Menopause? No Sweat!
Today a number of treatment options offer women relief from change-of-life symptoms.
If you’re a woman, menopause is as inevitable as puberty once was, and as natural as an inherent love of chocolate. Yet despite the fact that every female will eventually go through it, this transition is not typically greeted with good-natured equanimity. Perhaps that’s not surprising. After all, menopause marks the permanent end of fertility.
“Menopause literally means the final menstrual period,” says Cynthia Stuenkel, M.D., past president of the North American Menopause Society (NAMS ). “The menopause transition results in lower levels of estrogen and other hormones, and it’s caused by reduced functioning of the ovaries due to aging.” In today’s youthcentered society, that may be a bitter pill to swallow. The good news? Modern treatment options, both natural and hormone-based, can help ease women through this phase with comfort and grace. '
“On average, a woman in the United States goes through menopause at age 51,” says women’s health expert Cindy Parnes, M.D., a gynecologist and founder of New Jersey Women’s Wellness Center in Montvale. However, symptoms brought on by ever-shifting hormones often begin two to eight years earlier.
This period in which they occur, called perimenopause, literally means “around menopause.” It ends once a woman has missed her period for 12 full months, at which point she is officially postmenopausal. A common saying that counsels women to “Ask your mother if you want to know when the big change will start” does reflect a truth: Hereditary factors come into play, though cigarette smoking and chemotherapy have been shown to lower the age of menopause.
To further complicate matters, there is no definitive procedure one can undergo to conclude unequivocally that this phase has begun. “Hormone levels shift daily, so drawing blood to test for estrogen is impractical,” explains Dr. Parnes. “Still, if you’re a middle-aged female experiencing certain symptoms, you can make a fairly common-sense determination.”
Symptoms of the change
The most obvious physical symptom is cycle irregularity. “Whereas normally you may have had your period every 28 days like clockwork, in perimenopause you may get it every 14 days or skip months altogether,” says Dr. Parnes. Irregularity can continue until menstrual periods stop completely. Some women suffer from insomnia, headaches, mild depression and memory loss. Weight gain, night sweats, decreased libido and vaginal dryness can also occur or develop.
Of course, the most common complaint is hot flashes. Though doctors think this unpleasant flushed-face, body-sweating condition results from alterations in the hypothalamus, the region of the brain that regulates body temperature, that theory remains unproven. “It’s amazing,” says Dr. Stuenkel with a smile. “We’ve sent men to the moon and mapped the human genome, yet we still don’t fully understand a woman’s menopausal hot flash!”
Every menopause experience is different, and each woman will deal with changes in her own way. “Many don’t want to do the medication dance, so I start by suggesting simple lifestyle modifications,” says Dr. Stuenkel. Avoid alcohol, spicy foods and hot liquids that might make you overheat. Dress in removable layers that can be peeled off easily, and wear lightweight pajamas to bed. A Wayne State University School of Medicine study found that paced respiration— expanding and contracting the abdomen through slow, deep breaths— can cut in half the frequency of irksome hot flashes. Exercise to reduce stress, or take the herbal supplement St. John’s wort for mild depression, says NAM S. “Some women also find that acupuncture and yoga can relieve hot flashes, headaches and overall body aches,” says Dr. Parnes.
For those whose symptoms aren’t relieved by these lifestyle changes, there are several available forms of hormone treatments:
Estrogen Therapy (ET)
Approved by the Food and Drug Administration and used for more than 50 years by millions of women, this is the most effective treatment for hot flashes and vaginal discomfort. “Estrogen also helps maintain bone mineral density, which is important for preventing osteoporosis in older women,” says Dr. Stuenkel. It can be administered orally in tablet form, through the skin via a patch or gel or as a vaginal ring. However, taking estrogen alone for five or more years can triple one’s chance of developing uterine cancer, according to NAM S. This is why progesterone, another hormone, is often added to the equation.
Estrogen-Progesterone Therapy (EPT)
“Progesterone protects the lining of the uterus from the cancer-promoting effects of estrogen, so if you have a uterus we recommend this second hormone,” says Dr. Stuenkel. (Women who’ve undergone hysterectomy can just take estrogen alone.) EPT hormones are usually administered orally or by patch, as the FDA has not yet approved progesterone skin creams for menopausal use. Benefits for hot-flash relief and vaginal dryness are identical to those provided through ET, but there is an additional hazard: A Women’s Health Initiative (WHI) study found that the risk of breast cancer increased by 24 percent (or about five cases out of 1,000 women) after five years of EPT use. Also, women 65 or older should not start EPT treatment, as it may cause a slight increase in the risk of dementia, heart disease and stroke.
“Women must decide on an individual basis if the benefits are worth the risk,” says Dr. Stuenkel. New data from studies done at the University of California, San Francisco, suggests that breast density as measured on mammography may help determine which women are most at risk. “In the studies, women with the most dense breasts have a twofold increase risk of breast cancer while on EPT, compared with women with fatty, low-density breasts,” Dr. Stuenkel says.
Molecule by molecule, these hormones (estrogen, progesterone, testosterone and others) are chemically identical to the ones produced in our bodies. Derived primarily from wild yams and soybeans, the prescriptions are specifically prepared by compounding pharmacists for every patient based on his or her hormone levels. Many feel this personalized treatment method is superior to ET or EPT, though FDA-approved bioidentical hormones are available. “We use a computer program, into which we enter a patient’s height, weight, medical history and blood work,” says Susan Matos-Cloke, M.D., an internist at Advanced Hormone Solutions in Paramus. “Based on those results, we prescribe an individualized hormone combination that addresses the specific needs of that patient. If you’re heavier, you may need more hormones.
If you’re younger, you’ll probably need less. Every patient leaves here with a different dose.” Yet controversy still abounds. “The FDA does not approve of these individually mixed recipes because there is no standardization in either manufacturing or content, nor any labeling requirements for communicating risks and benefits for safety’s sake,” says Dr. Stuenkel. “Furthermore, clinical trials haven’t clearly shown that bioidentical hormones are better at relieving symptoms or safer from a risk-benefit standpoint than their FDA-approved counterparts.”
The bottom line? There are many ways in which a menopausal woman can improve her quality of life. “It’s essential to talk about symptoms with your healthcare practitioner,” says Dr. Parnes. “No one should have to suffer this change in silence.”
Male Menopause: Fact or fiction?
Sometimes known as andropause, the age-related hormone changes experienced by men are very real, says Cynthia Stuenkel, M.D., past president of the North American Menopause Society (NAMS). Men’s gradual decline in testosterone beginning in their mid-30s is not comparable to the abrupt estrogen drop experienced by menopausal women, yet symptoms can be similar, including reduced sexual desire, insomnia, increased body fat, decreased bone density, mood changes or mild depression.
Some men are turning to bioidentical hormones to treat andropause, says Michael Gross, M.D., the medical director of the Active Center for Health & Wellness in Hackensack. “The benefits include increased energy, stamina and mental alertness, improved sexual function and libido, and decreased body fat,” says Dr. Gross.
Many testosterone supplements (both natural and synthetic) are marketed to men, but a New England Journal of Medicine study recently reported that testosterone supplements were associated with higher rates of heart attacks and elevated blood pressure. Thus Mayo Clinic experts recommend that instead of using supplements, men who feel the effects of hormonal changes should stick to a healthy diet and incorporate plenty of physical activity into their daily routines to naturally combat the effects of male menopause.
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