The menopausal transition is a gradual process that starts with irregular menstrual cycles and ends with your final period. Menopause, the absence of menstrual periods for 12 months, occurs at age 51 on average, but it may happen as early as the 30s or as late as the 60s. At this point, your ovaries quit functioning, and you can no longer become pregnant. Up to three-fourths of American women experience bothersome side effects when their bodies stop producing estrogen because of natural or medically induced menopause.
Symptom types, severity, and longevity vary widely per woman from the early peri-menopausal days well into the post-menopausal stage. You may experience hot flashes, night sweats, vaginal changes (dryness, itching, irritation, painful sex, and/or increased vaginal infections), and urinary differences (frequency, urgency, incontinence, and more urinary tract infections). Insomnia, fatigue, memory problems, irritability, rapid mood fluctuations, weight gain, skin changes, and facial hair growth also may occur.
Luckily, medications can help relieve life-disruptive symptoms. The American College of Obstetricians and Gynecologists just revised its menopause treatment guidelines to provide the safest, most effective relief. These recommendations overlap the North American Menopause Society’s recent position statements.
Learn Details from Extensive Multi-Study Analysis
After examining scores of studies and claims, Dr. Clarisa R. Gracia, an associate professor of obstetrics and gynecology at the University of Pennsylvania, prepared the “Management of Menopausal Symptoms” bulletin for doctors. It offers treatment recommendations based on the best available evidence for preserving the health and well-being of women experiencing menopausal symptoms.
This updated document addresses hot flashes and vaginal dryness/atrophy, the most common distressing consequences. Hot flashes can cause drenching, sometimes embarrassing sweating and even disrupt sleep. The loss of vaginal lubrication and elasticity can make sex painful and depress libido. Irritation and bleeding may occur during exercise. Hot flashes can last for months or even decades, but untreated vaginal problems can persist for the rest of your life.
Curb Hot Flashes with Hormone Replacement Therapy
Most women manage their vasomotor symptoms (VMS) best when their physicians offer remedies that well-designed studies have found to be efficacious. Estrogen alone or in combination with a natural or synthetic progesterone (progestin) if you still have your uterus remains the most effective hot flash therapy. It also helps prevent osteoporosis, which causes weak and brittle bones that can break easily.
You may administer hormone replacement therapy (HRT) orally or through the skin with a patch, gel or spray. The guidelines recommend a preference for the transdermal route such as the Estraderm Patch (Estradiol). If you still have your uterus, an alternative to estrogen-progestin HRT combines conjugated equine estrogen with a selective estrogen receptor modulator (SERM).
ACOG’s report emphasizes that doctors should individualize treatment and prescribe the lowest effective dose for the shortest time necessary to relieve hot flashes. But because some women may need hormone therapy to control this ongoing symptom even in their Medicare years, the guidelines recommend not discontinuing systemic estrogen routinely at age 65.
Consider Approved Non-Hormonal Alternatives
While the hormone therapy recommendations are similar to prior guidelines, more evidence supports non-hormonal alternatives including low doses of antidepressants as helpful for hot flashes and insomnia. These include selective serotonin reuptake inhibitors (SSRIs) such as Paxil (Paroxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like Pristiq (Desvenlafaxine). Studies have found that Clonidine, a blood pressure medication, and Neurontin (Gabapentin), an anticonvulsant, provide relief.
The report also recommends common-sense lifestyle solutions like dressing in layers, lowering room temperatures, and drinking cool beverages while avoiding caffeine and alcohol. For overweight and obese women, weight loss also can help.
Avoid Ineffective Herbal Options
Gracia also analyzed studies on various natural remedies. All had their advocates, but they lacked rigorous scientific evidence for effectiveness. Research promoting the estrogenic effects of soy-based foods and supplements cited the low reported rates of menopausal symptoms among Asian women, whose diets are especially rich in soy. An authoritative review of placebo-controlled, plant-based estrogen studies, however, found no convincing proof that they reduce hot flashes.
She concluded that too little evidence supports the hot flash relief benefits of compounded bioidentical hormones, complementary botanicals, phytoestrogens (like isoflavones, soy-based foods, and red clover), herbal remedies (including black cohosh, ginseng, St. John’s wort, and gingko biloba), vitamins, acupuncture, and exercise. One exception was genistein, a substance in soy that researchers advised warranted further investigation.
Relieve Vaginal Dryness with HRT
As with hot flashes, vulvovaginal atrophy (VVA) symptoms respond best to estrogen therapy, which you can obtain through your mouth, skin, or vagina via a cream, tablet or ring. The report noted that even a low-dose vaginal tablet containing 10 micrograms of estradiol can reduce vaginal dryness symptoms.
You must administer this type of vaginal treatment daily for a week or two at first and then once or twice a week indefinitely as maintenance therapy. An oral selective estrogen receptor modulator is effective for dyspareunia, difficult or painful sexual intercourse, relief because of reduced vaginal moisture.
Try Over-the-Counter Remedies
Many women experience symptom relief with water- or silicone-based lubricants and moisturizers. Applying a lubricant just before sexual intercourse can reduce the friction and pain that dryness cause. Using a vaginal moisturizer routinely can relieve dryness, itching, irritation, and pain while improving elasticity.
Consult Your Doctor
Discuss your symptoms with your gynecologist or primary care physician to determine the best treatment for your unique situation.