Menopause

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is menopause?

Strictly speaking, a woman is in menopause when her ovaries stop producing estrogen and progesterone, and she hasn’t had a menstrual period for a full year. This signifies the end of a natural ability to bear children.

As estrogen levels decline, many women begin to experience some decidedly unpleasant symptoms: an intense heat, flushing, and sweating known as hot flashes (felt by 75% of women), night sweats, insomnia, vaginal dryness, less interest in sex, mental fuzziness, and/or mood changes. These symptoms may be subtle and short-lived, ending after just a few months, or you may experience several years of sudden sweats, sleep loss, and surliness. Once your body adjusts to the hormone reduction, though, symptoms diminish.

Decreased hormone levels can have long-term effects. After your final period, estrogen declines rapidly, as does your body’s ability to absorb bone-building calcium. This leaves you more vulnerable to a thinning of the bones known as osteoporosis. Almost half of women over age 50 are at risk for this condition. Left untreated, it can result in an annual 3% loss of bone during the first five postmenopausal years (after that, bone loss continues at a rate of 1% to 2% a year). Reduced estrogen also raises levels of blood cholesterol, which may explain increased risk for cardiovascular disease and heart attack in postmenopausal women.

Who will experience menopause?

The average age most women experience menopause is 51 (although it can occur as early as your late 30s or as late as your 60s). The loss of hormones is usually gradual, often beginning a decade earlier. This time frame is now commonly known as perimenopause.

Treatment for menopause

There’s no doubt that the drop in female hormones during menopause profoundly affects your body, but don’t make the mistake of thinking of menopause as a “disease.” Menopause may actually bring about a feeling of freedom—namely, freedom from menstruation and concerns about contraception. Still, for many women, menopause can be decidedly uncomfortable, and it can carry with it the potential for future health problems.

Until recently, the most widely prescribed treatment for women experiencing unbearable hot flashes, irritability, insomnia, and other menopausal symptoms was hormone replacement. Doctors believed that resupplying a woman’s body with estrogen not only offered short-term symptom relief, but provided lasting protection against osteoporosis and heart disease. New research proves that long-term use of hormones may not be safe. Many women are opting for natural treatment approaches.

Whichever treatment you choose, your personal health profile must be a key factor in your decision. If you have a history of breast cancer or heart trouble, for instance, your treatment may be different from another woman’s. What works for your best friend, your neighbour—or even your sister—may not be right (or even safe) for you. Look to your doctor for help in reviewing the pros and cons of the treatments you’re considering.

Medications for menopause

For more than 50 years, the first-line drug treatment for menopausal symptoms has been supplemental hormones. Estrogen alone (“unopposed estrogen”), known as estrogen replacement therapy (ERT), was the earliest option. Later, estrogen in combination with progestin (a form of progesterone), known as hormone replacement therapy (HRT), became the choice for most women. Today the benefits of both have been studied and re-evaluated. Because unopposed estrogen can increase the risk of cancer of the uterus, it is now recommended for treating menopause symptoms only in women whose uterus has been removed (hysterectomy). Its long-term risks are still being examined: One study showed that estrogen alone increased a woman’s chance of developing cancer of the ovaries.

HRT, which was used by more than 12 million menopausal women at its peak, has also suffered a setback. In 2002, during a study investigating the long-term effects of the popular HRT drug Prempro on more than 16,000 postmenopausal women, researchers found a slightly increased rate of breast cancer and blood clots in the group taking the estrogen/progestin combination. They also discovered a very disturbing increase in incidence of heart attack and stroke—precisely the ailments they had believed HRT would protect against.

While these results have caused many women to re-evaluate HRT, doctors point out that your personal risk for developing these problems is less than one-tenth of 1% per year. In spite of the data from the study, HRT may eventually be recommended to women who have especially severe menopausal symptoms and no history of breast cancer or heart disease. Rather than using HRT for years, your doctor may prescribe a low-dose short course for the period your symptoms are at their worst. You’ll gradually taper off the hormones to avoid bringing on the symptoms all over again.

If osteoporosis is your primary concern with menopause, you might try a bisphosphonate, such as alendronate (Fosamax) or risedronate (Actonel). These reduce fracture risk by 40% to 50%, contain no hormones, and some need be taken only once a week. A newer choice for preventing osteoporosis is the so-called “designer estrogen” drug raloxifene (Evista), a selective-estrogen receptor modulator (or SERM) that mimics the effects of estrogen to keep bones strong. A statin drug such as lovastatin (Mevacor) might help for heart disease prevention, and for hot flashes, ask your doctor about using an antidepressant or a blood pressure medication. Discuss side effects before you start. They might be worse than your present symptoms.

Lifestyle Changes

Whether or not you’re on medications for your menopause symptoms, changes in your daily habits will help keep you physically and mentally agile. Because unwanted weight gain tends to go hand in hand with menopause, adopt a low-fat, high-fibre diet that includes lots of whole grains and fresh fruits and vegetables. To keep hot flashes in check, cut way back on alcohol, caffeine, chocolate, and spicy foods. If your diet’s shy on bone-building calcium (aim for 1,200 to 1,500 mg daily), include more reduced-fat dairy products, fortified orange juice, and canned salmon (with the bones). You might also want to eat more tofu and other soy products, which are rich in isoflavones, estrogen-like compounds found in plants. Research shows that isoflavones may help relieve hot flashes and night sweats, and may protect against osteoporosis and breast cancer. Soy isoflavone supplements have never been found to have the same effects as dietary soy, and some research suggests that very large doses of the supplements may cause a hormone imbalance that increases the risk of certain estrogen-sensitive cancers.

Another way to keep your bones in good shape is to engage in about 30 minutes of weight-bearing exercise—any activity that’s carried out on your feet, such as walking, running, jumping rope, or playing tennis. Try to exercise at least three times a week. If urinary incontinence is a problem, Kegel exercises, which strengthen and tone the pelvic-floor muscles, can help. Don’t buy into the myth that menopause makes you less of a woman: Many women report feeling sexier than ever once they’re in menopause—and remaining sexually active helps preserve the elasticity of your vaginal walls.

If you are feeling anxious or worrying about your self-esteem or sexuality, consider seeing a counselor or psychotherapist or joining a women’s support group.

Alternative Therapies for Menopause

In addition to getting plenty of calcium in your diet, it’s also important to get enough vitamin E, vitamin D, and magnesium. These can be taken in supplement form to boost the amount you get from foods. Vitamin E stimulates the body’s estrogen production and as one of the antioxidant vitamins (along with the carotenes and vitamin C), acts to prevent LDL (“bad”) cholesterol from causing plaque in your artery walls. Magnesium and vitamin D help prevent osteoporosis and are often combined with calcium in a “bone-building” supplement. There are a number of other herbal supplements, such as black cohosh and red clover, which you also might want to consider to help keep menopausal symptoms in check. In addition, some women have found success with acupuncture, an ancient Chinese technique in which thin needles are inserted at key points on the body to relieve headaches, sleep disturbances, and other menopausal symptoms.

Questions for Your Doctor

• Could low-dose, short-term HRT be good for me?
• Will using HRT after years of birth control increase my risk for breast cancer?
• Is my failing memory a symptom of menopause?
• Can I still get pregnant now that I’m going through menopause?

During Menopause

If you’ve begun menopause, here are a few quick tips to help you take control:

• Dress for success. Pull on layers of breathable cotton garments—a tank top, T-shirt, or cardigan—that can be easily removed when a hot flash hits. You also might want to sleep on cotton sheets, which wick away moisture better than polyester ones.
• Breathe from your belly. Deep-breathing exercises, such as inhaling slowly through your nose and down to your belly, have been shown to reduce hot flashes by 50%.
• Use drops for dry eyes. Women on ERT may be at greater risk for dry eye syndrome, according to a study of 25,000 postmenopausal women. The longer the therapy continued, the greater the risk.
• Stay sexually active. Regular intercourse increases the tone and lubrication of vaginal tissues. If necessary, use a vaginal cream containing a nonestrogenic water-soluble lubricant to relieve dryness. Popular choices include Astroglide, Replens, or K-Y Jelly. Progestin-free estrogen products that are minimally absorbed by the body include a tablet that dissolves in the vagina (Vagifem), a ring that slowly releases estrogen over three months (Estring), and a vaginal cream (Estrace).
• Keep up with regular physicals. After menopause, continue with yearly Pap tests and pelvic exams, along with such appropriate screenings as mammograms and lipid profiles to check cholesterol levels, and continue to do a monthly breast self-exam.