Dealing with Menopause
What is Menopause?
Menopause is a normal part of a woman's natural aging process and occurs as hormone levels in the body decline.
It marks the end of a woman’s menstrual cycle and reproductive years. Menopause begins 2 to 5 years before a
woman’s last menstrual period (peri-menopause) and ends when she has not had a menstrual period for 12
consecutive months (pos-tmenopause) in the absence of other causes. The term menopause is used to describe
the period between the beginning and end of symptoms.
Physical signs of menopause begin several years before the end of the menstrual period and ends one year after
menopause. This transitional period is called peri-menopause. Normal symptoms of peri-menopause include
irregular and/or unusually heavy periods, hot flashes, mood changes, problems sleeping, vaginal dryness,
headaches, mood swings, and dry skin.
Most women experience menopause between the ages of 40 and 58, with the average age of 51. Women often
reach menopause around the same time as their mothers and sisters. Women who smoke often reach menopause
two years earlier than those who do not smoke.
Induced menopause
Menopause can also be medically induced by such procedures as the surgical removal of the ovaries
(oophorectomy) and chemotherapy or pelvic radiation therapy (causing serious ovarian damage).
Post-menopausal Changes
• Increased cholesterol levels
• Dryness and thinning of the vaginal walls
• Increased risk of osteoporosis
• Dryness of the skin
• Decreased bladder capacity and tone
Menopause treatments
Every woman’s experience of menopause is different. Some women find relief of symptoms from non-prescription
therapies while others may require prescription medications. It is important to keep in mind that improvement of
symptoms may take up to eight weeks.
Treatments vary from lifestyles changes, stress reduction, herbal substances, to over the counter and prescription
medications. All treatments should be discussed with your health care provider.
Lifestyle changes
• Discontinuing use of substances such as nicotine, alcohol and caffeine, which destroys estrogen in the body.
• Participating in regular exercise to decrease sleep disturbances (30 minutes of aerobic activity a day, such
as, walking, dancing, tennis)
Adequate nutrition
• Low saturated fat, high fiber diet. Lots of fruits and vegetables.
• Calcium intake of 1,200 – 1,500mg/day. Calcium supplements with added vitamin D and magnesium taken in
two or three divided doses on an empty is optimal. If you take Calcium with meals it will likely bind to oxalate and
phosphate in food and not get absorbed.
• Adequate hydration 6-8 glasses of water a day.
Herbal Therapies
• Soy and Isoflavones contain natural estrogens and may reduce hot flashes and cholesterol levels.
Recommended amounts are 40-80mg/day.
• Black Cohosh – reduces hot flashes and vaginal dryness. Mechanism of action is not understood but it is
believed not to act as or contain estrogens. However, its safety in women at risk for or with a history of breast and
uterine cancer is not fully established. Also helps with insomnia (20mg twice a day, 5-30 drops of extract 2-3 times a
day).
• Chaste berry (Vitex) – helps eliminate vaginal dryness and reduce hot flashes
• Flax seed oil – reduces hot flashes, lowers cholesterol (1-2 tbsp or tablets/day ground fresh seeds).
• Dong Quai – Chinese herb thought to help relieve symptoms of PMS and menopause (2 capsules daily). It
may increase your risk of bleeding.
• Oil of Evening Primrose – thought to help relieve symptoms of PMS and menopause (500mg twice a
day) by normalizing hormone levels.
Non-prescription therapies
• Nonhormonal vaginal lubricants- help with vaginal dryness. Use water based products only (K-Y jelly,
Astroglide, Lubrin, Moist Again). Avoid lubricants such as hand lotions, Vaseline, and baby oil, they cause irritation.
• Vaginal moisturizers such as Repleans act directly on tissue making it less dry.
• Avoid douching and limit bath oils and bubble baths. These will only cause more drying out of vaginal tissues.
• Estrogen creams provide a good alternative to oral hormone replacement for menopausal women who are
sexually active. The cream acts locally and has minimal systemic absorption. It provides the benefits of estrogen’s
revitalizing effects on the vaginal mucosa but does not cause the untoward systemic side effects of estrogens when
administered in pill form. It also does not otherwise provide protection against hot flashes and other symptoms of
menopause.
Prescription medications
Until July 2002, hormone therapy had been the standard therapy in the United States for treating menopausal
symptoms. Not only did hormone therapy relieve such discomforts as hot flashes and vaginal dryness, but it also
seemed to protect against several post-menopausal conditions, such as osteoporosis and heart disease.
A large medical study reported that hormone therapy actually posed more health risks than benefits for most
women. These risks included the development of blood clots, heart disease, stroke, endometrial and breast cancer.
Most experts now agree that hormone therapy isn’t the therapy of choice for disease prevention in healthy older
women. However, it may still have a place in treating some menopausal symptoms.
Who can benefit from hormone therapy?
The number of women who take hormone therapy is rapidly diminishing. However, for some women who suffer
significant symptoms such as severe hot flashes, the benefits of short-term hormone therapy may still outweigh the
risks.
The absolute risk to women without other risk factors for cardiovascular disease taking hormone therapy is quite
low and may be acceptable to if symptoms are severe and other therapies have not helped.
Significant risk factors for developing complications of hormone replacement include: High blood pressure,
diabetes, smoking, previous stroke, heart attack or blood clot in patient or close family, breast or uterine cancer in
patient or close relatives.
What if I am already on hormone therapy?
If you’re already taking hormone therapy to relieve menopausal symptoms, you may need to rethink your options.
Do not discontinue your medication but discuss the risk and benefits associated with therapy with your health care
provider.
If you opt for hormone therapy, take the lowest effective dose for the shortest amount of time needed to treat your
symptoms. Bio-identical estrogen, such as Estrace may confer some benefit in comparison to other formulations.
Non-hormonal Prescriptions Medications
Neurontin, a well-tolerated medication for seizures and neuropathic pain as well as SSRI class of anti-depressants
(Prozac, Zoloft, Paxil, Lexapro, …) are used by many practitioners with variable success for controlling symptoms of
menopause.