In my recent post, “What is Menopause,” I talked about the symptoms that women may experience in the months and years preceding and following the cessation of periods. Fluctuation in energy levels, agitation, hot flashes, night sweats, difficulty concentrating and headaches are all possible as a result of changing hormone levels. These symptoms can be mildly irritating or more pronounced with a bigger impact on a woman’s quality of life. Following menopause, other noticeable symptoms can include changes in sleep patterns, weight gain, joint aches, vaginal dryness, change in libido, hair loss, loss of bone density, fine wrinkles and involuntary loss of urine.

These are the symptoms that frequently cause women to seek help. Here I’ve answered some of the most common questions related to treating the symptoms of menopause.

Are there effective treatments for menopause?

For many women, treatment is not necessary. Adjustments in lifestyle may be adequate. Consistent exercise and weight management promote energy and a sense of wellbeing. Exercise and weight loss have also been associated with reduction in hot flashes and night sweats. Smoking, alcohol, and caffeine have been recognized by some women as triggers for hot flashes.

Phytoestrogens are non-steroidal compounds that occur naturally in many plants, fruits and vegetables. Common examples are flaxseed, red clover and isoflavones from soy. Along with black cohosh, these supplements have become popular alternatives to hormone replacement therapy as a means to control hot flashes. Unfortunately, there are many products and formulations available without good scientific evidence to demonstrate effectiveness of any one product over another. Furthermore, caution is advised regarding use of these supplements in women with breast cancer because of possible estrogenic effect on breast tissue.

Non-hormonal therapies have been developed to target specific symptoms. Bisphosphonates have replaced of estrogen as the primary treatment for excessive bone loss (osteoporosis). Mood changes can be managed with antidepressants. Sleep disorders sometimes require medication, but are often manageable with mild, over-the-counter sleep aids derived from the antihistamines found in cold remedies.

What is the role of hormone therapy?

For some women, the effects of estrogen loss are very disruptive, especially in the early years, and hormone replacement is necessary when quality of life is significantly impacted. Hormone replacement therapy (HRT), primarily estrogen, initially became available to large numbers of women in the 1960s and was used to relieve hot flashes. Beneficial effects on long-term bone health were the primary reasons women continued with HRT as a means to prevent osteoporosis. In 2002, results from the Women’s Health Initiative were published that raised concerns about the long-term safety of hormone treatments in older women. Since then, HRT has evolved.

Today, HRT is used primarily during perimenopause when symptoms of estrogen loss tend to be the most acute. The interest in a more natural approach to hormone therapy has focused attention on bioidentical hormones — hormones that are identical in molecular structure to the hormones made by the ovaries. They’re not, however, found in this form in nature, but are made, or synthesized, from a plant chemical extracted from yams and soy. Bioidentical estrogens include 17 beta-estradiol, estrone and estriol. Technically, the body can’t distinguish bioidentical hormones from the ones produced by the ovaries.

There are many products available based on these bioidentical estrogens which are equally effective. The major differences are in the delivery systems—there are pills, lozenges, skin patches, creams and gels, as well as vaginal tablets, rings and creams. If a woman still has her uterus, progesterone is added to inhibit growth of the endometrial lining. Dosing is tailored for each woman to achieve relief of symptoms with the lowest possible dose. Hormone testing is generally not necessary before prescribing. While most women tolerate hormone replacement without serious consequences, underlying medical conditions and family history may raise concerns about long-term use. Therefore, extended use is reserved for women whose symptoms persist after the immediate postmenopausal years, with annual review between women and their health care providers about benefits and potential risks.

The Long Term Outlook

In terms of health, women have an advantage over men until menopause. Over the decade following menopause, aging of the cardiovascular system speeds up and by her 60s, a woman’s risk of cardiovascular disease is approximately the same as a man’s. Appropriate management of weight, blood pressure, diabetes and cholesterol are ever more important. Maintenance of bone health can be achieved with adequate vitamin D and calcium intake. Colon cancer screening is equally as important for women as men and begins generally around age 50. Mild symptoms of urinary incontinence can increase over time, but treatments may be available and consultation with a gynecologist is encouraged.

The postmenopausal years last for decades–possibly a third of a woman’s lifetime. Think of this as a new beginning. Focus on the positives, make time for fun and laughter, set new goals, and keep mentally and physically active. With attention to long-term health, women are able to live active, productive lives into their 70s, 80s and even 90s.

If you have started noticing changes and have questions about what perimenopause and menopause will bring, now is a great time to meet with one of our gynecologists, nurse practitioners or certified nurse midwives. Contact an officeto schedule an appointment >

This article first appeared in the national publication Women magazine. Check it out online at

Sources: Image – Gynaecologist Auckland