Menopause is not the end of a women’s femininity or sexuality.  Menopause is just another phase of life similar to puberty.  Menopause is a time of growth and for some liberation from monthly premenstrual issues.  Menopause is nothing to fear or worry about.  However, many women find the resulting symptoms difficult to manage and the treatment options confusing.  

Menopause

Menopause is technically defined as one year after the last menstrual cycle.  The period of time up to this point is considered perimenopause.  Perimenopause is from the time the menstrual cycle starts to change in frequency and sometimes in nature to either heavier or lighter than usual flow, to the year of time following the last menstrual cycle.  This period of time varies from women to women just like the amount of time that menopause takes for the body to complete this phase in life.

There are medical conditions or medical treatments that can either bring on premature menopause or simulate menopause for a short period of time.  The most common treatment that can induce menopause is a hysterectomy where the uterus and maybe the ovaries are removed.  If the ovaries are left there is a period of time prior to the initial symptoms of menopause are felt.  Other medical treatments that can induce menopause are some of the cancer therapies including chemotherapy and radiation.

The common symptoms associated with perimenopause and menopause include:  irregular menstrual cycles and decreased fertility, vaginal dryness, hot flashes and/or night sweats, sleep disturbances, mood swings, thinning of hair, and increased weight especially in the abdominal area.  These symptoms are a result of the loss of estrogen and progesterone in the body.  This can affect other systems in the body causing other problems to occur.  The decrease in estrogen and progesterone increases your risk for cardiovascular diseases (stroke, heart attack), osteoporosis (loss of bone density), loss of muscle tone (urinary incontinence), nerve degeneration (memory loss), and weight gain.

To understand the treatment options for menopause, it is important to understand the nature of the different types of estrogens and progesterones.  There are three types of naturally occurring estrogens in the body, which are estradiol, estrone, and estriol.  In simplistic terms estradiol is the good estrogen protecting the body against all of the negative effects that can occur in the body from a loss of estrogen.  Estrone is the bad estrogen, which can actually lead to many of the negative effects of estrogen and can promote the negative effects that occur with a loss of estrogen, specifically estradiol.  Estriol is like an intermediary estrogen similar in effects to estradiol, but less potent.

Several studies have shown that the ratios between estradiol and estrone are important predictors of premenstrual symptoms and to risk factors following menopause.  Those women with a balanced higher level of estradiol compared to estrone, have less problems during their menstrual cycle and are at a decreased risk to develop breast cancer, cardiovascular disease, osteoporosis, and nerve degeneration later in life.  Those women with a high level of estrone compared to estradiol have considerable issues during their menstrual cycle and are at increased risk for all of the before mentioned conditions.  So this ratio should be considered when considering any hormonal therapy at any time in a women’s life.  During menopause these ratios should be considered and checked at the beginning of therapy to establish risk, but also checked during treatment to make sure that this risk is not increasing with therapy.

Progesterone is a hormone usually neglected by many doctors because it is only thought of as a hormone of pregnancy.  It is the hormone that helps to prepare the uterus for pregnancy and to maintain a pregnancy.  However, research is defining more effects of progesterone.  One important effect to be considered is the effect that progesterone has on the estradiol and estrone levels in the body.  When progesterone is low, estrone is higher than estradiol.  When progesterone levels are normal, estradiol is higher than estrone levels.  This effect continues on into menopause.

Treatments

The most commonly prescribed therapy for menopause is hormone replacement therapy.  It continues to be the most effective treatment option available to relieve the majority of menopausal symptoms.  Depending upon personal and family medical history the recommendation to use a low dose hormonal replacement might be made.

There are two forms of hormone replacement therapy options available to patients currently, synthetic hormones and ‘natural’ hormones.  The choice of which treatment to use is ultimately up to you and your doctor.  After discussing the risk and benefits of hormone treatment versus non treatment, the decision to begin treatment is made along with the most appropriate form of hormone therapy.

In some cases hormone replacement therapy may be contraindicated due to increased risk factors for taking hormone replacement therapies.  There are a few medications like Gabapentin (Neurontin) and Clonidine that can help with hot flashes, antidepressants to help with mood swings, and other medications to help with the potential issues that can occur with having little to no estrogen later in life.

It is also important to check for other hormonal imbalances and treat these if they occur.  Low thyroid function and low adrenal function are common in women, especially during and after menopause.  It is important to identify these and treat to help lessen the symptoms of menopause.

There are several effective and helpful alternative or complementary therapies along with several lifestyle changes available to treat menopausal symptoms.  It is very important if using alternative therapies that you do so under the direction of a trained health care practitioner so that interactions with medications do not occur and that you are getting adequate treatment.

Some of the alternative and complementary therapies recommended include:

• Phytoestrogens – Phytoestrogens are found in some plants like soy and red clover that may help to relieve some of the symptoms of menopause.
• Black cohosh (Cimicifuga racemosa) – Black cohosh has been shown to have some effect in reducing some menopausal symptoms particularly hot flashes.
• Dong quai (Angelica sinensis) – Dong quai can help to reduce hot flashes, but can interact with some anticoagulant medications.
• Ginseng (Panax ginseng) – Ginseng helps with the mood swings and sleep disturbances that can occur with menopause.
• Exercise to improve vessel tone and improve quality of life
• Stop smoking or smoke exposure
• Stress management