Approaches to Menopause: What's Right for You?

Managing menopause symptoms and finding appropriate therapies

A woman smiles in an outdoor setting while reflecting on her menopause treatment options.

by K.B. Lim, MD, Catharine Marshall, MD, and Linda Lee Lim, L.Ac.

For most women, menopause is a very natural and normal part of life. It is simply the next step in a long series of hormonal transitions that begin in adolescence with the onset of menstruation. Menopause, which generally occurs between the ages of 45 and 55, signals the end of menstruation and the final stage of the hormonal cycle.

So why all the hype? There are a few reasons. For many women, menopause may bring with it a variety of rather unpleasant side effects, such as sudden hot flashes, night sweats, insomnia and vaginal dryness. Some women experience psychological and emotional symptoms, including mood swings, depression and forgetfulness. Over the long term, low levels of estrogen can lead to osteoporosis, or bone loss.

Symptoms usually start during perimenopause, which begins about two to five years before a woman has her final menstrual period. If menopause occurs as the result of a surgical or medical procedure that disrupts normal hormonal functions, symptoms may begin immediately.

Is treatment required?

Some women seem to breeze through menopause without really experiencing any side effects, while others have symptoms so severe that medical treatment is required. Most fall somewhere in the middle. If your symptoms don’t bother you, simply let nature run its course and discuss any concerns with your doctor.

However, if your symptoms interfere with your usual activities or are worrisome, help is available. From the newest hormonal replacement therapies to ancient treatments like acupuncture and herbal remedies, there are a number of options out there. No single choice is the best. Every woman is different, and the most effective treatment plans are tailored to individual needs. With the help of your doctor, you can find the approach that is right for you.

Hormone replacement therapy

Hormone replacement therapy uses synthetic forms of estrogen and progestin to raise hormone levels and help alleviate symptoms. In addition, it slows or stops bone loss, maintains vaginal lubrication and has a positive effect on cholesterol levels. Testosterone therapy can help restore libido and a sense of well-being.

Hormonal therapy may be taken either as a pill or a transdermal (through the skin) patch or cream. How much you need will be determined by your symptoms and your body’s response to treatment.

Another type of hormonal therapy, using “bioidentical” hormones, is making headlines with claims that it is made purely from plants and more closely matches the hormones our bodies produce naturally. However, no matter how “natural” a hormone replacement product claims to be, it still requires laboratory processing to make it usable by our bodies.

To date, there is no evidence that natural or bioidentical hormones are safer or more effective than traditional hormone replacement therapy.

There is some controversy over whether long-term hormone replacement therapy may increase the risk of breast cancer. While the jury is still out, the latest research from the Women’s Health Initiative study has found no increased risk for breast cancer in women using estrogen therapy alone. If you are concerned about risks, be sure to discuss them with your doctor.

What about soy?

Soy foods, powders and supplements have been in the news for the past several years as potential treatments for menopausal symptoms. Soy is one of a handful of natural products high in phytoestrogens, naturally occurring plant compounds that resemble a form of estrogen. Other products high in phytoestrogens include black cohosh, flax seed and legumes. While they may help alleviate symptoms associated with estrogen deficiency, research has yet to prove phytoestrogens effective in treating or preventing osteoporosis.

Complementary approaches, individualized solutions

There are also integrative and complementary options such as Traditional Chinese Medicine (TCM), which has an ancient Chinese lineage spanning more than five thousand years. TCM aims to restore or maintain the harmonious balance of “yin” and “yang”, “qi” (pronounced “chee”) and blood throughout the body’s interconnected network of energy channels and internal organs.

TCM physical therapies, such as acupuncture, acupressure, or reflexology, as well as nutritional remedies such as healing foods or classical Chinese herbal blends, are customized for each patient to treat the root causes of channel or organ dysfunctions. The goal is to restore the body’s own self-healing abilities for the relief of symptoms resulting from such dysfunctions and, more importantly, for the maintenance of optimal health.

The bottom line? There is no one “best” solution for the symptoms associated with menopause. Treatments are as individual as you are, and the “best” approach is the one that keeps you feeling good.

This Scripps Health and Wellness tip was provided by K.B. Lim, MD, Catharine Marshall, MD, and Linda Lee Lim, L.Ac., at Scripps Memorial Hospital La Jolla.