At a time in their lives when most women are finally starting to feel like they have things under control, along come the first signs of menopause to throw everything out of whack. Hot flashes, mood swings and a host of other physiological and psychological conditions can appear several years before the onset of menopause, giving women little reason to look forward to the next phase of their lives.
Thankfully, there are ways to alleviate some of the symptoms, and get those raging hormones under control.
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Lufkin Obstetrician/Gynecologist, Dr. Cheryl Suiter
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Charm was on hand when Lufkin Obstetrician/Gynecologist, Dr. Cheryl Suiter, spoke about the subject at a recent Women's Power Lunch, presented by Memorial Health System of East Texas.
What is menopause?
"Menopause is the cessation of periods from loss of ovarian function," explains Suiter. "The average age of menopause is 51, but it can occur earlier in cigarette smokers, women who have had hysterectomies and women who haven't had children."
Because there is no test for menopause, it is usually diagnosed through its symptoms, the most common being menstrual irregularity. "Ninety percent of women will have this happen in the last four years prior to menopause," Suiter says. "Unfortunately, this is where a lot of them will decide to have hysterectomies."
Perimenopause — the phase that begins the transition to menopause — usually occurs in the mid- to late-forties and can last for several years. Because ovulation is sporadic during this phase, unexpected pregnancies can happen. "Little miracles happen occasionally during this time, because every now and then you will ovulate," Suiter says, mentioning a 51-year-old woman she knew of, who became pregnant this way.
Why are we raging?
During perimenopause, hormone levels fluctuate, which can lead to depression and mood swings, along with other common complaints of menopause.
"We're raging because there is a decrease in our estrogen level due to the depletion of the eggs in the ovaries," Suiter explains. "We see about 20 percent of women in menopause with depression, although it may not be solely because of the lower estrogen level."
Suiter points to other contributing factors that can cause depression during this time in a woman's life, such as children who move away (or move back home again), an ill spouse or aging or ill parents.
Other symptoms include anxiety, night sweats, hot flashes, forgetfulness, irritability, weight gain and insomnia. While some women might experience few or no symptoms, most will show some signs. "Everybody is affected differently, "Suiter says. "Some people sail through menopause without any complaints, but others may have a lot more trouble, and it can be very serious, sometimes."
What's not raging?
Most likely, our sex drive, says Suiter. "A decrease in testosterone and estrogen causes this; it's a natural occurrence," she says "There is no FDA-approved treatment for that, although some people will use testosterone, regardless of FDA approval. But, you have to be careful because of the side effects. We don't use it a whole lot, but we do use it."
Sometimes the discomfort of vaginal dryness, caused by thinning vaginal tissue, can be the reason for infrequent sex. "There are treatments for this," Suiter says. "Estrogen cream works best, but there are other methods that work, including the Femring, tablets, and over-the-counter lubricants."
The good news is there are ways to ease some of the complaints of menopause.
\• Nutrition — "Some people increase their intake of soy to control hot flashes," Suiter says.
\• Exercise — "This can help by improving general well-being," Suiter says.
\• Herbal supplements — "We don't recommend taking these for more than six months," Suiter says, "because we don't know the longterm effects from them."
\• Black cohosh — "This has up to an 80 percent reduction in hot flashes," Suiter says. "It's Estradol-like, so you may still have potential breast cancer risks... More studies should be coming out soon. Also, if you're severly anemic, you want to avoid it."
\• Red clover — "Forty milligrams a day results in a significant reduction in hot flashes, but you have to be really careful if you're taking anticoagulants because it causes blood thinning," Suiter says.
\• Soy — "You see about a 15 to 20 percent reduction in hot flashes over the placebo," says Suiter. "The effective dose is quite a bit — 40 grams a day. You want to avoid it with thyroid hormones."
\• Ginseng
\• Vitamin E — "This helps a little with hot flashes, but you need to use about 400 iu a day," Suiter says. "You don't want to use more than that or you have an increased risk for heart attack."
\• Calcium — "You lose the most amount of bone density in the first three years of menopause," Suiter explains. "The effective dose is 1200-1500 milligrams a day, whatever you can tolerate."
\• Vitamin D
\• Baby Aspirin — "Take one a day, particularly if you have a family history of heart disease," Suiter advises. "This can lessen the risk of heart attack by 30 percent."
\• Thyroid panel (TSH)— Recommended every five years, depending on health
\• Colonoscopy — Recommended every ten years after the age of 50
Hormone replacement therapy
Another option to ease menopausal symptoms is hormone replacement therapy (HRT).
"There are many factors that influence if hormone therapy is appropriate for you or not," Suiter says. "You have to individualize hormone therapy based on medical history and whether you still have a uterus... and if you do start hormone therapy, we try to taper it over five years time where you're not on it anymore after that."
Benefits of HRT include improvement of hot flashes, insomnia, night sweats, vaginal dryness and depression symptoms. "It's not a treatment for depression, but it's amazing how much better people feel once they get on them," Suiter says.
HRT also decreases the risk of colon cancer, hip fractures and helps with urinary problems and maintaining skin integrity. And, total mortality from all causes is reduced by 30 percent in women who start hormone therapy under the age of 60, Suiter says.
One drawback of hormone therapy is an increased risk of breast cancer for some women. "If you have a uterus, you have to use estrogen plus progesterone, and in this group there is an eight in 10,000 increased risk of breast cancer," Suiter explains.
Other risk factors, particularly among women who have been in menopause for years before starting HRT, include increased risk of heart attacks, strokes and blood clots, Suiter says.
According to the National Association of Menopause Society, the optimal time to start HRT to benefit menopausal women is when menopause begins, sometime before age 60, Suiter says. "If you do it then, the risk versus benefits ratio is favorable," she says.
Hormone therapy is available in different forms, including transdermal patches, pills and compounded preparations.
Women should discuss the risks and benefits of HRT with their doctor, based on their personal medical history, to find what treatment is best.
