Menopause marks the end of reproductive years for half the population, and it can bring on significant symptoms as soon as a decade before menopause officially hits. And although it’s such a common process, some say the care for menopause is lacking. But now there are some providers in Maine who make menopause care a focus of their practice.
During their child-bearing years, women can easily find classes and support groups dealing with pregnancy and labor. But when it comes to the next big change in women's lives — menopause — that education is noticeably absent, says 47-year old Hazel Labbe of Belgrade.
"I didn't even really know that there was something called perimenopause,” Labbe says. “I didn't really know what that was and how long you could be in it, and if that's what I was in."
Perimenopause is the time leading up to menopause, when estrogen levels start to fluctuate and, eventually, drop. When Labbe was in her early 40s, she says she started getting hot flashes and night sweats. Her moods swung from bouts of crying in the shower to fits of anger.
"One day, I was in a fine mood, but I happened to go in my bedroom. And my husband had left something on the floor, and I just lost it. Like, if he had been here, I probably would have ripped his head off. And it was something silly,” she says. “And I just thought, why am I so angry about this?"
The symptoms went on for years. When she brought them up during her annual exams, Labbe says her doctor told her she probably was in perimenopause. But she didn't receive much advice on how to deal with the symptoms. As Labbe searched for help, she eventually found her way to Susan Kamin.
"I am a certified nurse midwife," says Kamin. Nurse midwives are typically associated with helping women have babies, but, Kamin, who practices in Readfield and Brunswick, says their work extends beyond childbirth.
"Midwife means ‘with women,’ So we are trained to take care of women throughout the lifespan, and we are actually trained as primary health care providers for women," says Kamin.
Kamin did focus on the childbirth years for much of her 32-year career, but recently she shifted to treatment for women going through menopause.
"Many years after I went through menopause myself and reflected back on my experience, looking at how little care I got, and how little I knew, even though this was part of my training — even though my training was about 30 years ago in this field — I found there was this huge void, and people really weren’t being cared for in the way they should," she says.
Menopause is defined as when an individual stops having menstrual periods, which is usually around age 51. But it takes about one year to know that menstruation has ended. And Kamin says the time to address menopause is well before a woman has reached it.
"So much is happening and changing for women in their 40s, or women during the perimenopause period, that could have incredible implications for their life later on," she says.
Kamin says the symptoms of perimenopause — the hot flashes, night sweats and mood swings — can affect a woman's sleep, stress and eating habits, and that can set women up for chronic health problems like cardiovascular disease and diabetes.
That's why, she says, it's important to manage symptoms. But that's difficult to do in a typical 15-minute office visit, says Chris Kuhni of Milbridge. She's a nurse practitioner whose been certified in menopause care because of what she saw as a need for more specialized care.
"This is one area in my practice where I get referrals from physicians,” says Kuhni. “Physicians don’t typically refer patients to nurse practitioners for care. But because I'm able to carve out the time for these women, that seems to be working very well."
And it takes time, Kuhni says, to tease out the root cause of symptoms, some of which have far-reaching effects.
"So a woman experiencing, for example, just very severe night sweats, may become so sleep deprived that her relationships suffer, her work suffers, and ultimately her mental health is impacted," Kuhni says.
Women can also experience bladder issues and pain when their estrogen drops as they're entering menopause. That's what sends many women Andrea Laskey's way. She's a pelvic floor physical therapist at Greater Brunswick Physical Therapy.
"The pelvic pain that nobody wants to talk about it is really hard,” she says. “People come in in tears because they’re like, 'My marriage — I can’t have intimate relations with my partner."
Laskey says too often, menopausal symptoms are brushed off as something to just accept, when there are ways to address them. Hazel Labbe, for example, says her night sweats are gone and her hot flashes and mood swings are far less severe now that she's taking hormones.
"I feel like that has really changed my life, you know. I just feel so much better."
Her nurse midwife Susan Kamin says despite the challenges of menopause, there are benefits. And as more women talk about the subject and get help managing symptoms, they may come to embrace it as a new chapter in their lives.