Introduction:
Menopause
-- when a woman stops menstruating and can no longer get pregnant -- is
a natural event, not a disease or illness. However, for some women the
physical and emotional symptoms can be difficult.
Menopause
involves hormonal changes in your body that may cause physical
symptoms: As the ovaries stop producing estrogen and progesterone, the
female sex hormones, estrogen levels decline over a period of years.
That decline can cause hot flashes, night sweats, and mood swings.
For
some women, menopause may bring on feelings of sadness. However, it's
important to remember that menopause doesn't mean an end to your
sexuality or that you are any less feminine. In fact, some women find
the years after menopause to be a time of freedom, when they no longer
have to think about having a period or becoming pregnant.
Today,
an estimated 50 million women in the United States have reached
menopause. Most women will spend at least one-third of their lives in or
beyond menopause.
Technically,
menopause is considered complete when a woman has not had a period for
an entire year. On average, menopause occurs at age 51, but it varies
from person to person. Because menopause is a process that happens over
several years, it is divided into two phases. Perimenopause, when you
begin having symptoms but are still having periods, can last 4 - 5
years. Postmenopause occurs once you have gone 12 months without a
period. Your ovaries have stopped releasing eggs and produce much less
estrogen.
Another type of
menopause, known as surgical menopause, happens if both ovaries are
removed for medical reasons. This may be done if you have a
hysterectomy, the removal of the uterus.
After
menopause, women lose the protective effects of estrogen and are at
increased risk for osteoporosis and heart disease. There are a variety
of treatments available, however, to help ease the symptoms and reduce
health risks associated with menopause.
Treatment:
Menopause
itself doesn't need treatment, but you may want to treat some symptoms
and reduce your risk of long term medical conditions, such as heart
disease and osteoporosis, that are more common after menopause. Many
treatment options are available, so it is important to discuss them with
your doctor.
In the past, a
number of women took hormone replacement therapy (HRT), which consists
of supplemental estrogen and progesterone. Those without a uterus (womb)
sometimes took estrogen replacement therapy (ERT), which consists of
estrogen alone. Only women who have had a hysterectomy usually take ERT,
because taking estrogen without progesterone increases the risk of
uterine cancer.
Taking HRT
seemed to help reduce symptoms such as hot flashes, and it was thought
that it also reduced a woman's risk of heart disease. But an important
2002 study, the Women's Health Initiative, found that HRT and ERT posed
more risks than benefits. That study showed that women who took HRT for
several years had an increased risk of breast cancer, heart disease,
stroke, and blood clots. Women who took ERT long term, for more than 7
years, had a greater risk of stroke.
While
the Women's Health Initiative didn't find a greater risk of breast
cancer among women who took ERT for 7 years, other studies have found a
slightly increased risk at 10 years. Right now the evidence shows that
taking estrogen long-term slightly increases the risk for breast cancer,
and taking it with progesterone increases the risk more.
Researchers
have begun new studies to look at HRT, but the results aren't known
yet. The Women's Health Initiative looked at women who were already past
menopause -- the average age was 63. So researchers don't know if the
same results would apply to women who took HRT early in menopause, and
for a shorter period of time. Currently, the decision about whether to
take HRT is an individual one. If your menopause symptoms are so severe
that they interfere with your daily life, talk to your doctor about the
risks and benefits of using HRT for a short period of time.
In
addition, there are non-hormonal medications and non-drug therapies
that can help reduce your symptoms and lower your risk for long term
medical problems that sometimes occur after menopause.
Lifestyle
Exercise
The benefits of exercise include:
Diet
Eating
a healthy, well balanced diet can help you reduce the risks and
discomforts associated with menopause. A diet low in saturated fat and
cholesterol, for example, may reduce your risk of heart disease by
providing the following benefits:
Some
evidence suggests that eating soy-based foods such as tofu might help
reduce certain symptoms of menopause, including hot flashes. Adding
plenty of calcium and vitamin D to your diet should help you avoid bone
loss. Foods rich in calcium include dairy products, leafy green
vegetables, almonds, and dried beans. High-fiber foods may also help
lower your risk of high cholesterol and heart disease.
Medications
Several medications are available to treat the symptoms of menopause and to help you maintain your health as you grow older.
Hormone replacement therapy (HRT) -- Your doctor may suggest using supplemental
estrogen to provide relief from your symptoms depending on a number of
factors, including your medical and family history, risk for hormone
related cancers such as breast cancer, age, and the severity of your
symptoms. You and your doctor will carefully weigh the risks and
benefits of HRT and prescribe the lowest dose of estrogen for your
symptoms.
Low dose
antidepressants -- Venlafaxine (Effexor), an antidepressant that is
related to the class of drugs known as selective serotonin uptake
reinhibitors (SSRIs), can help reduce hot flashes. Other SSRIs, such as
fluoxetine (Prozac), sertraline (Zoloft), may also help.
Gabapentin (Neurontin) -- This drug, which is approved to treat seizures, also helps reduce hot flashes.
Bisphosphonates
-- These drugs are used to prevent and treat osteoporosis. They reduce
bone loss and the risk of fractures. They include:
Selective
estrogen receptor modulators (SERMs) -- This type of drug has a
positive effect on bone health, much like estrogen but without
estrogen's side effects. Currently one drug, raloxifene (Evista), is
approved for use. It can cause hot flashes, and should not be taken by
anyone with a history of blood clots.
Vaginal estrogen -- Estrogen tablets, rings, or creams can be applied locally to relieve vaginal dryness.
Nutrition and Dietary Supplements
Some
symptoms of menopause, especially hot flashes, show improvement when
women take placebo, making it harder to tell if a treatment is working.
Some researchers think other nutrients in soy are responsible for
reducing symptoms.
Researchers
also aren't sure whether isoflavone supplements would increase risk of
breast cancer after menopause, just as supplemental estrogen does. More
studies are needed. In the meantime, it may be better to include soy
foods in your diet instead of taking supplements. Talk to your doctor to
see which is best for you. Tofu, soy nuts, tempeh, and soy milk are
good sources of soy.
As
with soy, researchers aren't sure whether flaxseed supplements would
also increase risk of breast cancer after menopause, just as
supplemental estrogen does. More studies are needed. In the meantime, it
may be better to include flaxseed in your diet instead of taking
supplements. Talk to your doctor to see which is best for you. Flaxseed
also contains alpha-linolenic acid, which the body converts into omega-3
fatty acids. These fatty acids are good for heart health.
It
can be hard to get enough calcium through your diet, so you may need to
take a supplement. It is important to read the label to see how much
elemental calcium a supplement contains (that's how much calcium your
body can actually use). There are several kinds of calcium supplements.
Calcium citrate seems to be more easily absorbed by the body, but it has
less elemental calcium than calcium carbonate. Calcium carbonate,
however, needs an acid environment to be absorbed, so is best taken with
a glass of orange juice.
No
matter which form of calcium you take, it's better to divide your doses
throughout the day so that you are not taking more than 500 mg at a
time. You may have to take more than one dose as a result. Remember that
you may also get some calcium through your diet, and count that into
your total for the day.
Herbs
The
use of herbs is a time honored approach to strengthening the body and
treating disease. Herbs, however, can trigger side effects and can
interact with other herbs, supplements, or medications. For these
reasons, you should take herbs with care, under the supervision of a
health care practitioner. Treatments used to relieve menopause symptoms
vary in their effectiveness from woman to woman. As with prescription
medication taken to relieve menopause symptoms, some women may find
relief with complementary therapies while others may not.
The
following herbs are also sometimes suggested to relieve symptoms such
as hot flashes, vaginal dryness, and mood swings, although evidence is
mixed or lacking. Like soy, they may contain plant based estrogens
(phytoestrogens) that could act like estrogen in the body and possibly
raise the risk of breast cancer. Talk to your doctor before taking these
herbs:
In the past, wild yam (Dioscorea villosa)
has sometimes been mentioned as a treatment for menopausal symptoms,
because hormones including progesterone were manufactured from wild yam
in the 1960s. However, studies show that the body is not able to convert
wild yam into progesterone, so it is not likely to help relieve any
symptoms of menopause.
Acupuncture
Several studies show acupuncture may help many women with symptoms of menopause, particularly with hot flashes and mood changes.
Homeopathy
Although
few studies have examined the effectiveness of specific homeopathic
therapies, professional homeopaths may consider the following remedies
for the treatment of menopause based on their knowledge and experience.
Before prescribing a remedy, homeopaths take into account a person's
constitutional type. A constitutional type is defined as a person's
physical, emotional, and psychological makeup. An experienced homeopath
assesses all of these factors when determining the most appropriate
treatment for each individual.
