Women are misled about menopause

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The WHI trial measured the most serious, life-threatening outcomes: breast cancer, heart disease, stroke and clots, among others. But for a woman who is constantly losing hair, who has aching joints, who suddenly realizes that her sense of smell has changed (and not for the better) or who is depressed or tired—many of those women For, the net benefit of taking hormones, to experience a better quality of life, may be worth facing whatever incremental risks hormone therapy poses, even after age 60. Even for women like me, whose symptoms are not as drastic but whose risks are lower, hormones may make sense. , “I’m not saying that every woman needs hormones,” Rubin says, “but I’m a big believer in your body, your choices.”

The conversation about menopause, among many other things, lacks language to help us make these choices. Some women happily go into motherhood, but there’s a term for the extreme anxiety and depression that other women have after childbirth: postpartum depression. Some women menstruate every month without any major upheaval; Others experience mood swings that disrupt their daily functioning, which we call premenstrual syndrome (PMS), or, in more severe cases, premenstrual dysphoric disorder. A significant portion of women do not have any symptoms as they go through menopause. Others suffer near-systemic breakdowns with brain fog, recurring hot flashes, and exhaustion. Others feel detached enough to know that they don’t like what they feel, but they are hardly incapacitated. Menopause—that baggy word—is too big, too overdetermined, creating a confusion that’s especially difficult to talk about.

no symptoms More closely linked to menopause than hot flashes, a phenomenon often reduced to a comedic trope – middle-aged woman waving a fan at her face and throwing ice cubes down her shirt . Seventy to 80 percent of women have hot flashes, yet they are almost as mysterious to researchers as to the women who experience them — given how much we still have to learn about the biology of menopause. Scientists are now trying to find out whether hot flashes are just a symptom or whether they trigger other changes in the body.

Surprisingly, the intense heat that a woman feels inside is not reflected in any significant rise in her body temperature. Hot flashes originate in the hypothalamus, a region of the brain rich in estrogen receptors that is important in the reproductive cycle and also acts as a thermostat. Deprived of estrogen, its thermostat now wonky, the hypothalamus is likely to perceive small increases in body temperature as too hot, triggering a rush of sweat and a massive dilation of blood vessels in an attempt to cool the body. This also increases the temperature of the skin. Some women experience these misfirings once a day, others 10 or more, lasting anywhere from one second to five minutes each. On average, women experience them for seven to 10 years.

What hot flashes might mean for a woman’s health is one of the main questions Rebecca Thurston, director of the Women’s Biobehavioral Health Laboratory at the University of Pittsburgh, is trying to answer. Thurston helped lead a study that followed a diverse group of 3,000 women over 22 years and found that about 25 percent of them were what are called superflashers: Their hot flashes began long before their menstrual cycles became irregular. was gone, and women continued to experience them. More than 14 years, debunking the idea that, for most women, hot flashes are an annoying but short-term discomfort. Of the five racial and ethnic groups Thurston studied, black women were found to experience the most hot flashes, find them the most bothersome, and endure them the longest. In addition to race, low socioeconomic status was associated with the duration of women’s hot flashes, suggesting that life conditions, even years later, may affect the menopausal body’s management. Women who experienced childhood abuse were 70 percent more likely to report night sweats and hot flashes.

Could those symptoms indicate harm beyond the impact on a woman’s quality of life? In 2016, Thurston published a study in the journal Stroke showing that women who had more hot flashes — at least four days — had more symptoms of heart disease. The link was even stronger than the association between cardiovascular risk and obesity, or cardiovascular risk and high blood pressure. “We don’t know whether this is causal,” Thurston cautions, “or in which direction. We need more research.” Thurston told me that there may be some women for whom hot flashes intensify physical harm and others do not. At the very least, she says, reports of severe and frequent hot flashes prompt doctors to look more closely at a woman’s heart health.

As Thurston was trying to determine the effects of hot flashes on vascular health, Pauline Maki, professor of psychiatry at the University of Illinois at Chicago, was establishing links between hot flashes and mild cognitive changes during menopause. Maki had already found a clear correlation between the number of hot flashes a woman had and her memory performance. Maki and Thurston wondered whether they would be able to locate some physical representation of that association in the brain. They launched research, which was published last October, that found a strong correlation between the number of hot flashes a woman had during sleep and signs of damage to the small vessels of the brain. In a Pittsburgh lab with the world’s most powerful MRI machines, Thurston showed me an image of a brain with tiny lesions, which showed up on the scan as white dots, ghost-like absences. Both their number and placement, she said, differed among women with a higher number of hot flashes. But whether the hot flashes were causing the damage or whether changes in cerebral vessels were causing the hot flashes, she couldn’t say.

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