Treatments that can help you manage the symptoms of menopause

During perimenopause (the period of time that leads up to menopause) and menopause (when a woman has not had a menstrual period for more than a year), the ovaries try to maintain normal levels of the hormones progesterone and estrogen. This effort, however, actually causes fluctuations in hormone levels. And those fluctuations are the cause of the wide range of symptoms women may experience during perimenopause and menopause.

Each woman experiences menopause differently. Some experience more symptoms or their symptoms are more severe, while others experience few symptoms or very mild symptoms. The symptoms, which can occur starting in perimenopause, include:

• Irregular periods
• Vaginal dryness and an increased risk of vaginal infections
• Hot flashes
• Chills
• Night sweats
• Changes in mood
• Increased risk of anxiety and depression
• Slower metabolism and weight gain
• Change in distribution of body fat, with more fat distributed in the abdominal area
• Thinning hair
• Dry skin
• Bone loss, which can increase the risk of osteoporosis
• Loss of fullness in the breasts
• Decreased libido
• Urinary incontinence
• Memory problems and/or trouble staying focused
• Trouble falling asleep and/or staying asleep
• Increased risk of heart disease

How can I manage the symptoms of menopause?

Because menopause is a natural biological process, treatment focuses on managing and relieving symptoms rather than stopping the cause of the symptoms. Talk with your gynecologist about the symptoms that you’re experiencing and their severity and frequency to find out what treatments and lifestyle changes can help you manage your specific symptoms. Your doctor may recommend that you:

• Pinpoint and avoid hot flash triggers: Caffeine, spicy foods, alcohol, warm weather, and stress may trigger hot flashes. Hot flashes can also be managed by dressing in layers so that you can remove or add layers as your body temperature fluctuates.
• Eat a healthy diet and get regular exercise: These healthy behaviors not only help you manage your weight, they can also help you sleep better, prevent bone loss through weight-bearing exercise, help manage stress, anxiety, and depression, and lower your heart disease risk.
• Don’t smoke: In addition to the other health problems that smoking can cause, studies have found that it can also cause earlier menopause and increase the incidence of hot flashes.
• Use water-based vaginal lubricants: These over-the-counter products can make sexual intercourse more comfortable and protect the tissues of the vagina from the tears that can increase the risk of infection.
• Strengthen the pelvic floor: Exercises that strengthen the pelvic floor, known as Kegel exercises, can decrease the symptoms of some types of incontinence.
• Use hormone therapy: If your hot flashes are severe, your doctor may prescribe estrogen and progestin therapy. This therapy is prescribed in the lowest dose and for the shortest time to relieve your symptoms. Long-term use of hormone replacement therapy has been associated with breast cancer and cardiovascular disease risks in some studies, so discuss the risks and benefits with your doctor.
• Use non-hormonal medications for hot flashes: Your doctor may recommend low doses of anti-depressants called selective serotonin reuptake inhibitors (SSRIs), the epilepsy medication gabapentin, and the high blood pressure medication clonidine to manage hot flashes.
• Use vaginal estrogen: This treatment is available as a low-dose cream, tablet, or ring that’s placed in the vagina to decrease dryness and improve the symptoms of some types of incontinence.

There are also a number of alternative medicine treatments available for menopause symptoms, such as black cohosh, plant estrogens, and bioidentical hormones derived from plants. To date, there’s no strong scientific evidence that supports these treatments, and they also carry some risks, including liver damage. In addition, if you’ve had breast cancer, the estrogen-like effects of some of these treatments may make them inappropriate for you.