a dramatic drop in its usage.

Many people in the health community have since questioned those results, noting the average age of women in the study was 63. The Women’s Health Initiative released a report in 2013 clarifying the findings, saying the risks and benefits depended on the age of the patient. In short, it could be beneficial for women in their 40s or 50s dealing with the symptoms of perimenopause or menopause but not older women looking to prevent chronic diseases.

“If you start [HRT] with someone who is younger, the benefit will be there,” said Rabin, who is also a professor of obstetrics and gynecology at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell. “If you start on somebody in their 60s ... you’re giving it to somebody who has many blood vessels that are at risk for heart attack and stroke.”

Rabin said women can use hormonal patches, creams and gels. Some studies have found these methods may be less likely than pills to cause blood clots in women.

She added it is vital for doctors to make sure women with more severe symptoms are also screened for possible undiagnosed illnesses before moving to hormone therapy.

Espada’s doctor prescribed hormones that she said helped with her symptoms.

“My energy level and body pain had gotten a little better,” Espada, now 59, said. “I was so happy and felt like my body’s back.”

After three years, she decided to take a break. Now that those symptoms are returning, Espada said she expects to resume HRT.

She called menopause “a wake-up call.”

You feel your production as a woman is done, and there’s a little sadness in a way and also a relief because you no longer are worried about pregnancy.

- Margarita Espada, artist and educator

“You feel your production as a woman is done, and there’s a little sadness in a way and also a relief because you no longer are worried about pregnancy,” Espada said.

With her son and daughter now adults, she has embraced this time to indulge in her love of the arts and travel. Espada said she has taken trips to collaborate with colleagues in Ecuador and Mexico and journeyed to the Amazon. On a whim, Espada traveled to Cuba for a women’s performing arts festival.

She has continued to practice yoga and engage in morning and nighttime stretches to alleviate stiffness. Dance has allowed her to “embrace” her new body and “make peace with it,” she said.

In addition, Espada said she has added a “moment of silence” to her daily meditations to help her connect with her new self.

DEMOGRAPHIC DIFFERENCES

Doctors emphasize that every woman experiences menopause in her own way and that symptoms vary widely. But research, especially the decades-long Study of Women’s Health Across the Nation (SWAN), has shown that menopause can impact Black women differently than other racial groups.

A 2022 study from the now-defunct journal Women’s Midlife Health showed Black women experienced vasomotor symptoms — such as hot flashes and night sweats — on average for 10 years while it was 6.5 years for white women.

Researchers said social disadvantages, “likely related in part to structural racism [are an] important driver” of many health disparities.

“Black women not only have more intense and symptomatic hot flashes or vasomotor symptoms, but also other symptoms that health care providers may not ask about . . . and Black women may be reluctant to offer — such as sleep issues and depression,” Dr. Gloria Bachmann, associate dean for women’s health at Rutgers University’s Robert Wood Johnson Medical School, told Newsday in an email. “They also tend to experience these adverse menopausal symptoms for a longer period of time.”

Bachmann said Black women’s symptoms are more severe than those of white women, but also may impact their quality of life more negatively.

“Contributors to the increased severity and longevity include [that] they’re often living in a more stressful environment with less social support,” she said.

OSTEOPOROSIS RISK

The reduction of hormones during perimenopause and menopause can put all women at risk of developing certain health conditions. Estrogen helps protect a woman’s body from cardiovascular disease and osteoporosis.

Osteoporosis is a common bone disease that affects 1 in 3 women over the age of 50, according to the National Institutes of Health, also based in Bethesda. It is marked by a weakening of bones and loss of bone mass, leaving people more vulnerable to fractures.

A bone density test revealed that Dianne Szwed, 56, had osteopenia, a midpoint between normal bone density and osteoporosis that happens when the body doesn’t make new bone mass as quickly as it reabsorbs old bone, according to experts.

Szwed, a licensed optician on the North Shore, said she stopped menstruating when she was 43. “Toward the tail end, it was very heavy, and I had to have a cauterization procedure to stop the bleeding,” she said.

Szwed said she started experiencing sleep problems and hot flashes when she was 45. Although “they were never bad,” those menopausal issues ended three years ago with progesterone tablets and an estradiol patch that delivers hormones through the skin.

Keen on staving off osteoporosis, Szwed, who had already been doing cardio workouts and using weights, said she kicked up her fitness regimen with “a little heavier weights.” The hormone therapy along with the increased weights she is lifting led to about a 10% improvement in her bone density results, Szwed said.

She said she also lost three of the 10 pounds she had gained during menopause. “Seven are still hanging on,” she said.

Although the optician relies on her own doctor, as well as podcasts, for information about menopause and the aging process, she also compares notes with friends.

“Friends can ease your mind and let you know that you’re not the only one experiencing certain menopausal symptoms,“ Szwed said.

SOME HAVE FEW SYMPTOMS

Susan Barbash, 70, became menopausal in her early 50s, and other than a bout with night sweats, she said she didn’t have serious symptoms. Her mother had the same experience.

“Sometimes I just wonder if it’s the luck of the genes,” Barbash said.

“I had no hot flashes during the day, no depression, no mood swings and never had headaches,” added the Bay Shore resident, who manages two family-owned apartment complexes.

Because she said she had been a “chubby kid” in the prepubescent years, Barbash has long been committed to eating healthy so her weight didn’t vary with menopause, she said. And because she said she “didn’t like the idea of taking drugs,” she steered away from HRT.

Looking back, she recalled her mother, who was relatively late to menopause, going to the doctor for her annual checkup and complaining that she was tired of still getting her period. The doctor’s response — “You are forever young” — both “exasperated and pleased” Barbash’s mother, she said.

TALKING TO DOCTORS

Women should feel comfortable discussing all aspects of menopause with their doctors, whether it’s her primary care physician or her gynecologist, experts said. However, some women have said they are embarrassed to talk about symptoms while others feel like their doctors just don’t listen to them.

A 2024 study in the journal Menopause titled “Addressing Menopause Symptoms in the Primary Care Setting” concluded that primary care clinics, in addition to gynecologists, should do a better job of identifying women with bothersome menopause symptoms so that “appropriate treatment options, including hormone therapy, can be discussed and offered.”

Bachmann said all symptoms reported during the perimenopausal and menopausal years should be taken seriously starting with a comprehensive health history.

“A great way to start the conversation with midlife women is stating, ‘Many women as they go through the midlife and menopausal years have difficulty sleeping, feel depressed, have hot flashes and night sweats and vaginal dryness, to name just a few,’ ” Bachmann said. “ ‘Are you experiencing any of these symptoms?’ In this way, the menopausal woman is given ‘permission’ to talk about the symptoms she may have otherwise been reluctant to talk about.”