How to deal with a woman going through menopause?


A Man’s Guide to Menopause

Many women don’t know what to expect when menopause starts — and because of this, their husbands and significant others can be even more clueless.

As a woman approaches menopause, the stage of life where menstrual cycles permanently stop, hormone levels in her body can fluctuate, resulting in mood swings, tiredness, and bothersome menopause symptoms like hot flashes. With all of these changes, it can be difficult to figure out what to do — and what not to do — to keep both you and your partner happy and on an even keel. But there’s good news: You can get out of it alive, says Grace Gibbs, DO, an ob-gyn with Charlotte Women’s Health in Lansing, Mich.

“There are some things that are a little bit harder for men to understand,” Dr. Gibbs says. “They often don’t quite get what we’re going through and how menopause can affect you as a whole. It’s about much more than just your period stopping.”

How to Survive Her Menopause

To help keep the peace at home, consider the following tips:

  • Prepare for crabbiness. Unless you’re with one of the few lucky women who aren’t bothered with menopause symptoms, mood swings are likely. This happens as the female hormones estrogen and progesterone surge and ebb in the body. Grumpiness can also result from poor sleep, which menopausal women experience as they deal with hot flashes and night sweats. “When you don’t sleep well, everything is just kind of crazy,” Gibbs says.

    Flexibility is the key to dealing with mood swings, even the ones that seem to be caused by … nothing. If your partner is steamed because you brought home the wrong brand of milk, for example, give her some space instead of getting defensive. Likewise, if she’s sobbing at a cat food commercial, lend her a shoulder to cry on. And, perhaps most importantly, don’t complain if she turns the thermostat to just a few degrees above freezing. “Bundle up under a blanket if you have to,” Gibbs suggests.

  • Be patient in the bedroom. Sex can, quite literally, be a sore spot for a woman going through menopause. As estrogen levels drop, the tissue in and around the vagina can dry out, making it more sensitive. “Estrogen makes the tissue soft and pliable,” Gibbs says. “When women go through menopause, it just gets paper-thin. They can get cuts just from using toilet paper.”

    Many women also tend to lose interest in sex during menopause because their levels of the male hormone testosterone, which helps fuel libido, can drop along with other hormones. “Women have it in small amounts, and it’s derived from some of the estrogen in our bodies,” Gibbs says. “So we actually lose a little of our testosterone, too.”

    The bottom line? Be patient. If your partner just isn’t in the mood (again), don’t press the issue. Most women’s libidos usually revive after menopause is complete. If she’s willing but has physical pain, suggest she talk to her doctor about vaginal estrogen creams to help relieve the dryness.

  • Make her feel beautiful. Many women feel less than feminine as they go through menopause. Some mourn the loss of their reproductive abilities. Others may find their weight creeping up, even if they’re maintaining their normal diet and exercise routines. Add that to the constant hot flashes, — “the body’s function is in overdrive,” Gibbs says — and you’ve got a recipe for one sweaty, unhappy woman.

    To help improve your wife’s self-image, remind her that she looks great. You can also suggest a date night, a leisurely dinner out over a glass of wine, for example, or even just an evening on the couch with some movies or playing cards.

  • Know that menopause is not forever. Menopause may seem like the bad gift that keeps on giving, but you can take comfort in knowing that things do get better. The transition into menopause can last up to eight years or so, but most women feel their symptoms most acutely for only about two years.

“It does get better,” Gibbs says. “Things will go back to the way they were before. Just offer support. She’ll notice that, and appreciate it.”

Menopause isn’t just a rough time for women — it’s also hard for the men who love them. If your spouse or partner is in the throes of “the change,” unpleasant symptoms like hot flashes and mood swings will probably affect you and your relationship.

In a recent survey, 38% of men said their wife’s night sweats and insomnia related to menopause affected intimacy, and they cited their partner’s lack of sleep or poor sleep as the main reason.

You may not be able to prevent hot flashes, but you can help the woman in your life get through this trying time — and preserve and strengthen your relationship.

Know what to expect. The average age of menopause in the U.S. is 51, but many women start to get symptoms in their early 40s. They can begin as early as 7 years before a woman’s final period and last 5 years or more afterward — that’s some 12 years of disruptive symptoms, like hot flashes, night sweats, and insomnia.

What causes them? “Changes in hormone levels during menopause can affect the body’s ability to regulate its core temperature,” says Rebecca Brightman, MD, OB/GYN, assistant clinical professor at Mount Sinai Hospital. Some women may also have vaginal bleeding at unexpected times, vaginal dryness, and pain during sex.

Be empathetic. Along with the biological changes, the emotions surrounding menopause can be difficult. For example, “even if no one wants more children, menopause can still represent a certain loss of youth and potential that may strike your wife as sad,” says Gail Saltz, MD, author of The Ripple Effect: How Better Sex Can Lead to a Better Life. “Try to imagine yourself reaching some biologic milestone that changes your body — and how you might feel about it. By standing in her shoes, you’ll be better able to be supportive about the changes.”

Talk about it. Many men are uncomfortable discussing menopause, Saltz says, but try to talk about ways you can help relieve her symptoms as a team. Ask how you can ease her stress. Also, encourage better sleep habits, or start an exercise regimen together. Some women may need encouragement to see a doctor to look into various hormonal and non-hormonal treatments.

Keep up the romance. A woman still wants to feel desired and appreciated during this time, Saltz says. Don’t avoid intimacy; embrace it, as long as your partner feels comfortable. “A romantic dinner or holding hands on a walk can make a big difference in her view of both herself and the two of you as a couple.”

Dealing with the symptoms of menopause

Updated: March 21, 2017Published: June, 2009

You could argue that the physical and mental changes that occur during menopause aren’t really “symptoms.” The term is usually associated with a disease, which menopause is not. Also, it is often hard to say which changes are a direct result of a drop in hormone levels and which are natural consequences of aging. Some of the symptoms overlap or have a cascade effect. For example, vaginal dryness may contribute to a lower sex drive, and frequent nighttime hot flashes may be a factor in insomnia.

Hot flashes and vaginal dryness are the two symptoms most frequently linked with menopause. Other symptoms associated with menopause include sleep disturbances, urinary complaints, sexual dysfunction, mood changes, and quality of life. However, these symptoms don’t consistently correlate with the hormone changes seen with menopause transition.

Hot flashes

Also called vasomotor symptoms, hot flashes may begin in perimenopause, or they may not start until after the last menstrual period has occurred. On average, they last three to five years and are usually worse during the year following the last menstrual period. For some women they go on indefinitely.

Hot flashes probably begin in the hypothalamus, a part of the brain that controls body temperature. For reasons that remain elusive, the thermostat in a midlife woman’s body is suddenly reset at a temperature lower than normal. The hot flash is the body’s way of cooling itself, like the way a refrigerator kicks on when you open the door on a hot day.

Hot flashes can be extremely troubling for the 15% of women who have the most severe form. Women who have had surgical menopause or those who are taking tamoxifen to prevent breast cancer are often in this unfortunate group.

The outward signs of a hot flash — sweating and pink or reddened skin — tell the world that a woman’s estrogen production is dwindling. Heart palpitations and feelings of anxiety, tension, or a sense of dread also may accompany hot flashes; some women say they feel agitated or unsettled right before a hot flash occurs. Women experience hot flashes differently. Some feel warm; others complain of burning up. A lot of women feel chills afterward. Hot flashes that occur during sleep, called night sweats, may disrupt sleep, causing fatigue and mood changes.

Treating hot flashes. Depending on their severity and how much they affect your day-to-day activities, you can take several steps to help alleviate hot flashes. Begin with a commonsense approach. Some possible triggers of hot flashes are hot beverages, spicy food, warm air temperatures, stressful situations, alcohol, caffeine, and some medications. If you can identify your own triggers, you may be able to avoid some hot flashes. Keep a diary to note which of these or other triggers were present before each hot flash. Review it each week to pinpoint the most common triggers.

During the day, dress in layers so that you can take off garments when needed. If possible, regulate the air conditioning and heat in your environment to accommodate your temperature changes. If you wake up hot at night, sleep in a cool room. Go to bed with a frozen cold pack under your pillow, and turn the pillow over when you wake up. Keep a change of nightclothes next to your bed so that you can change easily if you wake up soaked.

Some women find deep-breathing exercises helpful. Research suggests that a technique called paced respiration can cut in half the frequency of hot flashes. To perform paced respiration, take slow, deep, full breaths — expanding and contracting the abdomen gently while inhaling and exhaling — at a rate of about six to eight breaths per minute. One of the best ways to learn paced respiration is by taking a yoga class. Practice this technique twice a day for 15 minutes. You can also use paced respiration whenever you feel a hot flash coming on. Stress-relief techniques and biofeedback may also be of some benefit.

Several herbal products and dietary supplements claim to lessen menopausal related symptoms. But it’s important to remember that all of the hot flash studies using a placebo show that at least 25%–30% of women respond to the placebo. That’s worth knowing before you spend money on over-the-counter remedies. In addition, most hot flashes wax and wane, although the summer months can be especially difficult.

Short-term hormone therapy is quite effective in treating hot flashes. Doctors try to prescribe the lowest dose of estrogen that effectively relieves symptoms. If you can’t or don’t want to take hormones, you may find that an antidepressant such as paroxetine (Paxil), venlafaxine (Effexor) or fluoxetine (Prozac) helps. The antihypertensive medication clonidine (Catapres) or the antiseizure medication gabapentin (Neurontin) relieves hot flashes in some women. Talk with your clinician about which medication may be right for you, and remember that most hot flashes improve over time on their own.

Vaginal changes

Decreased estrogen causes the vaginal lining to thin and vaginal secretions to diminish. The vagina also becomes shorter and narrower. The result often is dryness and irritation, which can make sexual intercourse unpleasant. Inflammation of the vaginal wall also may occur, causing a condition called atrophic vaginitis. It isn’t an infection, but if it is not treated, further thinning and ulceration of the vagina may occur; this can cause bleeding or make intercourse or pelvic exams painful at best and impossible at worst. It is important to keep in mind that there are a variety of conditions other than menopause that can cause painful intercourse, so consulting a clinician is wise.

Treating vaginal changes. A simple vaginal lubricant such as Astroglide or Silk-E may help treat vaginal dryness. A vaginal moisturizer such as Replens may also be helpful. Estrogen treatments applied directly to the vagina in the form of creams, rings, and tablets are quite effective. Also, experts say regular sexual stimulation can help keep the vagina healthy by maintaining its elasticity.

Irregular uterine bleeding

A pear-shaped organ about the size of a fist, your uterus is made mostly of muscle. As you move through perimenopause, your uterus shrinks slightly, and the inner layer of tissue, or endometrium, no longer builds up and sheds on a predictable monthly cycle. Changes in the menstrual cycle are a hallmark of perimenopause, so determining what’s normal and what isn’t can be a challenge for women and their clinicians. Only 10% of women stop having periods with no irregularity in their cycles.

Uterine bleeding: What’s normal, what’s not

One concern for perimenopausal and postmenopausal women is knowing whether irregular uterine bleeding is normal. Most women notice normal changes in their cycle as they approach menopause. Periods are often heavy or more frequent, and they may stop and start. But abnormal uterine bleeding may be a sign of benign gynecologic problems or even uterine cancer. Consult your physician if any of the following situations occur:

  • You have a few periods that last three days longer than usual.
  • You have a few menstrual cycles that are shorter than 21 days.
  • You bleed after intercourse.
  • You have heavy monthly bleeding (soaking a sanitary product every hour for more than a day).
  • You have spotting (bleeding between periods).
  • You have bleeding that occurs outside the normal pattern associated with hormone use.

When you report abnormal vaginal bleeding, your clinician will try to determine whether the cause is an anatomic problem or a hormonal issue. He or she also will investigate other possible causes. In addition to identifying the cause, he or she will help you manage any excess bleeding, which sometimes leads to anemia.

On rare occasions, postmenopausal women experience uterine bleeding from a “rogue ovulation,” which is vaginal bleeding after a hiatus that may be preceded by premenstrual symptoms such as breast tenderness. Presumably, the ovaries are producing some hormones and maybe a final egg.

Postmenopausal women who are not taking hormones should not generally have vaginal bleeding and should seek medical care if they do. But it is normal for women who take hormone therapy in continuous doses to experience bleeding or spotting during the first several months of taking these medications. And women on cyclic hormone regimens sometimes have light monthly bleeding. Vaginal bleeding outside the usual pattern for hormone therapy in a postmenopausal woman is always a cause for concern.

Irregular periods

In the early stages, your menstrual cycle may shorten, with periods beginning sooner than you expect. Maybe your periods used to come every 28 days, exactly at 3:15 p.m. Now, they may still come at 3:15 p.m., but the cycle is every 24 or 26 days. But any pattern is possible. Bleeding also may become lighter or heavier. Going for three months without a period suggests menopause is at hand, although more than 20% of women have regular periods again after such a break.

These irregular patterns may be exacerbated by other gynecologic problems common in midlife — for example, uterine growths such as polyps or fibroids. Declining fertility, another sign of perimenopause that accompanies irregular periods, can become a stressful emotional issue for women who still want to become pregnant.

Treating troublesome periods. For women whose periods become very irregular, prolonged, or heavy, doctors often prescribe birth control pills, which can make periods lighter and more regular. Alternatively, intermittent doses of progestogen (a version of progesterone, the hormone that causes the uterine lining to slough) may be helpful for women who are having intermittent bleeding and who are not ovulating. Some women find it helpful to take nonsteroidal anti-inflammatory pain relievers such as ibuprofen (Advil, Motrin) and naproxen (Aleve). An intrauterine device (IUD) called Mirena, which secretes a low dose of the progestogen levonorgestrel, can help control excess or unpredictable bleeding caused by irregular ovulation or hormonal problems. In addition, a variety of procedures can stop excess bleeding by destroying the endometrial lining of the uterus; these include thermal (heat) and cryo (cold) therapies. Talk with your doctor about your symptoms to determine the best approach.

Other physical and mental changes at midlife

Some common midlife changes that are often attributed to menopause are not necessarily related to the fluctuating or decreasing hormone levels of menopause. The four most commonly reported changes include mood changes and depression; insomnia or other sleep problems; cognitive or memory problems; and decline in sexual desire, function, or both. Other physical changes that crop up in the middle years include weight gain, urinary incontinence, heart palpitations, dry skin and hair, and headaches. For these, a hormonal link is possible, but has not been proved. Consider the fact that men, who don’t experience a dramatic drop in hormone levels in their early 50s, often notice many of these same symptoms!

Mood swings and depression

Studies indicate that mood swings are more common during perimenopause, when hormonal fluctuations are most erratic, than during the postmenopausal years, when ovarian hormones stabilize at a low level. No direct link between mood and diminished estrogen has been proved, but it is possible that mood changes result when hormonal shifts disrupt the established patterns of a woman’s life. These changes can be stressful and may bring on “the blues.” Mood swings can mean laughing one minute and crying the next, and feeling anxious or depressed. These changes are transient, however, and do not usually meet the criteria for a diagnosis of clinical depression, a more profound dysfunctional emotional state.

Over their lifespan, women have more depression than men. But there is no evidence that decreased estrogen alone causes clinical depression. Although women who have had previous episodes of depression may be vulnerable to a recurrence during perimenopause, menopause in and of itself does not cause clinical depression. The incidence of depression in postmenopausal women is not any higher than at any other time in life.

Disrupted sleep from night sweats can cause a woman to feel fatigued and irritable. Also, remember that perimenopause coincides with many of life’s stresses — children who are teenagers or leaving home, peaking professional responsibilities, illness or death of elderly parents, and aging itself. These events, combined with unpredictable hormonal changes, can leave a woman feeling fatigued, overwhelmed, and out of control.

Treating mood swings. Many women choose to make lifestyle changes before turning to medications. Taking care of yourself by getting more sleep, exercising regularly, and using stress-control methods can all help even out your mood. For an herbal approach, St. John’s wort may have some mood-elevating effects, although studies have been conflicting. Prescription antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), effectively moderate moods.

Memory and concentration problems

During perimenopause, women often complain of short-term memory problems and difficulty with concentration. Study results looking at the relationship between falling hormone levels and cognitive function have been inconsistent. Some women do believe that low dose estrogen after menopause helps them think. But the research has not supported this. Stress likely plays a more important role in memory and thinking compared to hormonal fluctuations.

Treating memory and concentration problems. Just as it isn’t clear what causes memory and concentration problems, there is no obvious remedy. Staying physically active and scheduling at least 150 minutes per week of dedicated exercise may be the best way to maintain brain health. Brain and memory experts also recommend that people work to keep their brain functioning at its peak by taking on new and interesting challenges. Use your mind in many different ways. Do crossword puzzles. Learn a new musical instrument or sport. Play chess. Read more books. Learn a new language or how to use the computer. The idea is to challenge your brain in new ways.


Disrupted sleep is a common complaint during perimenopause. Whether hot flashes during sleep cause sleep disruption is not completely clear. Some women report that they perspire so profusely that they soak the bed linens and wake up. Others sleep right through their hot flashes. At least one study showed that hot flashes disrupt the most restorative form of sleep, even if the woman doesn’t wake up.

Insomnia also can be a problem for women who don’t have hot flashes. Some women may have difficulty falling asleep, but a common pattern is to sleep for a few hours, awaken too early, and not be able to fall back to sleep. Whether sleep disruptions are due primarily to hormonal changes is currently unknown. Sleep cycles change as people age, and insomnia is a common age-related complaint. The problem is a troublesome one that can leave sleep-deprived women fatigued, tense, irritable, and moody. Insomnia is not a trivial matter, as sleep problems also have been associated with heart attacks and congestive heart failure.

Treating insomnia. Medications are available for temporary treatment of insomnia, but you can also take some practical steps to improve your chances of getting a good night’s sleep. If hot flashes are keeping you awake, trying a treatment for hot flashes may also improve your sleep.

Low sexual desire

Sex drive may decline at midlife for a variety of reasons. Diminished estrogen or age-related changes in circulation may reduce blood flow to the genitals and cause a decrease in sensation. Vaginal dryness or thinning can make intercourse painful. And women who have sleep problems may feel too fatigued to be interested in sex. Urinary incontinence may cause embarrassment that diminishes the appeal of sex. Concern about changes in physical appearance and body image can also reduce sex drive.

During perimenopause, not only can women’s sexual responsiveness decline, but their partners also can have a significant increase in sexual performance problems. As a result, women may not feel quite as warmly toward their partners as they had earlier in the relationship. As women enter the postmenopausal years, this can lead to further decreases in sex drive, sexual responsiveness, and frequency of intercourse.

Treating low sexual desire. Lifelong perceptions about sex and the quality of relationships also have a profound impact on women’s sexual function at midlife. Some women don’t have a partner. Some have partners who are themselves suffering from sexual dysfunction; this, too, may play a role in the woman’s declining interest in sex. Talking with your partner about each of your needs and expectations can go a long way toward helping solve this problem. If talking is too difficult, counseling with a trained sex therapist can help pave the way.

Weight gain

Although weight gain is a significant issue for a lot of women in this age group, there’s no clear evidence that it’s a direct result of hormone changes or even age. A 2004 study in the American Journal of Epidemiology of more than 3,000 women found no link between menopausal status and weight gain or an expanding waistline. Instead, the classic middle-age spread seemed to stem from a variety of factors, including the fact that older women (and men) are simply less physically active. There is also some speculation that weight gain in midlife is due, in part, to a slowdown in metabolism.

Treating overweight. Many strategies are available for losing weight. For women who have yet to gain excess weight, the best strategy is to try to avoid gaining by exercising and eating right. Measure your waistline regularly and try to prevent any increase. As your waist size grows, so does your risk of heart disease and diabetes. Walking, swimming, or other aerobic exercise is your best bet because it helps prevent accumulation of fat at the waistline.

Urinary incontinence

Up to 30% of American women ages 50–64 have problems with urinary incontinence, compared with, at most, 5% of men in the same age group. The disproportionate impact on women is from the effects of vaginal childbirth on pelvic tissues and basic anatomical design differences between men and women.

Decreased estrogen may cause or contribute to thinning in the lining of the urethra, the tube that empties urine from the bladder. Problems may include a more frequent need to urinate, a sudden urge to urinate even though your bladder is not full, pain during urination, the need to urinate more often during the night, and urine leakage when sneezing, coughing, or laughing. Urinary problems persist and worsen in postmenopause because changes in the urinary anatomy occur with general aging as well as estrogen loss. Some other causes of urinary incontinence include bladder and urethral infections, muscle weakness caused by aging or injuries during childbirth, and some types of prescription medication.

Treating incontinence. Bladder training may be useful for urge incontinence. This entails holding urine for five minutes after feeling the urge to void and increasing the holding period by five minutes each week. Eliminating diuretic beverages such as coffee, tea, and alcohol as well as citrus juice and other bladder irritants may also help. Pelvic floor exercises, known as Kegel exercises, can be effective. They involve repeatedly contracting and releasing the pelvic floor muscles used ordinarily to halt urination. Women with atrophic vaginitis may benefit from topical estrogen therapy. Talk with your doctor about your treatment options, which include lifestyle habits, medications, and surgery.

Dry skin and hair

Many women experience dry skin and hair at midlife. While some research suggests that declining estrogen levels may contribute to dry skin, it may also be the result of cumulative sun exposure or smoking. With age, the skin’s ability to retain water and produce oil diminishes, too. But there is little evidence that decreased estrogen is directly involved in causing skin to dry and wrinkle.

Treating dry skin and hair. Because these conditions are so common, many remedies are available. Protect your skin from sun exposure with sun blocks, hats, and clothing. Use moisturizers and hair conditioners, especially in the dry winter months. Buying a moisturizer is one case in which the old adage “you get what you pay for” doesn’t hold true. Inexpensive and effective moisturizers are widely available and often equal or superior to high-end products. For instance, petroleum jelly is an inexpensive and highly effective moisturizer for skin that is extremely dry.

Menopause is no longer the obvious sign of aging it once was. A Guide to Women’s Health: Fifty and Forward takes a view of the whole woman and helps her sort through the latest medical findings and choose the most practical strategies for making her midlife transition as easily as possible. Read more “

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

What Husbands Need to Know About Menopause

I recently saw a couple in my office for a medical visit. The husband insisted on accompanying his wife, who was in her mid-50s, into the exam room because he wanted to make sure she relayed all of her symptoms and all the things that were going on in her life. He immediately commandeered the examination: “First of all, she just isn’t interested in having sex with me anymore, and she does everything that she can to avoid being intimate with me.” The wife put her head down in embarrassment.

I shifted the conversation to the patient and asked, “Have you noticed any significant changes in your behavior or the way you feel lately?” She launched into a lengthy list of symptoms: depression, severe hot flashes and night sweats, forgetfulness. She also reported waking up three to four times each night and lacking energy. Without a doubt I knew what she was dealing with — menopause.

She finished by saying, “I don’t want to have sex because I feel so ugly and unattractive, and also because it hurts so much now.” The husband sat there, his mouth open in disbelief. “Wow,” he said when he regained his speech. “That’s the first time that I’ve heard any of that.”

His wife said, “I thought there was something wrong with me, and I was embarrassed to tell you.”

A natural time of life

Sadly, this woman’s feelings about what was happening in her life — there’s something wrong with me — are shared by too many women. While menopause can come with discomforts and inconveniences, it is not a disease or abnormality. It’s a natural time in a woman’s life, and most of the things a woman experiences at this time are typical.

Menopause is the point in life when a woman’s ovaries begin to significantly decrease production of the hormones estrogen, progesterone and testosterone. Estrogen and progesterone are the two principle female hormones, while testosterone, although commonly thought of as a male hormone, is produced in small amounts in the ovaries and adrenal glands. In women, testosterone plays an important role in sexual desire and energy enhancement.

Menopause is defined as 12 months of going without a menstrual period. The most common symptoms are hot flashes, sweating, increased irritability and mood changes, sleep disturbances, difficulty concentrating and thinning of hair on the head. Vaginal dryness resulting in painful intercourse often occurs later.

Menopause doesn’t occur at a specific age, although the average age it begins is just over 51 years. If a woman’s ovaries are surgically removed, she enters what is known as surgical menopause.

The effects on relationships

While menopause is natural and normal, husbands and wives are often caught off guard by changes in their marriage relationship. Many husbands become confused by the behavior of their wife during menopause. The first thing men often notice is a decrease in sexual desire by their spouse.

As both partners age, a decrease in the frequency of sexual intimacy is normal, but during menopause some women have a significant loss of desire — or begin to experience so much discomfort with intercourse that they choose to avoid contact. The husband may not understand what’s going on and feel rejected or even suspicious that his wife is interested in someone else.

If a couple is already experiencing marital problems, then moodiness, irritability, confusion and sudden outbursts of anger may add another level of difficulty. Counseling may be necessary for both spouses during this crucial time of hormonal change.

Actions and attitudes

Menopause doesn’t necessarily spell trouble for a relationship. The key to stabilizing and strengthening the marriage is to embrace this new season of the marriage. Every marriage goes through transitions. You have the opportunity to create some new normal for your relationship.

Communicating through this season of change is extremely important. It’s critical for the husband to show deep understanding and compassion for his wife. (He should remember that while he didn’t ask for this, neither did she.) The husband needs to avoid blaming and shaming his wife for what is in many ways beyond her control.

He should be curious about her feelings and emotional needs during this transition. Ask questions like, “How are you doing emotionally? How can I best show you love in the midst of menopause? How can I best encourage you through this season?”

Women should likewise extend grace to themselves. The feelings and emotional disruptions they undergo are the result of dramatic hormonal changes.

A woman can often benefit from the care of a qualified medical professional, who can provide information about menopause and treatments for discomforting symptoms. Similarly, the counsel of a licensed therapist or a pastor can be valuable in dealing with relationship issues. Research shows, however, that only about 20 percent of women feel comfortable enough to discuss their symptoms with their health care professional, and many women struggle through this time without the support they need. Setting aside time to talk with other women who are going through menopause can also help.

A well-balanced diet; regular exercise; interacting with others; Bible study and prayer; and taking appropriate vitamin and mineral supplements can also help. (Talk with your health care professional before taking any new supplements, as some can interact with other drugs you may be taking.) Finally, it is of utmost importance that you talk with family members about how you are feeling.

Menopause does not have to be the beginning of a downhill course in life, or of relational difficulties. Nor does it mean the end of your sexual life. Many couples find greater sexual intimacy and fulfillment as they grow closer to each other.

What Wives Wish Their Husbands Knew About Menopause

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Husband’s don’t need to ‘fix’ the problem, just show that they care.

By Lois Mowday Rabey

“Men want to fix everything,” one woman told her group. “I just want him to hold me and tell me he still loves me.”

Her sentiments ring true for many women. There is no easy fix for every problem that vexes the menopausal woman.

While some things can be done to alleviate some physical symptoms, it’s the emotional effects that have women—and men—so bewildered. Combine these two—the physical changes and the emotional ups and downs—and you have a situation that can frustrate a marriage and challenge a woman’s identity as a sexual being.

For married women, the comments below will resonate. Further on, we’ll see how the mental transition from the childbearing age to the grandchildren-rearing stage does not change—but rather enhances—femininity.

More than having their menopause problems “fixed,” women want to know that their husbands will stay connected to them, or begin connecting with them, and walk through this stage of life together.

“Don’t give a lot of advice,” another woman responded when asked about what she tells her husband she needs. “I want to be able to say how I feel—without feeling like I have to take his advice.”

This woman may sound ungrateful, but she is only frustrated. Like so many husbands, her man wants to help. Yet his attempts to fix her only frustrate her.

It is difficult for men to accept that they can do nothing to make menopausal symptoms go away. There are, however, many ways husbands can provide the one thing these women truly need: support. And that support will be awfully hard to offer if they don’t accept certain rules of encountering menopause moments.

Be assured that emotional symptoms are (usually) caused by physiological changes, not by husbands. One woman said, “My husband never knows exactly what he’ll find when he gets home from work. Some days I’m my normal self, which is pretty calm. Other days, I am off the wall. I am agitated and tearful. He comes in, and I just light right into him. I don’t mean to take my frustration out on him, but I do.”

The women I interviewed agreed that husbands should be assured that they are rarely the true cause of emotional outbursts, but they may often be the recipients. Now that’s a tall order: asking men to bear the brunt of fluctuating emotions—without taking it personally. But if they don’t, they may be hurt in ways their wives never intended.

Steve and I talked about how to get through the times I felt like an emotional basket case. He tried not to be detached, but rather to verbalize that he was sorry I felt bad and that he was there for me. I would do my best to remember that he didn’t cause my feelings and that this trying time would pass. He didn’t pressure me to change; and most importantly, I allowed myself some time alone to regain my composure.

Of course, couples can have interpersonal problems that cause emotional distress completely unrelated to menopause. There may be stress over adjusting to issues such as children leaving home, caring for elderly parents, finances, and retirement. These issues need to be addressed with reference to whatever is the root cause of the problem—communication, self-worth, and more.

Don’t make fun of menopausal women. Women don’t want to be the object of jokes. A sense of humor is fine, but jokes or remarks about being old or menopausal won’t build relationships—especially when these comments are made in front of other people. Most couples are able to laugh together privately about some of the strange behaviors women demonstrate, but only after the symptoms causing the behavior have passed. Steve and I would often joke about my forgetfulness, but this occurred privately, not while I was frantically looking for a vanished item.

Validate that symptoms are real. In the same way that women don’t want their suffering to be mocked or minimized through jokes, they do want their feelings validated. They don’t want to be dismissed as hysterical or suffering from some imaginary dysfunction. They don’t want to be told that their symptoms are cases of mind over matter—change your mind and the matter will change.

Husbands can communicate their support by being willing to read a book or an article that explains menopause. They don’t need to be experts, but their interest is very encouraging.

Support new interests. Many women are venturing out into new territory during the mid-life years. A woman may go back to work for the first time in years. She may go back to school or pick up an old interest with new enthusiasm. It is wonderful to be asked about any new area with sincere interest. These conversations are not unlike dinner conversations where men talk about their time at work. A woman is deeply encouraged when her husband remembers and is willing to spend time talking about her interests.

These newfound interests may also require that her husband make some accommodations. If she’s the family chef, he may forego a home-cooked meal for take-out if she has a class. He may delay purchasing a new power tool to buy her a sewing machine or other hobby tools. Whatever the sacrifice, she’ll appreciate his endorsement as she transitions to this new season.

Remain faithful. There are too many stories of men who have mid-life crises and decide to leave their wives. This term is often used to explain why men become involved with younger women. Unfortunately, a man’s mid-life crisis often coincides with a woman’s menopause.

An article in Woman’s Day quoted a rise in the percentage of divorces after the age of fifty-five due, in part, to this very reason:

They enter their golden years and their husband walks out the door, often for a younger woman. That’s what’s happening to an increasing number of women in their fifties and sixties these days. While divorce among younger people seems to be leveling off, there’s a worrisome rise in marriage breakups among the over-fifty-five crowd—up 22 percent in the last decade and expected to climb.

As these women grapple with feelings of low self-esteem and inadequacy, their husbands wrestle with their own feelings of inadequacy. Most women I interviewed whose husbands had extra-marital affairs said privately that they were unaware of how their husbands felt until it was too late. The affairs had already occurred as their husbands sought to have their needs met superficially in relationships with other women.

Mid-life can be a rough time for both men and women, but a solid commitment to weather the storms together will help solve problems. Unfaithfulness by either men or women will only create many more painful problems.

Ask questions, really listen, and respond. Women want their husbands to talk to them. They want their husbands to risk asking them how they feel. Husbands might encounter differing responses to that question—emotional reactions, withdrawal, confusion, appreciative answers—but, whatever the response, most women appreciate interest in how they feel.

“My problem,” Marie said, “is that my husband will ask me how I feel, then he won’t really listen to what I say. He asks me as he is walking into the other room, or glancing at the paper, or shuffling through the mail. So I answer and that is the end of the conversation. His question was not sincere.”

A helpful sequence goes like this: Ask, listen, respond. Husbands who say they don’t know how to respond should simply confess, “I don’t know what to say, but I want to try to understand.”

Women want to know they are cared for and cared about. They want to know that their husbands think about them. For women, that means discussing the aging processes relevant to themselves and their husbands.

Adapted from Postcards from Menopause: Wishing I Weren’t Here. By Lois Mowday Rabey. Published by FamilyLife Publishing. Copyright © 2003 by Lois Rabey. Used with permission.

8 Things Men Need to Know About Menopause

Even though roughly half the world’s population is female, it often seems that men understand surprisingly little about menstruation and menopause. That’s not to say that all men have to fully understand menopause — and let’s face it, who does? — but it could be helpful for guys who have beautifully aging women in their lives to learn a little more of what goes on with menopause. The whole process is uncomfortable, for starters, so a little empathy would be nice.

Men of the world: We know you care about us, so it’s time to brush up on your menopause IQ!

First things first

Let’s start with the basics: Menopause officially occurs when a woman stops having menstrual cycles altogether. However, the process of getting to that point can take a long time. In fact, it starts at the age of 20, when a woman’s menstrual cycle gradually shortens until perimenopause.

Although scientists know that there are many factors at play, including hormones, they aren’t completely sure of the cause behind menopause. It’s widely accepted, however, that menopause is directly related to the dwindling number of eggs a woman has as she ages.

Hold on: What’s the difference between perimenopause and menopause? “

Regardless of the cause of menopause, however, here are a few things that women — and men — can expect from the experience:

1. Be prepared for the long haul

Oh, you thought hitting menopause meant you’re in the clear? Think again, because menopause doesn’t just happen overnight. Menopause actually begins with perimenopause, which can take years.

A woman can’t breathe a sigh of relief that she’s safely past her period until after she’s been period-free for over a year, says Mary Esselman, 54, a writer from Charlottesville, Virginia and author of “How Did This Happen? Poems For The Not So Young Anymore.”

“For many years of perimenopause, you can get your period any time — 10 days after you just had one, or 120 days after you just had one,” she explains. “It’s a guessing game. It’s also sometimes spotting, sometimes a geyser.”

2. It’s not something you just “go through”

Esselman is passionate about warning women (and men) that menopause is never something you just “go through.” Instead, she notes, you’ll go through years of a stuttering period, crummy sleep, weird anxiety, and not-super-fun mood swings.

“We can’t gloss over it,” she says. “Aging is not an abstraction, it’s a real thing, and part of what I hope to do is help younger women learn more about it before it hits them over the head — menopause and other perfectly natural (but pretty disruptive) aspects of growing older as a woman.”

3. Every woman experiences menopause differently

No woman and no menstrual cycle is ever alike, so it’s important for men to realize that not every woman will experience the same things in the same way. Women have different outlooks on their menstrual cycles and different comfort levels with their bodies. These factors all affect their experience going through menopause.

Laurie Pea, who has experienced menopause firsthand, says her life seems more timeless.

“I can no longer keep track of my days and nights by my cycle, and I live without a sort of boundary,” she says.

4. It’s not always better than a period

From a male perspective, it might seem like a woman would be downright gleeful to get rid of a monthly occurrence that forces her to bleed from her vagina. But appearances can be deceiving.

“It isn’t always better,” warns Victoria Fraser. “In my experience, it felt like dementia and puberty had a kid together!”

5. There will physical changes that can be hard to handle

Menopause can cause many physical symptoms, including headaches, vaginal dryness, and changes in your hair. Although Michelle Nati, 51, admits that never thinking about her period is a positive, the cons far outweigh the benefit of getting to wear white undies 24/7.

Nati also says the physical symptoms of hot flashes, brain fog, crying, and abdominal weight gain felt like they came “out of nowhere.”

6. The PMS doesn’t always go away

If you think menopause means saying sayonara to the torment that is PMS, think again. Nati and others like her find that instead of skipping through postmenopause life PMS-free, menopause has been like one long preperiod week.

“ like PMS with no relief,” she says.

7. There will be shifting

“I’ve always been skinny, but at 54 I’ve got the pudge that won’t budge around the waist,” notes Esselman. “I expected weight gain to some extent, but not the shifting of weight, the pull of gravity on everything, from apple cheeks (turning them into jowls) to my lovely vagina.”

So men, when you’re no longer going with the flow, perhaps you could learn to just let things fall where they may.

8. Hitting the gym is essential — or, at least, indulging less is

One side effect of menopause is that some women tend to experience slowed metabolism.

“While never having a period again has been a great boon, the tremendous weight gain that has occurred (despite no increase in eating!) has not been my favorite part of this experience,” says Lorraine Berry, another woman who shared her menopause experience.

How to help her transition through menopause

So, gents, here is some great advice for maintaining healthy relationships with the women in your life, especially during menopause.

When it comes to mood swings: Help her work through mood swings by understanding that they aren’t aimed at you. Sometimes, binge watching a favorite show together or treating her to a spa day is enough to lighten the load.

When it comes to sex: Be aware that her body is changing. Along with it, her body confidence, sex drive, and sexual pleasure may change as well. Be willing to talk about these things respectfully, and find ways to approach them as a couple.

When it comes to her body: Share the differences you see happening in your own body. Age affects us all, and it’s valuable for her to know she’s not the only one going through changes.

When it comes to confidence: Support her in working out if and when she wants to, but if she wants to enjoy a great meal, feed her well and tell her she’s beautiful. Because she is!

Chaunie Brusie, BSN, is a registered nurse with experience in labor and delivery, critical care, and long-term care nursing. She lives in Michigan with her husband and four young children, and she is the author of the book “Tiny Blue Lines.”

A Man’s Guide to Menopause: How it works and what to expect

Dr. Bitner has heard many comments from women in her office going through menopause complaining about their husbands not understanding what they’re going through. As a result relationships can be strained because men either take their partner’s behavior or moods personally, or feel like their wife doesn’t love them anymore. The fact is women don’t really know what’s going when they go through the changes of menopause either, making the task of trying to understand a women going through menopause that much harder.

Most men want to be supportive of their wives or partners and want to help in anyway they can, but they just don’t know what’s going on or what to do to make it better. So Dr. went through the basics of menopause and the most common symptoms that women display during this difficult time.

Midlife changes and menopause do not happen in a vacuum; female body and hormone changes can affect everyone including the spouse or partners, children, co-workers, and other family members. 80 percent of women have significant symptoms between the ages of 42 and 62 including hot flashes, night sweats, mood swings, sleep disturbances, fatigue, joint pain, heart racing, worse headaches, heavy and irregular bleeding, and low sex drive.

These symptoms aren’t meant to effect anyone else other than the woman going through menopause, and it’s nothing personal if a woman’s mood does not match up with her typical behavior.

Hormones are another part of the women’s body that go through extreme changes, effecting her mood. Body chemicals like estrogen, progesterone, and testosterone go from one part of the body to another with a message of what to do.

For example during a period, estrogen levels go up and down during the month and lead to body changes to promote pregnancy. If no pregnancy happens, then women get their period and the cycle starts all over again. However these levels are completely out of balance once a woman goes through menopause and no longer gets her period.

So what can husbands or partners do to make menopause better? There’s no need to make assumptions about what she wants how she feels, just understanding what women go through during this big change is more than enough. Asking simple questions like “What can I do to help?” or “How are you feeling?” can be the difference between a healthy and secluded relationship with a partner. Once there’s a better understanding of how women behave, relationships can improve and bring couples closer together.

Dr. Bitner’s office is located at 3800 Lake Michigan Drive Northwest, Suite A. To schedule an appointment with her, call (616)-267-8225.

All information was provided by Dr. Diana Bitner and her blog. Read more.

Many of the patients Dr. Wendy Wolfman sees as director of Mount Sinai’s Mature Women’s Health Clinic in Toronto are surprised—and less than thrilled—by the sudden onset of perimenopause symptoms. “They often feel that they haven’t been told enough about what’s happening to their bodies,” she says. “And many women put up with symptoms unnecessarily.”

Perimenopause means “around menopause” and usually kicks in during your 40s (or even in your mid-to-late 30s) as your ovaries start producing less estrogen and your reproductive system starts winding down. It can last anywhere from five to 10 years—until your periods stop altogether (once you hit 12 months period-free, you’re officially in menopause).

The symptoms, Dr. Wolfman says, can be troublesome and disruptive. One of the first signs of perimenopause is shorter menstrual cycles and heavier, more irregular periods. You may also experience hot flashes, headaches, vaginal dryness and mood swings. “It’s important to recognize the symptoms and know that you can do something about them,” she says. Here are five of her top perimenopause survival tips.

How to banish bloating and cramping

As your hormones start to fluctuate, your periods can become heavier and more erratic, bringing with them the bonus side effects of cramping and bloating. Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) can help take the edge off and reduce menstrual bleeding. (If your periods become particularly heavy or painful, see a doctor to rule out fibroids and endometriosis, both of which can be triggered during perimenopause.)

For more severe bleeding, your doctor may prescribe hormonal therapy, such as straight progestin, or combined oral contraceptives that contain both progestin and estrogen. “If you’re not a smoker, the birth control pill can be used to manage menstruation and heavy bleeding until you reach menopause,” Dr. Wolfman says.

How to deal with headaches

Research shows that if you have a history of migraines, they may become more frequent or intense during perimenopause. Even women who never experienced migraines in the past can begin being afflicted by them, says Dr. Wolfman. Hormone Replacement Therapy (HRT) is the treatment most often prescribed, usually in the form of a patch that provides a low, steady supply of estrogen. If a headache does hit, over-the-counter pain relievers and applying a cold cloth to your head and neck can help relieve the pain.

How to improve your mood

“Increased irritability and mood swings are common during perimenopause,” Dr. Wolfman says. “It’s important to get help because not only do these symptoms affect you, they also affect the people around you.” In some cases, your doctor may prescribe an anti-depressant, but often you can manage symptoms yourself with relaxation techniques like yoga and meditation. Studies show that exercise also helps — the Mayo Clinic recommends 30 minutes or more of activity for perimenopausal women on most days of the week, just not right before bedtime.

What to do about a lagging libido

As estrogen levels decrease, the lining of your vagina gradually gets thinner, dryer and less elastic, all of which (no surprise) can lead to a lagging libido. Your doctor may recommend low-dose contraceptives or vaginal estrogen (which comes in cream, tablet or ring form), but you may also find relief with over-the-counter vaginal moisturizers and water-based lubricants. On the plus side, staying sexually active helps by increasing blood flow to the vagina.

How to get a full night’s rest

Hot flashes and night sweats are two of the biggest sleep disruptors during perimenopause. The first step toward better sleep is to avoid potential triggers (like spicy food for dinner or a hot cup of tea before bed). Low-dose estrogen is the most common medical treatment, but not all women can—or wish to—take hormones. Other options include antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), andNeurontin, which is an epilepsy drug.

Perimenopause is a natural part of aging, Dr. Wolfman says, and it doesn’t have to get in the way of your life—especially if you take steps to manage your symptoms.

‘It feels impossible to beat’: how I was floored by menopause

I took my new boxes of patches, a pump gel of oestrogen to top up with on the bad days, my precious testosterone, and went home with hope. It took months, but things stabilised. Now, there is never more than one bad day at a time. On the good days, I am at peace with my age, with what I have done, with who I am, menopausal or not. I delight in what I can do, and when I run, I hurtle headlong down a steep descent with the joy of a child, aged nearly 50. But on other days, that woman seems like someone else.

Monday 25. First morning I haven’t felt dread and weepiness. Not giddy like before, but like things are possible. But also scared of mood flipping – and it did. Horribly. Weepy, panicking, total anhedonia. I haven’t left the house. At 3.30 I went to bed and woke up at 6. I feel profoundly sad, black, AWFUL. Did it all change after I drank coffee? Tuesday 26. No coffee. Panic, dread, weepy. Can’t focus, can’t wash up.

I grasp for reasons. I look for patterns. I keep a diary for 18 months. If I can understand the patterns, I can predict the bad days and allow for them. I can plan for them. Tom Cruise in Minority Report had “pre-crime” to prevent and disrupt future criminal threats. Perhaps I can have pre-depression. For many months, I think that the bad days come when my oestrogen dips on the last day before I get new patches. I stop scheduling things on Mondays and Fridays. But then the pattern changes, so I know it never was a pattern. Sometimes it’s a Tuesday. Sometimes, a Sunday. I can’t tell. I give up the diary.

I try to take control by being less embarrassed. Once, when I still had flushes and was out at dinner, I got out my fan and a relative said: “Must you?” I don’t understand this reaction. People are not mortified by cancer patients on chemo who sweat and use fans. Is it because menopause is to do with periods? Is it because women’s health must be hidden and quiet? Is it because women do hide it? I can’t think why the irregularities of the hypothalamus should be socially unacceptable. I kept using my fan for as long as I needed to, though I felt faintly uneasy.

The only acceptable place for menopause is in menopause jokes. The humour that masks distress and shame. The woman in a meeting who laughs off her sweating, who talks of “power surges”. The comedians and their mothers-in-law and their hot flushes. What if it came out of jokes and into accepted conversation?

For many months, I told people I was “unwell”. Not crippled, not weeping, not disabled. “Unwell.” The implication: that there is something physically wrong, a proper illness. What if I told everyone I had a severe headache? They would understand. Then, one day, as I sit at my computer and think of my writing deadline and feel despair, I try to read medical literature and instead put my head in my hands. I decide to write to the commissioning editor, even though we have not worked together before and this may form her opinion of me, and say: I can’t function today. I can’t write. And it is because of depression. Please give me leeway. It shames me to write it, but I do. And I do it again, when needed. So far, every response has been profoundly kind. I should have done it sooner.

Mental illness. Such an odd concept. How strange to put a division between mental and physical illness, as if the brain is not in the body. As if emotions are not regulated by the brain. As if feelings are not linked to hormones. And still mental illness is put in a different category. Easier to fix, to underfund, to sweep into the dark corner of the unspoken. Imagine the contrary. Broken your ankle? Cheer up. Third-degree burns? Chin up. Think yourself better, you with your chronic lymphocytic leukaemia. Smile.

May 4. Finally felt better yesterday. Tweeted fury about BBC menopause doc and all its talk of “low moods”. Messaged with a doctor who thinks 50mg of estradiol is too low and particularly for someone who was prone to PMT. She also thought I should try testosterone. Went downstairs and put another patch on. Retroactively furious with doctor for sticking so firmly to dose, but maybe I played down the depression. Today I slept well. Mood good. A feeling in my stomach that is positivity, like I can do things.

I wake gloomy, my head foggy apparently from just one glass of prosecco the evening before. The room is hot, the city noises are infuriating. I put new oestrogen patches on my abdomen. I smear testosterone gel, two pea-sized globs, on my inner thighs. I go through the motions of other activities and wait. Half an hour later, as I am walking to the station, I feel a quiet flood of good mood. It feels as though the oestrogen is lifting me slightly. I picture a tide floating buoys higher and higher in a harbour. Oestrogen is hefting and hauling me out of depression, for today.

This is my theory. It is unproven, according to the literature. I wish the urge to better understand the extent of oestrogen’s reach, and the devastation its fluctuation can bring, had happened decades ago. There has been more research in recent years, but I doubt that the driver for this knowledge is how poorly menopause is treated or understood; it’s probably that oestrogen is implicated in higher rates of Alzheimer’s disease in postmenopausal women. There is money in Alzheimer’s, but not in making women’s lives better.

Friday 22. Woke up at 10. Awful, awful, awful. Got up at 12 and ran 10 miles, got back and burst into tears. Profound sadness, depression, weepiness. One of the worst yet. Panic at night.

My mother says, the day after another bad day: “I feel so awful for you. Why can’t they fix it?” They are doing all they can, I say. I don’t really believe this. The trouble with women is we cope. We always do.

I keep fit. I gave up alcohol for months, reasoning that it plunges me into depression the next day – and I can produce those days all on my own without paying money to make them happen. Over the years, I have taken citalopram, sertraline, black cohosh, red clover, omega 3, magnesium, iron, vitamin D. For a while, I saw a serene herbalist, who mixed dark potions and told me I should eat chickpeas and tofu to get their phytoestrogens to bind to the receptors all over my body. Many perimenopausal women with depression are prescribed antidepressants. I hope theirs work, as mine did nothing. I know the iron helps, and I think the magnesium does, too, because when I forget to take it, I start to feel stupider.

In scientific papers, researchers argue about whether women feeling depressed in menopause (pre-, peri-, post-) are actually just experiencing the ups and downs of life. We are brought low, they reason, by the hot flushes and sleeplessness, not by hormonal fluctuations. Or we are diminished by life. At that age, I read, women may have ageing parents to care for; grown children and an empty house; empty marriages. Their depressive symptoms are a mourning for who they were and what is to come. They have what is called “the redundancy syndrome”. It’s just coincidence that they are also menopausal. “Research has found,” I read, “that depressed mood and depressive disorder in middle-aged women are related less to menopause than to the vicissitudes of life.”

I bristle at this. Although I wonder. I remember a month in France when I had not a single bad day. I notice that my mood lifts once my book is written and its huge pressure is also lifted. I wonder: is my problem not menopause-specific depression, but that the removal of oestrogen leaves me less protected against my natural lows? This theory lasts until the next bad day, when I remember how elemental it feels.

May 2. I slept fine and took no pills, but today was the same. Sad, weepy, furious. I can interact with people, but in-between is awful. I went home at 3 and went to bed until 6. I hate this.

Today. Today is a decent day. It has taken me months to write this essay, because when I am bad, I can’t write, and when I am not, I don’t want to remember. Tomorrow? My menopausal status is being masked by HRT, so I won’t know when I become postmenopausal until I dare to stop my artificial bolster of hormones. My postmenopausal friends tell me everything is better on the other side. I want to believe them, and ask my doctor, a young woman half my age, when I can stop taking HRT and what will happen if I do. She says: “Four years? That’s about right.” Stay on HRT for four years, wean yourself off it, and then see. This means that in order to get off HRT I have to plan for a time in my life when I can risk being brutalised by depression and insomnia for weeks at a stretch, when I might crash to the bottom again. Even on a good day, I think that time will be never.

This is an edited version of a piece that first appeared on the New York Review of Books Daily

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Surviving Menopause Naturally:
The Best Years of Your Life:

(c) Lisa Margolin, J.D., M.S.

Menopause should be a time in life for women to celebrate.

Monthly menstrual periods and PMS have finally come to an end. American women now enjoy a life expectancy of approximately 84 years, making menopause the beginning of the second half of our lives.

Yet many women dread this “change of life.” We have preconceived ideas about the “symptoms” of menopause, and fear of what this life stage will bring. Unfortunately, many women do suffer from uncomfortable and distressing symptoms during menopause.

To enjoy this time of life to its fullest, we need to prevent and minimize the unpleasant symptoms of menopause. From dietary to lifestyle recommendations, here’s an action plan to assist you in dealing with the menopausal transition:

Fresh foods. Make sure your diet is at least 50% fresh foods, such as fruits and vegetables.

Boron-containing foods. Balance your estrogen levels by increasing your intake of boron-containing foods. These include green leafy vegetables, apples, pears, grapes, nuts, and legumes. Boron helps to harden bones, and may help to prevent the onset of osteoporosis.

Calcium-rich foods. Eat calcium-rich foods daily. Soybeans, oats, almonds, sunflower seeds, aduki and pinto beans, broccoli, leafy greens, and non-fat dairy products are good sources of calcium.

Soy foods. Soy foods contain isoflavones (natural plant estrogens) that can help offset the drop in your estrogen levels. Eating soy may help to relieve hot flashes during menopause. Use soy products such as tofu, tempeh, miso, texturized vegetable protein (TVP), and soymilk; avoid meat proteins.

Sugary foods and alcohol. Reduce your intake of sugary foods, refined and processed foods, and alcohol. A diet to control hypoglycemia is beneficial in controlling menopausal symptoms. Select complex carbohydrates, such as whole grains like oats and brown rice, rather than foods prepared with refined flours and sugar products.

Dietary fat. Prepare your foods by steaming, baking, roasting, and broiling. Avoid fried foods. Reduce your intake of dietary fat by avoiding red meat and other saturated fats, such as butter and lard.

Whole grains. Eat 6-11 servings per day of whole grain products (1/2 cup cooked oats, pasta, rice, quinoa, etc. = 1 serving, 1 slice of whole grain bread=1 serving). Whole grains contain fiber that helps to regulate estrogen levels. Good sources of whole grains include oats, quinoa, rice, millet, corn, amaranth, barley, whole wheat, and buckwheat.

Carbonated beverages. Eliminate carbonated beverages such as soft drinks. They are loaded with phosphates that deplete the body of calcium and other minerals.

Caffeine and hard liquor. Avoid caffeine; choose naturally decaffeinated tea and coffee. Drink red wine in moderation. Always drink lots of bottled, purified water, preferably mineral water. Water transports nutrients through the body, lubricates joints, and helps to rid the body of waste products.

Natural Progesterone. Natural progesterone helps to relieve hot flashes in some women. Use natural progesterone in the form of cream to help balance your hormonal levels of estrogen.

Bone health. Spend about ½ hour outside in the sun daily, if possible, to take in vitamin D naturally. An adequate intake of vitamin D is important for maintaining bone strength during menopause.

Supplements. Take a good quality multi-vitamin and mineral supplement daily to provide you with added nutrients that you may not always get from your diet.

Exercise. Exercise regularly outdoors to enjoy the advantages of natural vitamin D for bone health. Take a brisk walk daily to improve your circulation, and to strengthen your joints, muscles, and bones. Make exercise a part of your daily routine.

Stretch. Make time to stretch and do deep breathing upon rising in the morning, and every evening before bed. Yoga postures and Pilates’ exercises will help you to maintain flexibility, and reduce stress.

Strength training. Strength training and weight bearing exercises should be part of your weekly exercise routine. Choose strength-training exercises three times a week to strengthen your major muscle groups. Combine this strength training with aerobic exercise to help to keep your skin toned and youthful, and to fight bone loss and osteoporosis.

Massage. Enjoy a massage once a month for energy restoration, to release tired and strained muscles, and to give you a sense of well-being.

Meditation. Practice meditation, breathing, and relaxation techniques to help relieve some of the symptoms of menopause, such as hot flashes.

Sleep. Go to bed by 10pm to assure that you get enough sleep nightly. Proper amounts of sleep will help to restore your adrenal function, especially important for women during menopause.

It is important to enter menopause consciously, with an action plan to successfully achieve personal health and long-term well-being. All around us, we see more and more women over the age of 50, who look more vibrant and radiant than ever before. Aging is part of the circle of life, but each of us holds our own personal key to growing older, with grace, energy, and continued vitality.

About the Author
Lisa Margolin, J.D., M.S. is a holistic nutritionist and co-author of ViVa’s Healthy Dining Guide, a comprehensive directory of more than 2,100 vegetarian, healthy ethnic, and natural foods restaurants, and markets across the United States. For more information on healthy lifestyles visit

The 8 things men need to know about the menopause

Q1. What on earth is the Menopause? I have heard it mentioned but have no idea what it actually is?

A. The Menopause is the time in a woman’s life when her hormonal balance start to change, with the eventual result that she will no longer get any periods. This time can cause all sorts of emotional and physical changes – many of which may seem negative or, at the very least, challenging to her.

Q2. When is all this supposed to start?

A. The approach to the menopause usually starts around the age of 45 but can be as late as 55.

Q3. How long is this likely to last? It’s been going on for weeks.

A. Unfortunately, this time of transition between having periods and not having periods can last for a few years – sorry! However, symptoms can come and go over this period depending on a number of factors including lifestyle and diet.

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Q4. She used to be so calm and collected but now she is snapping at everyone even when we have done nothing wrong.

A. Don’t take this personally – the hormonal changes at this time can cause havoc with her emotions! Very often even she doesn’t know how she is feeling, so it can be a very confusing and frightening time for her too.

Many women tell us that they can’t understand why they are acting so out of character during this phase of their life. They find they are lashing out or falling into a bad mood at the drop of a hat. This is where it is really important to be supportive. She needs to know you’re on her side and that you understand she’s not necessarily feeling in control of what’s going on at the moment. Be as sympathetic and understanding as you can, and keep talking! Communication is everything.

Q5. She keeps saying that she is stressed and unhappy but I don’t see why – nothing has changed at home.

A. Believe her when she says this. Her emotions can sometimes run away with her and she is really feeling these things even if there is no apparent reason. It is very important at this time to talk openly, and not to criticise or dismiss her feelings. Knowing that you will listen and sympathise can make a huge difference to how she feels, both about you and about what’s going on.

There are plenty of stress herbs available to help. You could suggest she try something like AvenaCalm, or the stronger Stress Relief Daytime.

Q6. Our children have finally left home and I thought we would enjoy our time together, but she just seems miserable all the time and cries.

A. Children often seem to leave home just as the menopause kicks in, and women may feel that their role as ‘mum’ has disappeared. This is called Empty Nest Syndrome. Also the menopause can cause physical changes such as weight gain, older looking skin and she may suddenly feel very unattractive and unlovable – so plenty to cry about! Again, it’s important to be supportive and talk about it all. Let her know how much you are looking forward to having her company and doing more things together, to give her back some of the confidence she may have lost.

You could suggest a gentle herbal remedy called St John’s Wort to help with low mood.

Q7. I just feel that she doesn’t love me anymore, and when I try to cuddle or kiss her she just pushes me away – and I can’t remember the last time we had sex.

A. Falling hormones at this time can affect her sex drive and can cause fatigue, so the last thing she is probably thinking about is sex. Also, hormonal changes can cause pain and discomfort during sex, so another reason to not feel like it. She is probably just as bewildered by these changes as you are, so again, talk about it – in a supportive way, not a criticising way.

Q8. I really cannot cope anymore. I feel like the person I married has disappeared and the atmosphere at home is horrible.

A. If her symptoms are really bad and affecting her daily life it is important for her to seen her doctor. For some women, the hormonal changes are so severe that they can cause depression, which would need medical attention. If you feel that suggesting it yourself would not get a positive response then maybe ask a close female friend or relative to talk to her about the emotional effects of hormonal changes, and encourage her to see the doctor. I often talk to women who are trying to cope on their own, when a little medical support would make all the difference. Hormones don’t care if you’re a heroine or not!

What you can do to help

Talking things through can often be the best and easiest way to help! She will appreciate the feeling of support, and it will help you to understand that many of the changes in behaviour and mood come from these changes in hormones, and your partner as not just turned crazy!

There are a number of herbs you could suggest to help. Soy isoflavones gently raise oestrogen levels to help balance out symptoms, while Sage is great for easing hot flushes and night sweats.

To find out which remedies are best for which symptoms, and other self help tips, have a look through our menopause symptoms pages.

Alternatively, point your partner towards this blog and A.Vogel Talks Menopause where she can find all the information she needs.

You may also be interested in:

About a boy – the ‘Male Menopause‘

It’s not only women who suffer the effects of changing hormones, men also go through a menopause of sorts! With testosterone levels gradually declining as a man ages, emotional and physical symptoms can occur.

Do a quick online search for the resources available specifically for men to learn about menopause. Seriously, go ahead. We’ll wait.

Well? I’m guessing you found information about lackluster libidos and vaginal dryness. Which tells you a lot about what our society thinks men are interested in. Now try looking for info about the menopause divorce rate. Uh huh.

If you have a partner going through midlife changes, I’m betting it impacts more than just your sex life. And I bet you’d love to make it easier on her, if only you knew how. “Menopausal rage” might be a thing, but menopause and anger toward husbands don’t have to go together.

Sunday is Father’s Day here in the US, so we thought we’d give a little gift to all you fellows (dads or not) who are now or one day may be sharing a life with a woman in menopause: advice from men who’ve been there, learned that.

Tip #1 – She may not tell you things

Menopause is still such a taboo subject that it can be hard to talk about, even between intimate, long-term partners. As this husband of 28 years said, “Don’t take it personally if she doesn’t want to share the details with you. What happened to her that day might be really embarrassing, like maybe she had a hot flash while training some 22-year-old intern. Be open to hearing it, but also be open to not hearing it. And it can depend on the day, too; one day it’s humiliating, the next day it’s hilarious. Just try to go with it.”

Tip #2 – She may tell you things

“Dude,” one man told us. “be ready. You are going to hear some stuff. Discharge, heavy flow, sore breasts, soaking through her pajamas with night sweats. For us guys, it can be hard to hear. But you gotta listen. As hard as it is for us to hear it, she’s actually living it, and that’s a whole lot harder.”

Listening when she needs to complain or just be frank about what’s happening is often the very best thing you can do. As someone who watches hospital shows with one hand over her face, I understand squeamish, but reacting negatively to her stories of heavy flow only embarrasses her and continues the stigma around women’s bodies and their natural functions.

“It’s not a disease – it’s biology,” one wise man said. “You’re not going to catch menopause like the flu. The more you listen, the more she’ll tell, and the more you’ll understand. And that makes it easier on both of you.”

Tip #3 – “Duck and cover” is not a relationship strategy

The stereotype is for men to just keep their heads down and wait for the storm to blow over. But the hormone fluctuations of perimenopause and menopause can last for years. “Know yourself and play to your strengths,” one man suggested. “If you’re an open-and-empathetic guy, then really listen. If you’re more of a fix-it guy like me, ask her for actual things you can do to help, then do those. Research hormone therapy, put ceiling fans in every room of the house, be ready to leave the party early if she sweats through her clothes. Just don’t give advice, and don’t ignore the problem and hope it goes away.”

Tip #4 – Education helps

All our guys agreed on one thing: learn stuff. (You’re off to an excellent start right here at genneve.) Check out the North American Menopause Society website and do some reading. Then go to the and do some more. Good information is out there, but you may have to do a little digging. There are even men’s menopause support groups in many cities, which can be a serious resource.

But understand first and foremost, “It’s different for every woman. I watched my mom, my sisters, and now my wife go through it, and the experiences are not the same, the way they deal with the symptoms is not the same. My mom and my sisters took HRT, but my wife’s family has a history of breast cancer, so that’s not an option for her. It makes a huge difference. What if I didn’t know that, and I accused my wife of being overdramatic or – heaven help me – hysterical because her symptoms were so much worse than those other women?”

Tip #5 – No better present than you being present

There is nothing more attractive than a man who doesn’t just say he cares – he shows it. By being present. By hanging in. “I want to support the women I love,” one man told us. “My wife, my friends… you know, my sister just turned 50. So I read stuff I’ll never completely understand, like I did when my wife was pregnant. I just learned that women have a higher risk of heart disease after menopause, but the symptoms of a heart attack look different in women. Seems like an important thing to know.”

But being present and engaged is often easier said than done. There’s no doubt that menopause has impacts on the men in the relationship, and guys are often left without good solutions for what they’re going through. As one man put it, “Sometimes it’s annoying feeling like you can’t complain because your wife has it so much worse.” But if you end up resenting it, that’s not good either, he said, so, “Walk away when you have to. Tell her you need 30 minutes or an hour or an afternoon. Go do something ‘guy,’ if you want. Then come back when you said you would.”

So, partners, we’d love to hear from you how you’re helping the women in your life manage menopause. What resources are your go-to’s, what information is missing? With menopause still so taboo, are you even able to have conversations with women on the subject? Please share your thoughts in the comments below or on Facebook or Twitter. (Yes, share in public forums … remember that bit about not continuing the stigma?) And by the way, guys? Thanks.

For more ideas on making her menopause easier, check out our post, “go away come here go away: 10 tips to support someone through menopause“

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