There’s no reason to be a menopause martyr

Menopause is no longer being dismissed as a necessary evil. So if you’re struggling with hot flashes, sleeplessness, vaginal dryness, loss of libido, night sweats, mood swings or other symptoms, there is relief available.

Patients should no longer be told to “just deal with it” and to suffer silently, said Michael Neel, MD an obstetrician and gynecologist at Cape Obstetrics & Gynecology at Falmouth Hospital.

“Women’s feelings, symptoms, matter,” he said. “It’s not like you’re asking too much or that you’re complaining or you’re not being enough of a woman dealing with your menopause. You don’t have to deal with some of the symptoms if you’re not liking it. We have options.”

Officially, menopause is the time after a woman’s last period, which averages around the age of 50, according to the National Institutes of Health. But perimenopause, the years leading up to the actual cessation of menstruation, can last for 10 or 15 years. Both are associated with a drop in estrogen and other hormones that are not only important to the reproductive system, but contribute to cardiovascular and bone health, as well as brain function. As a woman enters perimenopause, and hormone levels drop, her body reacts with symptoms that can range from annoying to debilitating.

Strategies to Try

Some sufferers tolerate menopause symptoms more than others and might even be grateful to no longer be having periods that are heavy or painful, Dr. Neel said. Others might have hot flashes or sleeplessness or issues with sex that are intolerable. “It’s a pretty big range,” he said. “And you really treat the symptoms of what they have, not just one blanket treatment that’s going to fix everything.”

If you’re struggling with perimenopause or menopause symptoms, talk to your doctor but here are some things to keep in mind, Dr. Neel said.

• Consider hormone replacement therapy. Healthcare providers have recommended estrogen or estrogen/progesterone replacement therapies (HRT) for more than 50 years. But HRT was labeled as risky after the 2002 Women’s Health Initiative study reported that it put subjects at greater risk for breast cancer, blood clots and stroke. However since then, new studies have shown that some forms of HRT can be used in younger women or in early postmenopausal women and benefit the cardiovascular system and relieve some classic menopause symptoms, according to reports published by NIH.

That said, each patient should be evaluated for the risks, Dr. Neel said. “Do they have any sort of family history for breast cancer; personal history of breast cancer; any history of strokes, blood clots, that kind of thing?”

Anyone with a uterus should take HRT that includes progesterone to decrease the risk of endometrial cancer, he said. Also, anyone on HRT should have annual mammograms and breast exams. “The recommendation is the lowest possible dose for the shortest possible time,” he said. Estrogen can now be administered through pills, patches, creams or vaginal rings. Some patients may also respond to low doses of testosterone, normally produced by the ovaries, Dr. Neel said.

• Consider non-hormonal therapies. If you’re struggling with mood swings or hot flashes, an antidepressant or anti-anxiety medication, or a blood pressure treatment such as clonidine may help, Dr. Neel said. “I think if somebody’s saying, ‘I can’t sleep, I can’t do this, these hot flashes are really driving me crazy, but we’ve had a strong family history of breast cancer’…, It's a worthwhile next thing to try.”
• Treat specific symptoms. For example, estrogen helps to maintain bone density, and if a risk of osteopenia or osteoporosis is the only issue, targeted medications might help. “If that's the only issue, we've got medicines that can be directed directly towards the bone densities – the Fosamax, the Boniva, those types of medicines,” Dr. Neel said.
• Understand the limits of supplements and folk cures. The internet and social media are loaded with information about menopause, some of it helpful, some of it cringe-worthy or commercial. For example, supplements such as compounded bioidenticals containing estriol, a type of estrogen, do not have a consistent standard, and are not approved by the Federal Drug Administration, according to research published by the Mayo Clinic. “We don't have anything on how good the concentration is, how good is the formulation, what are the side effects,” Dr. Neel said. “Some of this stuff isn’t benign over the counter products. They can have some issues.”
• Be entitled to treatment. There’s no reason to be a menopause martyr. Dr. Neel said. “You don’t have to deal with some of these things if you’re not liking it. We have options out there. Might not be perfect, might not be a one-size fits all or not have any side effects, but there are options.”