Menopause Treatment

  • Treatment

    Wear clothes that are hot-flash friendly, and sleep on cotton sheets.

    Dressing in layers is a good idea when you are experiencing hot flashes. Discarding outer layers can help to cool you down. Wear cotton and avoid wool. Also, sleep on cotton sheets. Just as articles of clothing can be discarded during a hot flash that occurs during the day, blankets and sheets can be thrown off during a night sweat. Keeping your environment 3 to 5 degrees cooler than normal can also help.

    If vaginal dryness is a problem, try using a lubricant or cream.

    Over-the-counter vaginal creams and lotions can help relieve vaginal dryness. Be sure to use only creams and lotions made specifically for vaginal use.

    Estrogen-based creams can help prevent thinning of the vaginal lining and lower the risk of urinary infections and incontinence, in addition to alleviating vaginal dryness. Discuss treatment options with your clinician if you are bothered by vaginal dryness.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Low-dose oral contraceptives may be helpful for some perimenopausal women who experience excessive bleeding, such as menstrual periods that are coming too close together or very heavy periods.

    Women experiencing a long perimenopause marked with unpredictable, too frequent, or heavy vaginal bleeding may benefit from low-dose oral contraceptives. Oral contraceptives can help decrease vaginal bleeding, regulate menses, and prevent hot flashes. Since women are still fertile during perimenopause, oral contraceptives have the added benefit of preventing an unwanted pregnancy. They may also help prevent bone loss. Your clinician may need to perform a gynecologic examination and certain tests to rule out other causes of irregular bleeding before you are started on oral contraceptives.

    Hormone replacement therapy (HRT) may be used to treat particularly bothersome menopausal symptoms, or to treat or prevent certain diseases. It is important to discuss the risks and benefits of HRT with your clinician.

    Replacing estrogen (and in many cases, progesterone) is controversial because several recent studies have reached conflicting conclusions about the risks of HRT. Your clinician is the best source for the most up-to-date information regarding HRT and whether it is right for you. Every woman should have a serious discussion with her clinician about whether or not to take hormones. Your clinician will consider the severity of your symptoms and your individual health history, as well as the risks of HRT.

    HRT can help relieve hot flashes, improve vaginal tone, decrease the risk of colorectal cancer, and prevent osteoporosis. Expect to be on estrogen replacement therapy for about four to six weeks before you notice a decrease in hot flashes. Estrogen replacement may also help minor sleep problems.

    Estrogen replacement increases the risk of blood clots, heart diseae, stroke and gallstones. Taking estrogen alone (without progesterone) is also correlated with an increased risk of uterine cancer. This risk, however, doesn't apply for women also taking progesterone. Taking progesterone along with estrogen replacement may decrease this risk; however, the risk of ovarian cancer may be increased. Even with HRT, the occurrence of ovarian cancer is rare.

    When estrogen and progesterone replacement is needed, most women prefer to take both hormones daily because alternating between the two tends to cause unwanted vaginal bleeding.

    Estrogen is available in natural and synthetic forms. Estrogen can be taken by mouth or through a skin patch. Estrogen also can be applied to the vagina as a cream when its intended purpose is to remedy vaginal dryness and urinary incontinence.

    Synthetic progesterone (progestin) can be taken orally, vaginally, or by injection into a muscle. Progesterone can cause bloating, weight gain, irritability, and depression in some women. However, most women can find a formulation that is comfortable for them.

    Recent large research studies indicate that taking HRT increases the risk of developing breast cancer. This is particularly true in women who have already had breast cancer. HRT may also increase the incidence of abnormal mammograms. Though the increased risk of breast cancer in the general population is not that great, many women nol longer want to take HRT.

    Because of this new information about the risks of HRT, most clinicians will not treat menopausal symptoms with HRT unless the symptoms interfere greatly with a woman's quality of life. Since hot flashes can be particularly bothersome for some women, HRT can be used for short-term treatment of hot flashes (less than 5 years) without significantly increasing a woman's risk of breast cancer.

    HRT decreases the risk of colorectal cancers and bone loss from osteoporosis. Other medicines are available for the prevention and treatment of osteoporosis.

    New forms of estrogen-like hormones, called selective estrogen receptor modulators (SERMs), are being evaluated as a possible alternative to standard HRT.

    Because of the risks associated with HRT, it is no longer prescribed solely to prevent osteoporosis. Other medicines are available to help combat postmenopausal bone loss, including SERMs. SERMs act like estrogen in some tissues but not others. They were designed to counteract estrogen's potential to stimulate breast tumors, while retaining the benefit of estrogen in preventing osteoporosis. Some SERMs may increase the risk of endometrial cancer and blood clots, or cause hot flashes, flushing, sweaty palms, and vaginal dryness. Therefore, SERMs are not used to treat symptoms of menopause, such as hot flashes.

    Soy has received a lot of attention as a remedy for problems related to menopause, but not studies have proven that eating soy products help with the symptoms of menopause.

    In Asian countries where soy is consumed regularly, hot flashes do not seem to bother perimenopausal women. Soy contains plant estrogens called isoflavones that are chemically similar to but much weaker than human estrogen. In medical studies, soy has not consistently relieved hot flashes. Any woman with breast cancer should consult their clinician before using soy to relieve hot flashes. There are many herbal remedies on the market that claim to help menopause symptoms. Long-term safety is not known for herbal supplements used for relief of menopause symptoms.

    Naturopaths and herbalists recommend herbs, such as black cohosh, chasteberry, and dong quai for menopause-related complaints. Anecdotal experience suggests they may be helpful, but there have been no large, controlled clinical trials to evaluate their safety and effectiveness. Only vitamin E has been shown to be more effective than placebo (sugar pill) in decreasing hot flashes, but its benefit appears to be minimal. Plus, the Food and Drug Administration does not regulate herbs, so there is no assurance of quality control among such products.

    Alternative therapies should not be used as a substitute for medical care. You should always tell your clinician or pharmacist what medicines you are taking, such as prescription or over-the-counter medicines, herbs, vitamins, or other supplements.

    Alternative therapies may react poorly with some prescribed or over-the-counter medicines. Taking herbs, vitamins, or other supplements may interfere with lab tests or healing after surgery or illness, or may worsen some illnesses and health conditions. Your clinician and pharmacist can help you choose the complementary therapies or supplements that are right for you.

    Most women get used to the symptoms of menopause over time. However, women who feel that their quality of life would be significantly improved by relief of menopause symptoms may want to discuss the risks and benefits of short-term hormone therapy with their clinician.

    Postmenopausal women should have yearly gynecological exams (pelvic and breast exams) and tests that are appropriate for their age and risk factor profile.

    In addition to gynecological exams, mammography (to detect breast cancer) and cholesterol testing should be performed on a regular basis. Bone density testing may be necessary for women who are at high risk of osteoporosis. Thyroid problems are more common in older women. Therefore, the thyroid should be checked every 3 to 5 years. Women at particularly high risk for disease (such as diabetic women) need to be checked more frequently and treated more aggressively for high blood pressure, cholesterol abnormalities, and increased blood sugar.

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