Blame it on menopause — because you can.

This week, I hosted Christmas Eve for 10 of my family members. Only six out of seven fishes made it to the table because I accidentally left the seventh fish in the oven on broil, not only ruining $70 worth of fish, but also causing a small fire that scorched the inside of my new oven.

This is our second Christmas without my mom. But as I stood in the kitchen, wearing her old apron half-crying half-laughing, I thought of her. Somehow she would have blamed a mistake like this on menopause.

For 10 years, my mother blamed everything on menopause. Hot flashes, forgetfulness, mood swings, sleepless nights of course. But somehow any problem we encountered from 1994-2004 was directly related to varying degrees of ovarian failure.

If her car ran out of gas, somehow menopause would get the blame. If she got lost while driving, she would pull over, cry a bit, and then laugh out loud at her mistake and say, “Leave me alone, I’m in menopause.” If she got caught up on a simple math problem, she’d give it a brief, weak effort and then tell someone else to do the calculation. After all, she was in menopause. Admittedly, she was never good with directions or math, but now she had a solid reason.

When she finally had her ovaries removed for ovarian cancer, we threw a little party bidding adieu to source of a decade of frustration. We thought for sure, the old mom would be back. But after five years of chemo side-effects, we would have taken back to quirks that accompanied menopause in a heartbeat.

But for the woman going through it, menopause is a frustrating and oftentimes confusing period. Menopause is a natural part of the life cycle that every woman will go through. Translated, menopause literally means the cessation of menses, secondary to ovarian shut-down.

The ovaries are the source of estrogen and progesterone that set the rhythm of the menstrual cycle. The hormones are the signals that build up the uterine lining to prepare for pregnancy, release an egg from the the ovary, and shed the uterine lining if fertilization does not occur. The ovaries are in chemical communication with the pituitary, thyroid and adrenals.

As ovarian function starts to wane, usually beginning after age 40, women may experience changes in their cycle. Menses may become irregular, lighter or shorter. The withdrawal from a normal hormonal cycle may cause unpredictable mood swings, hot or cold intolerance, fatigue or insomnia. Some women experience drying of the vaginal mucosa as a result of disappearing estrogen. Loss of breast fullness, slowed metabolism and therefore weight gain, thinned hair, insomnia are also common symptoms of fluctuating hormonal balance.
Many women come to my office desperate for help controlling the difficult symptoms of menopause. Testing the hormone levels in the blood can sometimes let us know if the

ovaries are shutting down. But usually you can diagnose perimenopause (the period leading up to the cessation of menses) based on symptoms alone. As I say, we can always do bloodwork, but if it walks like a menopausal duck and talks like a menopausal duck, guess what?

While the severity of symptoms can fluctuate throughout the course of perimenopause, many women choose to be proactive in controlling their symptoms. Regular exercise and a balanced diet are crucial is preparing your body for the endocrine disruption that comes with menopause. In addition to adopting an active and healthy lifestyle, there are several treatment options – herbal remedies, traditional hormone replacement and bioidentical hormone replacement.

On the conservative end of the menopause treatment spectrum are the natural remedies that have been used for millions of years. For example, black cohosh, red clover, kava and evening primrose oil are widely used as natural treatments for hot flashes. Scientific studies reveal mixed results, although anecdotally, I have found that many women rely on their effects to get them through menopause. Although it is not used to treat hot flashes, ginseng is another herbal remedy that is used primarily for mood swings, insomnia and energy.

Each of these may have safety concerns in patients with certain medical problems such as liver or blood disorders. As an aside, I encounter many patients who taken herbal medicines without knowledge of their potential side effects or contraindications. Many herbals interact with other medications making the other medications less effective or more toxic. You should always know why you’re taking a supplement and if there are any serious potential risks. Just because it’s natural doesn’t mean it’s completely safe. (Cocaine, heroin and tobacco are natural too!) Be sure to consult with a licensed professional before taking any medicine or supplement.

Hormone replacement therapy consists of traditional birth control pills, which control the symptoms of perimenopause by supplementing your body with a cyclic dose of synthetic hormones. It can also be used for pregnancy prevention and symptoms of postmenopausal hormone loss. The estrogen and/or progesterone that you receive through a pack of birth control pills mimics the body’s natural menstrual cycle and therefore replaces the hormones that your body is no longer making regularly. This usually alleviates most or all of the typical symptoms of menopause. HRT may have added benefits of protecting against colon cancer, osteoporosis, dementia and heart disease. However, It is well-known that any woman taking hormone replacement therapy for menopause or for birth control is at increased risk of blood clotting and therefore should not smoke. And possibly most controversial is the concern that taking exogenous hormones may confer an increased risk of breast or endometrial cancer.

Somewhere in the middle of the menopause-treatment-spectrum is bioidentical hormone replacement therapy, also known as BHRT. Unlike traditional HRT, BHRT consists of plant-derived compounds that are chemically identical to the hormones that our body produces naturally. Therefore, the body is unable to distinguish these exogenous hormones from our own. Theoretically then there should be no increased risk of unwanted side effects. Also, as opposed to a standard pre-determined dosage, BHRT is a cocktail of hormones, usually estrogen, progesterone (which is micronized for better absorption) and testosterone, which is measured and tailored to fit the individually for whom it is being prescribed. Essentially, it’s natural, customizable hormone replacement. But again, just because it’s “natural” doesn’t mean it is safe. Although many of the bioidentical hormones are bioidentical, large controlled research studies are needed to quantify their effectiveness and safety.

Whether you choose to treat menopause or not, it’s something all women will go through, a natural part of the life cycle that is not an illness or condition but a transient state of being. When assessing a woman’s reproductive cycle we can usually look at her mother and older sisters as a guide. Many women will mimic their female relatives with respect to age of onset, duration and severity of symptoms.

So lucky for me, I have a decade’s worth of wacky and wildly variable symptoms that begin somewhere around age 38. At that rate, I’ll be back in action in the year 2027. Which reminds me that keeping a sense of humor will certainly ease the transition. Check out The Menopause Bill of Rights, written by Eva Moon and published on The Huffington Post on Aug.30:

THE MENOPAUSE BILL OF RIGHTS
1 Establish procedures to respond to all partner complaints within 24 seconds and with appropriate resolution within two hours.

2 Notify partner within 10 minutes of diversions, delays and cancellations. Is it really too much to ask you to pick up the damn phone?

3 Provide for the essential needs of menopausal partner including chocolate, wine, foot rubs, ice packs, tweezers, magnifying glasses, gallon jugs of personal lube, Ambien, Valium, working aphrodisiacs, hair dye, Spanx and access to a decent shopping.

4 Provide for the needs of menopausal partners by establishing procedures for assisting with maintaining the pretense eternal youth and the feeding of unrealistic expectations at all times. This includes detaining Michelle Pfeiffer and slapping her until she confesses who she sold her soul to.

5 Publish, update and complete monthly a comprehensive list of chores, “honey-dos” and other household repairs and enhancements, including those that have been chronically delayed twenty-five years or more.

6 Compensate “bummed” women or women fed up with “this whole fucking aging thing” by refund of 150% of children’s college tuition.

7 Formal implementation of a Satisfaction Review Committee, made up actual consumers of pills that supposedly “revitalize your sex life,” diets that “let you eat whatever you want” and exercise equipment that “only takes four minutes a day” — which would have the legal authority to review, investigate, draw and quarter the manufacturers.

8 Make information about children’s sports and band schedules, orthodontist appointments, cancellations and frequent “ride to the mall” program requirements available in an easily accessed location, updated in real-time and administrated by a transit authority herein known as “somebody else.”

9 Ensure that “excess baggage” be handled with extreme caution; Refrain from notifications of baggage status even explicitly asked if “these pants make me look fat.” Neglect of this provision requires compensation equal to current market value of a week at a spa.

10 Require that these rights be posted in a prominent, central location because… um… because, um, what was I saying?

Alexis Hugelmeyer, D.O. is the wife of Michael, mother of Isabella, 5, and Lance, 3, and a family physician whose passion is hands-on manipulation for treatment and healing of any and every type of medical problem. She is the director of community outreach education at Peconic Bay Medical Center and also a private practitioner in Riverhead, where she has founded The Suah Center for Natural Healthcare. A graduate of Villanova University and New York College of Osteopathic Medicine, she lives in Baiting Hollow.