Mid-Life Changes & Menopause
Interview of OBGYN, Katarina Lanner-Cusin, M.D.
Dr. Katarina Lanner-Cusin: My name is Katarina Lanner-Cusin and I'm an obstetrician gynecologist who practices at Alta Bates Summit Medical Center where I both do obstetrics and gynecology and I’m also the Medical Director of Women’s Services.
Male Interviewer: Today we wanted to talk about mid-life changes, some of the challenges for women going through that time of their life. What’s the normal age range for mid-life changes for women.
Dr. Lanner-Cusin: The average age for menopause is around 52 years old. Menopause, then, is defined as the last menstrual period, but the transition through menopause is probably on an average 10 years, and most of the time starts somewhere in the mid-forties, and for most women probably ends around 55 or so.
Interviewer: What is perimenopause?
Dr. Lanner-Cusin: So part of that time period of those ten years is the perimenopause. It’s when the first changes leading towards menopause start occurring, so for most women that hits around 45 or so, and it’s the transition that is referred to often as the perimenopause.
For many women, they start realizing that they have some hot flashes right before their menstrual periods. Sometimes they maybe have other premenstrual symptoms that they didn’t use to have, which sometimes can be a little bit more emotional turmoil then they might have experienced before. Then also they notice that their menstrual periods become slightly more irregular, they change in character, and those changes are usually the first noticeable changes, it’s a normal transition.
From a medical point of view it’s important to be aware of too much irregular bleeding is not considered normal and that should require physician consultation. And it’s also a good time to think about health issues in life, how they want to approach this transition in life, which can include changing habits, maybe improving their exercise pattern, ways they eat, review how stressful work might be and make changes that can make the transition easier to go through.
Interviewer: What sort of decisions do women need to make as they’re going through these transitions.
Dr. Lanner-Cusin: The key thing is to review health issues in general, to decide how they can improve other circumstances in life to make this transition easier. Part of that involves just how we live every day life. To see if we can maybe start walking to work, spending time where you relax, think about other things is a good preparation, and in general eating well, paying attention to your surroundings more.
So some women, when perimenopause starts, and these hormonal changes become noticeable, many times she can actually treat that with herbal remedies that she finds. So some women will attempt to just review vitamins they might be taking, many women will go to the health food store and think of herbal remedies that could be recommended to use.
Now, other women will search for more medical solutions, and part of that can be using birth control pills actually to stabilize their mood changes, so that can also be part of that. And also, again, many of the recommendations for premenstrual symptoms, which is what becomes more significant at this time, is to eat frequent meals, exercise, no added salt, no added sugar, and many of those things can also improve the symptoms significantly.
Interviewer: If a woman wants to really do her homework, and look into the herbal remedies for example, look into the various medical options that she’s got, what would be a good resource?
Dr. Lanner-Cusin: I think that many times the best is to have a visit with her gynecologist to get some directions as to the different venues that she can choose to do. Obviously, most physicians are not trained in herbal remedies, so she might need to seek some alternative providers for those venues. In general, for the most significant medical issues around it, the gynecologist is a great source in that situation.
Interviewer: Would it be a good idea, or necessary, to seek out a menopause specialist.
Dr. Lanner-Cusin: I think some women, if the initial attempts that she has made, and she has tried what was recommended, and she hasn’t achieved much improvement, sometimes it can be good to see a physician that has a specific interest in menopause, because then she can maybe get more specific advice surrounding some of her symptoms.
This is a part of life, it’s like adolescence, you live it, and luckily by the time you come to menopause you have skills, you have a better skillset than when you were an adolescent, so you can actually make it very useful. It can make you think about who am I going to be? How am I going to age? What can I do to change my life? Is there anything I need to do to change my life? Maybe I should go back to school. Maybe I should find another position in life, another job. Maybe I should do something different to make this a new life. Because this is when children leave, when parents die. That’s what this is. It’s not about illness, it’s actually about health.
And this idea that this is something sorrowful, yes, it’s goodbye to reproduction. And for most women they complain about their periods endlessly, then one day they don’t have them. Then they say, “Does this mean I’m not a woman anymore?” It’s making me different. And women after 50 don’t exist. If you look at the imagery out there, women after 50 don’t exist. While men reach actually their power, mostly, after 50.
Interviewer: So this is an opportunity to sort of turn that on its head if you want to, and go exist.
Dr. Lanner-Cusin: Yes. For many women it’s the first time that they can actually somewhat detach from the patterns that they had to be in. Because they have to care for children, they have work, they have to clean the house, they have to get groceries, and all of a sudden they don’t need to buy as many groceries, their house doesn’t need as much cleaning because there’s not ten million towels on the floor.
It’s a lot of things that happen in a women’s life when she becomes beyond 50, which is menopause, and more about it is actually just an aging process, and menopause just signals to you that this is it. You become, you are different, this is a new entity. Not for men.
Interviewer: We [men] just get creepier and creepier.
Dr. Lanner-Cusin: Exactly, it’s not like there’s a real signal that tells you, okay, I can no longer reproduce. For a woman there’s a real signal that tells you that this is who I now am, and it’s tricky. But key here is that it’s an issue of health. And it is a normal transition of life and where we should really use our skills to make it something, and say,
okay, now I’ve got to prepare for what’s coming.
(Recording Ends)- INTERVIEW CONCLUDED -