For a woman, menopause is inevitable. In many cases, it can also be unpredictable.
“Because menopause is genetically driven, the strongest predictor of the age of menopause onset is when a woman’s own mother entered it,” says Gay Walker, MD, an internal medicine physician at Scripps Coastal Medical Center with a special interest in women’s health issues. “But your mother’s menopause symptoms are not a strong indicator of how easy or difficult your own menopause experience may be. While those symptoms may be uncomfortable, they are manageable.”
The earliest symptoms of natural menopause, called perimenopause, typically begin as much as 10 years before actual menopause, between the ages of 45 and 55, signaling the final stage of a woman’s lifelong hormonal cycle. Sudden menopause can also occur because of a surgical or medical procedure that removes the ovaries or disables normal hormonal functions.
As the ovaries stop producing progesterone and later, estrogen, women may experience a variety of physical effects, such as:
- Hot flashes
- Night sweats
- Mood swings or depression
- Vaginal dryness
Over the long term, low estrogen levels can lead to osteoporosis, or bone loss. It is important to make sure you are getting enough vitamin D and calcium to ensure bone health after 40.
“Fit women of a normal, healthy body weight typically have fewer problems with hot flashes and night sweats, so the first thing I do for menopausal patients is encourage women to work on themselves,” says Dr. Walker. “Too many women put themselves last in their 20s and 30s because of family and career obligations. In their 40s, when kids are leaving the nest, it’s a great time for them to take care of their bodies, get back to a healthy weight and start exercising again.”
If menopause symptoms interfere with your usual activities or are worrisome, your gynecologist or primary care physician can help. There are a number of menopause treatment options, both hormonal and non-hormonal. Since every woman has a different health history and lifestyle, the most effective treatment plans for menopause really depend on individual needs. Options may include:
Some prescription medications, such as anti-depressants, have demonstrated benefits in reducing hot flashes and night sweats. “Other medications prescribed off-label, including an anti-seizure medication and a blood pressure control medication, may offer relief and are included in guidelines issued by the American College of Obstetrics and Gynecology,” says Dr. Walker. Talk to your doctor about non-hormonal alternatives for this purpose.
Estrogen and progesterone
Hormone replacement therapy (HRT) uses estrogen and progesterone (progestin) to raise hormone levels and help alleviate symptoms. HRT can protect against osteoporosis, have a positive effect on cholesterol levels and help with vaginal lubrication. However, it has risks. Studies indicate HRT may increase the risk of breast cancer, blood clots and heart attacks. Women are now urged to weigh the risks and benefits of hormone therapy with their doctor.
While some physicians may recommend testosterone therapy to treat lowered libido, Dr. Walker says there are other, non-medical ways to address these concerns during menopause and beyond. “You need to find ways to re-kindle romance,” she says. “In the bedroom, men are microwaves and women are crock-pots — women take longer to get in the mood.” In Dr. Walker’s practice, she recommends a couple of books to her patients that consist of 101 sealed romantic scenarios that couples can decide to unseal together when they are in the mood for a special romantic night. “They often come back and tell me they love it — and they tell me it works,” she says. “No hormones required.”
Despite a lack of evidence, many women turn to herbs and natural supplements to relieve the symptoms of menopause. Black cohosh is among the products. It has been studied extensively for the relief of hot flash symptoms. Evidence, while inconsistent, has been characterized as encouraging. Like many pharmaceutical treatments, the herb’s mechanism is not understood, but some women taking black cohosh supplements report a reduction in hot flashes.
Some food products, like soy and flax seeds, are also commonly used alternative treatments. These products are high in phytoestrogens — which are weak plant-derived estrogens that are structurally similar to estrogen hormones produced by the body. While these foods and extracts have been studied as treatments for menopausal symptoms, the data thus far neither supports the safety or efficacy of these products.
Dr. Walker does not personally recommend herbal supplements to her patients. “Just because something comes from a plant doesn’t mean it’s necessarily safe or effective,” she says. “Nicotine, after all, comes from a plant — tobacco.”
Ultimately, she says, seeking treatment is important if symptoms disrupt your lifestyle and ability to sleep, especially since sleep deprivation carries with it significant health risks of its own.