Menopause

Alternative Names

Perimenopause; Postmenopause

Treatment

Menopause is a natural process. Treatment with hormones may be helpful if you experience debilitating symptoms such as hot flashes, night sweats, or vaginal dryness.

Discuss the decision to take hormones thoroughly with your doctor, weighing your risks against any possible benefits. Pay careful attention to the many options currently available to you that do not involve taking hormones.

If you have a uterus and decide to take estrogen, you must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If you do not have a uterus, progesterone is not necessary.

HORMONE REPLACEMENT THERAPY

For years, hormone replacement therapy (HRT) was the main treatment for menopause symptoms. Many physicians believed that HRT was not only good for reducing menopausal symptoms, but also reduced the risk of heart disease and bone fractures from osteoporosis. However, the results of a major study called the Women's Health Initiative has led physicians to change their recommendations.

In fact, this important study was stopped early because the health risks outweighed the benefits. Women taking the hormones did see some benefits. But they had a greatly increased risk for breast cancer, heart attacks, strokes, and blood clots.

If your symptoms are severe, you may still want to consider HRT for short-term use (2-4 years) to reduce vaginal dryness, hot flashes, and other symptoms.

To reduce the risks of estrogen replacement therapy and still gain the benefits of the treatment, your doctor may recommend:

• Using estrogen/progesterone regimens that do not contain the form of progesterone used in the study.
• Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill).
• Having frequent and regular pelvic exams and Pap smears to detect problems as early as possible.
• Having frequent and regular physical exams, including breast exams and mammograms.

ALTERNATIVES TO HRT

The good news is that you can take many steps to reduce your symptoms without taking hormones:

• Avoid caffeine, alcohol, and spicy foods
• Dress lightly and in layers
• Eat soy foods
• Perform Kegel exercises daily to strengthen the muscles of your vagina and pelvis
• Practice slow, deep breathing whenever a hot flash starts to come on (try taking six breaths per minute)
• Remain sexually active to preserve the elasticity of your vagina
• See an acupuncturist
• Use relaxation techniques like yoga, tai chi, or meditation
• Use water-based lubricants during sexual intercourse

There are also some medications available to help with mood swings, hot flashes, and other symptoms. These include low doses of antidepressants such as paroxetine (Paxil), venlafaxine (Effexor), bupropion (Wellbutrin), and fluoxetine (Prozac), or clonidine, which is normally used to control high blood pressure.

Possible Complications

Estrogen is responsible for the buildup of the lining of the uterine cavity. During the reproductive years, this buildup is shed (menstruation). This usually happens about once a month.

The menopausal decrease in estrogen prevents this buildup from occurring. However, hormones produced by the adrenal glands are converted to estrogen, and sometimes this will cause postmenopausal bleeding.

This bleeding is often nothing to worry about, but because it may also be an early indication of other problems, including cancer, your physician should always check any postmenopausal bleeding.

Decreased estrogen levels are also associated with an increased risk of developing osteoporosis and possibly an increased risk of cardiovascular disease.

When to Contact a Medical Professional

Call your health care provider if:

• You are spotting blood between periods
• You have had 12 consecutive months with no period and suddenly vaginal bleeding begins again

References

Weismiller D. The Perimenopause and Menopause Experience: An Overview. Clin Fam Practice. 2002; 4(1).

Stenchever, MA. Comprehensive Gynecology, 4th ed. St. Louis, Mo:Mosby, Inc.; 2001:1217-1250.

U.S. Preventive Services Task Force. Hormone therapy for the prevention of chronic conditions in postmenopausal women: recommendations from the U.S. Preventive Services Task Force. Ann Intern Med. 2005; 142:855-860.

North American Menopause Society. Estrogen and progestogen use in peri- and postmenopausal women: March 2007 position statement of The North American Menopause Society. Menopause. 2007;14:168-182.