Though all women will go through menopause, society is just starting to discuss this stage of life and the symptoms many women experience as part of their transition to it. Dr. Emily Griffin, an OB/GYN at Keystone Women’s Care, sheds light on the topic in today’s Take Care article.
Definitions
Biologically, menopause happens when the ovaries, the parts of the body responsible for making the hormones estrogen and progesterone, stop working. This means that women who have a uterus stop having periods. Menopause is defined as one year without periods due to this loss of ovarian activity. While a lab test can help support this diagnosis, hormone testing is not needed to diagnose menopause. In the US, the average age at menopause is 51.
For most women, menopause is not an overnight phenomenon but a gradual, months or years long transition. This transition is referred to as “perimenopause” or “the menopausal transition.” This occurs as the ovaries gradually decrease their hormone production over the course of several years.
Associated Symptoms
As estrogen production decreases, women experience changes throughout the body. Most people notice a change in their bleeding pattern before stopping their periods completely. Oftentimes more bothersome are the more general, body-wide symptoms associated with decreasing ovarian function. These include hot flashes and night sweats, skin changes throughout the body including within the vagina and a range of other symptoms that medicine (and society) are just starting to pay attention to including changes in metabolism, mood and sense of well-being.
Impact
For some women, these symptoms are mild or short-lived. For others, they last for 10 years or more and contribute to significant stress. The symptoms of menopause are also compounded, for many women, by life events common in the late 40s and 50s: the parenting of teenage and young adult kids, the aging of elderly parents, the height of career achievement. While menopause is a normal part of life, the symptoms that can be part of it can have significant negative impact on daily life.
For women who experience disruption in their lives from menopausal symptoms, there are a number of evidence-based interventions that can be helpful. The first step in accessing these tools is a conversation with your health care provider. Because menopause has been an overlooked part of life for so long, many providers may recommend a trained women’s health care professional for additional assistance.
Evidence-Based Management
Lifestyle interventions including smoking cessation, getting the recommended amount of exercise and eating a healthy diet are basic steps that can decrease the symptoms and medical consequences of menopause. That being said, for many women, these changes are very challenging or do not adequately address menopausal symptoms. In these cases, medicine can be warranted.
There are a number of well-studied medications that help with menopausal symptoms. Medical studies regarding the treatment of menopausal symptoms have traditionally focused on how well these medications treat hot flashes and night sweats. While these are not the only symptoms associated with menopause, they are, for many women, the most bothersome and easy to measure. Additionally, the medicines used to treat these symptoms can often impact the other, more generalized issues that some women face.
There are two broad categories of medication for the treatment of menopausal symptoms: hormone medicines and non-hormone medicines. Discussing your symptoms and medical history with your provider can help determine what the safest and most effective therapy is for you.
Nonhormonal medicines that have been shown to help with menopausal symptoms include some antidepressants, low doses of an antiseizure medicine (Gabapentin), and small doses of a medicine used to treat high blood pressure (Clonidine).
Hormone therapy with estrogen is the most effective therapy for management of hot flashes and night sweats. There are a variety of doses and ways of giving hormone therapy that can be tailored to a person’s symptoms and medical conditions. While these medicines can have risks, including serious conditions like cancer, these risks can be decreased significantly by proper dosing and careful consideration of a person’s health history by a trained medical provider.
Patient Awareness
Advertisement of complementary and herbal supplements for management of menopausal symptoms has grown significantly over the last decade. These interventions have not proven to be helpful in scientific studies at this time. Additionally, these supplements and a range of other products that can be prescribed for management of menopausal symptoms are not regulated by the Food and Drug Administration. This means that they are lacking in oversight regarding their effectiveness and safety.
Discussing the menopausal transition with your healthcare provider should be a routine part of medical care for women in their 40s and 50s. Should menopausal symptoms impact your life, as they do for a large proportion of people, know that there are women’s health care providers in our community who are well-versed in helping navigate this transition.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.
