It was waking up at night drenched in sweat that alerted Cindy Battino that something was different.
“The night sweats are just … they’re the worst,” said Battino, 60, a life coach and business owner in Front Royal, Virginia. “You’re dripping sweat one minute, freezing cold the next … You can’t stay comfortable.”
Battino — who was in her early 40s when the night sweats started — was going through perimenopause, the natural transition to menopause, which is often described as “the change” or a “part of life” that a majority of women go through.
Menopause is a normal part of aging that typically begins between the ages of 45 and 55. While it is experienced predominantly in women, trans and nonbinary people may be affected by menopause, as well.
Currently, a large part of Generation X women, those born between 1965 and 1980, are starting to or are already experiencing symptoms of perimenopause or they are in menopause. That accounts for some 32 million people in the U.S., based on latest Census numbers.
Menopause is having its moment, as famous women have been talking about it more openly, including Angelina Jolie, Michelle Obama and Gwyneth Paltrow. As menopause starts to enter mainstream conversation, women have been empowered to demand answers from their doctors about concerns that were perceived as taboo not many years ago; and they have found support on social media, which have become spaces for women to share what they are going through.
WTOP spoke with women about their menopause experience, as well as health care providers who shared some advise for people going through their menopause journey.
It came from the ‘center of my being’
Menopause is the time when women permanently stop having menstrual periods, signaling the end of their ability to have children, according to Johns Hopkins Medicine.
A woman is said to be in menopause 12 months after her last period. The years leading up to that point, when women experience changes in their monthly cycles, is called perimenopause.
It’s during perimenopause when women could experience changes to their bodies, particularly the body’s production of the hormones estrogen and progesterone, according to the National Institute on Aging.
These changes in hormones lead to some women experiencing a variety of symptoms, including hot flashes, night sweats, vaginal dryness, mood changes, insomnia and changes in sex desire, according to Endocrine.org.
Hot flashes can last for many years, according to the National Institute of Aging.
Like Battino, hot flashes were something Andrea Levy Itkin, 58, of Northern Virginia, remembered without much fondness, describing them as feeling as if they came from the “center of my being.”
“It was like a ripple effect, almost like a puddle. Like if you dropped a droplet of oil or water in a puddle outside, and you saw the ripple effect,” Levy Itkin said. “And I would sweat profusely. And I felt like if I opened my mouth, fire would come out. It was just awful.”
And more often than not, her hot flashes would come in the middle of the night.
“I would end up in a cool shower to kind of get all the sweat and everything off me. And no sooner would I get back into bed in clean pajamas and everything, I’d have a second one,” Levy Itkin said, leaving her sheets soaked and in need of changing again.
Battino said it took a while to regulate her environment and what was going on inside her body, from having the ceiling fan on, a fan by the bedside or specific blankets. She said some women she knows even have fans attached to their phones.
“It shouldn’t be embarrassing for a woman to walk around with a fan on her phone,” Battino said.
‘Not like a thunderclap’
Lindsay Spudic, a family nurse practitioner at the Menopause Center in Northern Virginia, said one of the biggest skin complaints she encounters is wrinkles or dry skin, which can be exacerbated by a lack of estrogen.
“It’s not like a thunderclap,” said Kaiser Permanente dermatologist Dr. Tola Oyesanya, when all of a sudden your skin is sagging and full of brown spots. “But I will say people definitely notice the dryness, and you may notice skin sensitivity, irritation. You might notice acne. But this is all kind of slow and over time.”
Levy Itkin said that she has to moisturize her body twice a day and has moisturizing cream in different parts of her house and in her car. She said the level of dryness even differs between the fingers on her hands, and her back itches so frequently that she has back scratchers around the house to help.
“Since I went through menopause, I have to have something on my lips 24/7, whether it’s a lip balm or Vaseline or a lipstick or lip gloss. I can’t even sleep without anything on my lips,” Levy Itkin said.
She also experienced changes in the hair on her body. And while there are areas she no longer needed to shave, there has been hair growth in other parts of her body, such as the upper lip and the chin. The hair on her head also changed, from being pin straight to now being curly.
And it’s not just on the skin and hair where dryness can occur. Atrophic vaginitis is the thinning, drying and inflammation of the vaginal walls that may occur when the body has less estrogen, according to the Mayo Clinic, and there are several ways to treat it.
“I have patients that come to me, and they say that it feels like sandpaper. It hurts having sex; they have pain with sex, where they never had that before, and just not really knowing what’s wrong with them,” Spudic said.
Spudic said that a lot of women say they almost feel as if they have a urinary tract infection, and they have to urinate all the time. “But it actually is vaginal dryness,” she said.
It was pain during intercourse that led Battino to seek treatment.
‘Get me a pill to fix my vagina because you have a pill to fix your penis’
Not knowing what to do about the pain, Battino asked her doctor for suggestions. After an internal sonogram to make sure nothing was wrong, she said her doctor recommended an estrogen cream.
The American Cancer Society said that while estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus. Doctors generally prescribe estrogen plus the hormone progestin, which the National Cancer Institute said is not associated with an increased risk of endometrial cancer.
Spudic said that at the Menopause Center, new patients undergo lab tests to tailor a hormone replacement treatment based on their needs and symptoms, including bioidentical hormones.
“Bioidentical means that the hormones that we give them are chemically like the hormones that are made by the body,” such as Estradiol or estrogen, Spudic said.
Perimenopause can take five to 10 years, and women would not be on these medications and supplements forever. However, if it’s a “quality of life issue,” Spudic said there are many interventions that can make women feel better and help them get through this change and improve their lives.
Many women do not know all the options available to them, Spudic said, and they are dealing with these symptoms alone and feeling miserable.
“They have no libido; they haven’t had sex with their husband … and just balancing their hormones. I see them again in three to six months for a follow-up, they come in, and they’re like a new woman,” Spudic said. “Sometimes just getting everything balanced … it just makes a difference in their life.”
Battino said that she wants pharmaceutical companies to figure out how to help women the same way they have figured out how to treat conditions experienced by men. And if she were told by someone, such as a man, who has not been affected by menopause that what she is going through is just a “part of life,” she would tell them, “Get me a pill to fix my vagina because you have a pill to fix your penis.”
Battino said that around the time some men may start experiencing erectile dysfunction is just about when women start experiencing perimenopause or reaching menopause.
Then a certain little blue pill entered the scene 25 years ago. The Food and Drug Administration approved Viagra on March 27, 1998 for the treatment of erectile dysfunction.
“So now you have men into their 70s and more that can pop a pill and get hard. But … our bodies don’t have the same options. It’s really frustrating as a woman, and it’s really difficult when your partner has a sex drive that you can’t keep up with because the medical world hasn’t invested in what women need,” Battino said.
There are other treatments available to treat vaginal symptoms associated with menopause, including vaginal laser treatment. However in 2018, the FDA issued a statement saying that the safety and effectiveness of devices for “vaginal rejuvenation” have not been confirmed or evaluated by the agency. Moreover, these types of treatment are typically expensive and not covered by insurance.
Let’s talk about menopause
The health and wellness industry has been paying attention. Last August, skin care brand No7 introduced its menopause skin care collection. With distinctive lavender packaging and the words “Menopause Skincare” prominently displayed, the products promise hydration, firming, brightening and calming for women’s skin.
“I think that this kind of marketing is an attempt to try to bring those women, who are of advancing age, back to the forefront, which is great; and also give them an opportunity to use skin care that is marketed toward them, that really fits their needs. And I think honestly, it’s an opportunity,” said Oyesanya, with Kaiser Permanente in Maryland.
As the topic of menopause becomes more mainstream, some feel there’s less of a feeling of isolation.
Gwen Harris started a menopause support group on Facebook 10 years ago. After a feature on Good Morning America in 2018, the group has since ballooned to more than 118,000 members, with some 100 women joining daily, Harris said.
Harris said that menopause was not a subject that you talked about 10 years ago, and it was something she was never educated on.
“I was feeling yucky. I felt with all the hot flashes and everything that was going on, I wanted to isolate myself,” Harris said. “It’s a scary, lonely transition.”
Harris said she wants menopause to be seen as a “season of transition.”
“What we inspire women to do is bloom through this last third of your life. It’s time to bloom; you’re just blooming in a different way,” Harris said, adding that she wants women to know that they are not alone and can learn to cope together.
“My advice with having this group for 10 years would be to join a community that knows what you’re going through. Because no one likes to feel isolated,” Harris said.
Battino agreed, saying that she believes women have more options for other women than perhaps doctors do. “I just think unfortunately … our society … does not treat women the same as they treat men.”
‘Everybody’s got their own journey to walk through this life’
Spudic, with the Menopause Center, said that the imbalance of hormones extends to women’s mental health.
“I’ve experienced this a lot, where a patient goes to another doctor, they’re experiencing menopausal symptoms, and they’re told, ‘It’s part of life. This is what women experience, what you’re feeling is normal. Here’s an antidepressant,’” Spudic said.
But all menopausal symptoms are different, Harris said. And while some women may not get hot flashes, they may notice a change in their level of energy, which Harris said is a symptom of menopause.
“They had a change of something,” Harris said. “Everyone will go through menopause to a greater or lesser degree. God bless the ones who don’t suffer as much.”
Levy Itkin said there are things that can be done to make what women are experiencing more palatable, and she urged them to look for the solution that works best for them.
From hair loss supplements, laser hair removal, topical skin treatments and moisturizing cosmetics, there are different ways to alleviate some of their issues of concern, including Botox — a drug made from a toxin produced by the bacterium Clostridium botulinum, which can be used to smooth facial wrinkles.
“As women age, you get wrinkles. It could be a self-confidence issue. So treating with Botox, if that’s something that makes a female feel better about themselves, and they look in the mirror that makes them happy, I think it’s great,” Spudic, a trained Botox injector, said. “The word needs to get out that menopause isn’t something you have to go through alone or deal with just being miserable. There’s certainly things that are out there to help.”
Levy Itkin said she would encourage women to talk to their friends and doctors and find out what all the options are. “Just because this solution may have worked best for me doesn’t mean it’s going to work best for Sue Smith. Everybody’s got their own journey to walk through this life,” she said.