Menopause Is Neither a Disease Nor a Disorder: Interview with Dr. Lubna Pal

What happens to the body during menopause?

”Menopause, just like puberty, is a normal phase of life. It’s not a disease. It’s not a disorder,” Dr. Lubna Pal says.

The body goes through changes in puberty as well as during menopause. Just like in puberty, there is a big upheaval in our hormonal profile, and the body undergoes some physical changes. 

Physical changes related to menopause are driven by declining levels of estrogen and progesterone. They typically arrive a few years before a person’s last period. 

Menopause has officially occurred when someone has had no periods for the last 12 months.  

Within the first two years after someone’s very last period, their body is adjusting to the absence of estrogen, and menopause symptoms are more common. Symptoms like hot flashes, night sweats, and sleep problems are much more common in the year before the last period and the few years after the last period. 

Later on after menopause, low estrogen can start to lead to symptoms such as vaginal dryness. Bone loss also happens rapidly within the first two years after menopause. Some people lose up to 20 percent of their bone mass within the five years after menopause. 

It is important to understand that aging is happening alongside menopause, and many symptoms can be attributed to aging itself. 

Dr. Pal also adds that some people may gain up to 10 pounds within a few years after their last period. Some studies have suggested that people who use hormonal therapy may gain less weight than those who haven’t been on hormonal therapy. However, that doesn’t mean that hormonal therapy should be used as weight-loss medicine. 

To sum up, post-menopause may be different for different people, but it is a normal experience, not a disease. “Many people don’t experience menopause symptoms. Many are at the peak of their careers and lives at the time when menopause happens. I think we need to approach menopause as a physiological state that can be difficult in some, but not in all,” says Dr. Pal. 

How to help menopause symptoms

Dr. Pal clarifies that menopause symptoms don’t happen all of the time to everyone. Some people have mild symptoms and aren’t bothered by them. 

Dr. Pal says that there are a plethora of options to address these symptoms: “Hot flashes, night sweats, and sleep problems are caused by declining estrogen. Giving back estrogen is a very effective way of addressing these symptoms, particularly if they are severe enough to affect the quality of life, and if there are no contraindications to the use of hormone therapy.” 

Whether or not to use hormonal therapy depends on the individual needs of each person, and the benefits and risks of therapy must be weighed in each case. There are some safe ways to deliver hormones in the right dose to the right person to minimize symptoms. Dr. Pal suggests this can be done in two steps:

Step #1 is identifying the symptoms that affect quality of life.

Step #2 is choosing the right tool to address the symptoms and reassuring the person that there are hormonal and non-hormonal approaches. 

“Hormonal approaches are more effective than non-hormonal approaches,”  Dr. Pal explains. “But the choice of non-hormonal approaches should be prioritized for patients who are either concerned about using hormones or have risks related to hormone use.” 

For example, someone who has a personal history of breast cancer may be worried about the risk of cancer recurrence with estrogen therapy. In cases like this, non-hormonal strategies might be a good first approach. 

Lastly, vaginal symptoms can be very effectively addressed with vaginal therapy, which has minimal to no risks, even for people with a history of breast cancer. 

If you’re experiencing menopause symptoms that are affecting your quality of life, have an open dialogue with a health care provider to find out more about your options. 

Can hormonal therapy help mood swings?

”This is a tricky question because mood swings per se are NOT considered menopause symptoms,” explains Dr. Pal. 

As Dr. Pal explains, some people experience PMS-related anxiety and stress because of fluctuations of hormones. Those who experience PMS are more likely to experience perimenopausal symptoms. 

The assumption is that the symptoms emerge due to fluctuating levels of hormones. When menopause happens, the hormonal profile essentially becomes a flat line, and mood swings should improve.

However, poor sleep and night sweats have been tied to worsening psychological well-being in perimenopause and just after menopause. In this situation, controlling symptoms can help improve psychological well-being.  

“If you are experiencing mood swings in post-menopause, it’s important to understand what can be contributing to it. Poor sleep and a lack of rest is a big contributor to emotional stress,” says Dr. Pal.

In conclusion

Dr. Pal’s approach to menopause is this: What can we do to maximize health?

“Maximizing health should be about maintaining physical activity to counteract the tendency to gain weight, improve our bone health, minimize bone loss, optimize our calcium intake, and optimize our general well-being,”  Dr. Pal suggests. 

She also says that vaginal dryness doesn’t have to be uncomfortable. There are a lot of ways to address the symptoms of vaginal dryness and maintain a satisfying sex life.  

It’s important to understand what changes are happening, what difficulties you may experience, and start a conversation with your health care provider about anything concerning. 

“An individualized approach to these common health issues is important,” concludes Dr. Pal.