Mastering Menopause

Transitioning to the years after reproduction—sometime between the ages of 40 and 55—can be smooth sailing for some, along with the added benefit of the end of concerns about becoming pregnant. But for most women it can be a time of recognizable transformations that often feel uncontrollable.

But there’s good news! Research is currently finding relief from many symptoms of menopause. An added bonus is that understanding the physical and emotional changes from menopause can offer women an important opportunity to stay focused on being healthy.

As you may know, menopause is clinically defined as a lack of menstrual periods for a full year, which in the U.S. happens to women age 51, on average. Although, generally, no tests are performed, simple blood tests can confirm the diagnosis if needed. Other terms to know: perimenopause describes the time directly before menopause, while postmenopause is the time after menopause is over.

For some women, this life transition can be tumultuous. Generally, symptoms are most dramatic in the year just before menopause, during perimenopause. Women should feel free to seek treatment for symptoms that interfere with their daily life.

Major Symptoms

Interestingly, if your mother suffered with menopause symptoms, then you’re likely to as well. If you haven’t already been through this phase, you may want to ask about her experience to help you predict if your symptoms are likely to continue for months or years.

About 80 percent of women experience the most striking symptoms of night sweats (waking up drenched in sweat) and hot flashes (a sudden burn you feel along with redness in the face, lasting from 30 seconds up to 10 minutes). Hot flashes most often happen during the day and can be quite disturbing and embarrassing. They can stop a woman in her tracks—literally interrupting her train of thought or her current activity.

Night sweats can disrupt sleep and affect a woman’s wellbeing, overall mood and energy. Interrupted sleep makes anyone more vulnerable to fatigue, depressed mood, and emotional vulnerability. Of the 80 percent of women experiencing hot flashes and night sweats, 20 percent experience them quite severely.

To complicate matters, other symptoms such as mood swings, unexplained crying, emotional disturbances and depression can also occur during menopause and be incapacitating. And still other symptoms that occur around this time of life—forgetfulness, osteoporosis, incontinency—may be related to age rather than menopause.

Causes and Treatments

What causes these symptoms? Fluctuations in estrogen—sudden rises and falls—play a central role. So how do we manage and hopefully master this?

One approach is through hormone therapy—using estrogen and progesterone. The decision to use hormones hinges on whether hot flashes and night sweats are disruptive enough to interfere with a woman’s ability to engage in her usual activities. Hormone therapy levels out the hormonal fluctuations and thus tempers menopausal symptoms, reducing hot flashes and night sweats and decreasing the potential for sleep disruption. The risks and benefits of hormone therapy are important to discuss with your physician or healthcare provider and should be reviewed each year.

Other medications—those prescribed for depression and anxiety—have also been successful for alleviating hot flashes and night sweats. One antidepressant, paroxetine, has recently been reformulated at a lower dose specifically to help combat hot flashes and night sweats. Low-dose oral contraceptives have also been used during perimenopause to mitigate unpleasant symptoms.

Natural or OTC?

Many women prefer a natural approach, using over-the-counter remedies to deal with menopause symptoms. Using natural supplements—black cohosh, chastberry, isoflavones—has been found to be beneficial. (But note that women who’ve been diagnosed with breast cancer should probably not use isoflavones because they have effects similar to estrogen, which can cause complications.) Some women find topical progesterone cream, available over-the-counter, to be useful to combat symptoms.

It’s important to keep in mind that every woman is unique and responds differently to these remedies. As with prescribed medications, talk with your physician or healthcare provider about the best strategy for you and revisit your decision periodically.

Women seeking non-medical approaches have other options. Research has found that regular aerobic physical activity, avoiding alcohol and doing deep breathing exercises all have a positive impact on both the emotional and physical changes of menopause. There’s evidence that exercise may also increase total sleep time and decrease the amount of time it takes to fall asleep—both helpful outcomes.

Some studies have shown that resistance training is very helpful in improving sleep as well as decreasing depression. Yoga and massage have also shown promise for overall wellbeing, but have not been found to reduce hot flashes and night sweats.

There’s currently a randomized controlled study in China to determine if acupuncture is effective, but results won’t be available until 2015. My opinion is that this time-honored therapy can’t hurt.

Another change in the menopause and postmenopause years that unfortunately escapes practically no one is weight gain and weight redistribution! Yuck! Patients complain about this change more than hot flashes and night sweats. The strategies mentioned previously—particularly regular aerobic physical activity along with a healthy diet—can counteract some of these unwanted changes.

I recommend you look at this phase of life as an opportunity. Embracing your ongoing development, engaging in fun and vigorous physical activity, and continuing to learn and grow will lead you to being happier and healthier.

Move gracefully forward. Always be the best you can be no matter what phase of life you are in. Carpe diem!

Dr. Hotmer is a Fellow of the American College of Obstetrics and Gynecology. She is a graduate of the Medical College of Pennsylvania, did her residency at the Hospital of the University of Pennsylvania, and is now partner at Chester County OB/GYN. Shes on staff at Chester County Hospital, a part of the Penn Health System. Contact her at ChesterCountyOBGYN.com.