hot FlasheS in the hot zone

By Anastasia Miller, Ph.D.

WHEN I WAS YOUNGER, IT WAS CONSIDERED HORRIFIC TO EVEN MENTION “AUNT FLO” (OUR NICKNAME FOR WOMEN’S PERIODS) IN MIXED COMPANY! LUCKILY, WE’VE SEEN A LOT OF BREAKING OF SOCIAL TABOOS AROUND THE SUBJECT OF WOMEN’S BODIES IN RECENT YEARS. MENSTRUAL CYCLES, WHEN THEY START AND WHEN THEY END, ARE NORMAL HUMAN FUNCTIONS.

While we now have hilarious TV commercials for feminine products that actually use red liquid (instead of baffling blue as in the past), and we seem as a society to have a better understanding of the importance of medical tests such as pap smears and breast exams, there is still a lack of communication around one monumental landmark of womanhood: menopause.

Even those who think they know something about menopause are often misinformed. I’ve encountered people who think every woman goes through menopause at a set age (false), that it means that a woman has run out of eggs (also false), or that it never lasts long (very false).

Let’s start by setting the record straight about what menopause is, so we can all be on the same page and normalize the discussion. The medical definition of menopause is “the point at which it has been twelve months in a row since a woman has had any bleeding” (i.e. her period). Menopause can happen naturally as early as age thirty right up to sixty or beyond. It can be induced by surgery (such as a hysterectomy) or the use of certain drugs (chemotherapy). For the average woman, menopause starts in the early-to-late forties or early fifties. The transition can be very rapid (such as when it is surgically caused) or it can take up to fourteen years. On average, it lasts for approximately seven years.

The time leading up to menopause is known as “perimenopause” – a stage when the ovaries start to produce estrogen and progesterone randomly rather than regularly. Women may begin to experience a host of symptoms including “hot flashes” (sudden feelings of heat, typically in the upper body, including perspiration, sometimes accompanied by anxiety) – which can be triggered by anything from caffeine to strenuous activity.

Perimenopausal women may have difficulty sleeping, experience sudden irregular periods and sudden weight gain, bladder control issues, and mood swings. There can be changes in sexual interest and comfort as well.

The story differs for every woman. For some, the symptoms are mild to begin with, and get stronger. Others report feeling as if they’ve hit a brick wall all at once, while others have few symptoms. There can be huge variances even between sisters in the same family. Because menstrual cycles will be difficult to chart and ovulation will be unpredictable, it’s wise to still practice birth control during perimenopause.

After menopause, women enter a period known as “postmenopause”. During this time, they are at an increased risk for heart disease, weight gain, memory issues, osteoporosis, and stroke. While it may be a relief to no longer have their periods, they may unfortunately still experience hot flashes for as long as another fourteen years. While birth control will no longer be needed, it’s important to remember that women can still catch sexually-transmitted infections. Any bleeding experienced after menopause is not normal and should be checked by a medical provider.

Menopause is not a “disease” to whisper about in dark corridors, it is simply a stage of life caused by changes in hormones. In fact, menopause is not unlike the so-called male menopause (more properly called andropause), that occurs when men naturally experience a reduction of testosterone in middle age, resulting in loss of muscle mass, mood swings, lack of energy, memory issues, and difficulty sleeping. There are some distinct differences and the two are not directly comparable (the rate of decline of testosterone in men is steady, as opposed to menopause, which is a sudden, drastic change in hormone levels) – but it is important to remember that all bodies change as we age.

How can the brotherhood/ sisterhood support fellow firefighters who might be going through menopause? Given that nearly one in five female firefighters report it being an issue, there are some basic tips to consider. Never assume a woman is going through menopause, but simply provide a safe space with resources she can access, and offer a listening ear. Clarifying medical leave and absence policies can help, as some of the symptoms of menopause – such as depression or extra heavy bleeding –may require time off.

The job is physical and that might induce hot flashes or put women at risk for bone injury or even osteoporosis. Ensure that there are ways to cool down, check in with a medical provider, or take a day off to recover. Keeping extra uniforms on hand in women’s sizes, particularly shirts, for when the hot flashes hit, can be a great relief as can looser-fitting uniforms. To lower core temperature immediately, women should be allowed to remove bunker gear/outer clothing when not required if they are overheating. On scene, things such as cold water and ice packs can help. Muscular strength may lessen more quickly as a result of hormonal changes, and bone density may also decline. To counter this, a proper diet and exercise routine should be encouraged.

Keep in mind that menopause is still a sensitive, even embarrassing issue for most women. Designate someone willing to be a representative for women’s issues – perhaps someone in HR or an outside person who stops by periodically – who can relay issues to officers.

If we all accept that menopause is simply another stage of life (and have an extra shirt and an ice pack on hand) we can support our sisters while doing the job we love so much.

LOOKING FOR MORE ANSWERS? THE OFFICE OF WOMEN’S HEALTH WEBSITE ON MENOPAUSE OFFERS RESOURCES AT WOMENSHEALTH.GOV/MENOPAUSE . THE NATIONAL INSTITUTE ON AGING ALSO HAS A FREE TOOL TO HELP YOU LEARN ABOUT YOUR SYMPTOMS AND CREATE A PERSONALIZED TREATMENT PLAN MYMENOPLAN.ORG