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Learning the Language of Menopause

The North Carolina native had her youngest son when she was 41. But she had a miscarriage the year before he was born. That's when her doctor first mentioned perimenopause, or the hormonal stage before your menstrual cycle stops.

Perimenopause is the hormonal stage before your menstrual cycle stops for good.

Menopause is when you've gone without periods for one year.

She'd already heard of menopause, which is defined as a year without periods. But right after her pregnancy loss, Burney-Scott started to think more about what it meant to be a perimenopausal person.

Her hot flashes began a few years later.

At first, she thought each heat wave might be a one-time thing. But then her sweating episodes came multiple times a week, sometimes multiple times a day. "That's what drove me to the doctor," Burney-Scott says.

What Are the Symptoms?

Lots of symptoms linked to menopause show up during perimenopause. On average, this transition phase includes the 4 to 7 years before your period permanently ends. But it can last longer for some folks.

JoAnn Pinkerton, MD, a menopause specialist and professor of obstetrics and gynecology for the University of Virginia Health System, says perimenopause is a time of hormonal swings. These ups and downs can change your body in unpredictable ways.

"Imagine you're leading a conference and it's warm in the room. All of a sudden, you have a hot flush. Your face turns red, and you start to sweat," she says. "That would be embarrassing, and you may need to leave the room."

But you could also have:

  • Skipped or irregular periods
  • More belly fat
  • Trouble sleeping
  • Breast changes
  • Heavy bleeding

Tell your doctor if you lose a lot of blood. You may need to take extra steps to prevent or treat anemia.

You might also have issues with your mood or how you think, including:

  • Brain fog
  • Trouble concentrating
  • Memory problems
  • A hard time controlling your emotions
  • Anxiety or depression
  • Less desire for sex

Eventually, you may notice vaginal and urinary issues, like:

  • Vaginal dryness
  • Pain with sex
  • A sudden urge to pee
  • Leaky urine when you exercise, laugh, or sneeze
  • Bladder or urinary tract infections

It's important to note that menopause-related memory and concentration issues aren't usually a sign of a long-lasting decline in your thinking skills.

"Many women are afraid that they have Alzheimer's," Pinkerton says. "When in reality, it's just that they're juggling too many balls and not taking care of themselves."

Managing Life in Menopause

Burney-Scott's primary care doctor asked about her symptoms and ran some blood tests to check hormone levels. While there isn't one way to diagnose the perimenopause transition, all signs pointed in that direction.

She started to map out her hot flashes. To do that, her doctor asked her some questions: Did a particular food make things worse? Did they happen in certain situations? Did she have night sweats?

Yes, yes, and yes.

He brought up hormone replacement therapy (HRT) right off the bat. That's because estrogen levels drop during menopause and HRT brings them back up. But Burney-Scott told her doctor HRT wasn't right for her. "He said, 'OK, it doesn't have to be.'"

Hormone Replacement Therapy

Estrogen levels drop during menopause and HRT brings them back up.

But she did make some diet changes. They made a big impact right away. "I'm very clear that spicy food, red wine, caffeine, and too many carbs or refined sugars would intensify my hot flashes," Burney-Scott says.

They also discussed dietary supplements, including black cohosh. That's an ingredient found in some over-the-counter menopause products. It's not scientifically proven to treat hot flashes, but Burney-Scott says it seemed to help her.

The Mental Health Connection

Emotional stress and physical anxiety can bring on or worsen vasomotor symptoms. And Burney-Scott had a lot going on when she started breaking out into sweats.

"My oldest son was in college. I was going through a divorce. My little one was in daycare," she says. "And I was working with a statewide voting rights organization that was fighting voter suppression in North Carolina."

But getting too hot wasn't the only problem. Sometimes her hands would shake, and her heart would race. According to her doctor, she was having perimenopausal hot flashes alongside anxiety attacks.

Now, she takes medication to ease her in-the-moment panic. And she talks to a mental health professional. Both help.

She hopes more people and providers will take a closer look at the connection between mental health, stress, and how severe vasomotor symptoms are among women of color.

"I know that any way my body responds to stress, if we cherry-pick out me being a Black woman living inside of a society where structural and institutional racism exist, then part of my personhood is being erased," Burney-Scott says. "I'm grateful that my primary care physician, my OB/GYN, and my therapist never did that."

Medical Treatment for Hot Flashes and Night Sweats

Treatment depends on how serious your symptoms are.

For mild hot flashes, Pinkerton says, you may only need to wear loose clothes, keep fans handy, sleep on a cooling gel bed topper, or lower the air conditioning to 68 F. Herbal menopause supplements may be worth a try, but you should talk to your doctor first.

If your symptoms are severe or happen a lot, you may need more.

It's unclear exactly what causes moderate to severe vasomotor symptoms in some people. But scientists think a drop in estrogen messes with your internal thermostat. As a result, small changes in your core body temperature may trigger sweating.

"What's really happening is that, in the brain, there's a thermoregulatory zone. Normally, you'd get hot if you have a fever, like the flu. Or you may get chills when you're sick," Pinkerton says. "But women who are symptomatic, that thermal zone narrows."

Treatment for vasomotor symptoms aims to widen that window. What works best?

But you've got other choices if you can't or don't want to use hormones.

Low doses of certain antidepressants may lessen the number of your hot flashes and how intense they are. Those drugs include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Gabapentin, a drug used to treat seizures and nerve pain, is another option. It can make you drowsy, so it might be a convenient choice if you also have night sweats.

In the near future, you'll likely have more menopause therapies to choose from.

For instance, neurokinin 3 receptor (NK3R) antagonists are a promising new therapy on the horizon. These drugs target the part of your brain that controls your internal body temperature.

"They very rapidly and effectively quell hot flashes and continue working," Pinkerton says. "And they're not hormonal."

Share Your Story

Burney-Scott's menopause care team included her doctors, spiritual community, and best girlfriends. "Also, my boys," she says.

But she's quick to point out that everyone's menopause journey is unique. And she's not a big fan of one-size-fits-all advice.

Instead, she likes to turn questions around: What do you think is going to help? What are three things you could do differently? What kind of support do you need to access those three things?

In 2019, Burney-Scott created a multimedia project to feature stories about how different groups of Black people go through aging. With The Black Girl's Guide to Surviving Menopause, she hopes to connect others to resources that'll help them make informed decisions about their own bodies.

"If you provide an opportunity for marginalized or disenfranchised people to talk about their own personal experiences with each other and to teach others, that becomes an onramp to advocacy and systemic change," Burney-Scott says. "But you've got to begin somewhere. And that somewhere is story."