Dr. Emily Stone, certified menopause practitioner, discusses the variety of menopause symptoms women might experience, the gold standard of treatment options, and other methods of menopause management.
Ok Gen X Sisters, we are back at it! Last year I wrote about perimenopause and fatigue; this year I am tackling menopause and its symptoms and treatment options.
Menopause and estrogen are having their moment in the sun right now…in the medical world and on social media. With new research findings and recommendations, there is a lot to unpack about this new phase of life.
All of us will experience the menopause transition – there are no free passes here. But every woman’s transition will be different. I’d like to take a look at the common menopause symptoms as well as different types of options for relief so that you can be more informed when discussing your own transition and needs with your doctor.
The Physiology of Menopause
I will start this blog by lifting my own words from Perimenopause and Fatigue: Tips for Boosting Your Energy Levels for some background on the physiology of menopause.
Your final menstrual period marks the beginning of menopause, though this earmark can only be defined by looking back: Natural menopause (not surgically or hormonally manipulated) is defined as no bleeding (no period) for one full year. This lack of period occurs when your ovaries have no more follicles (eggs) remaining, and thus your primary source of estrogen production is gone.
The transition to menopause can be considered “puberty in reverse,” and it simply takes time. The average age of menopause is between 51 and 52 years old, but the total transition time varies greatly: it can last approximately 2-8 years, and sometimes longer.
Perimenopause includes both the transition to menopause and the first year following your final menstrual period. The menopause transition is the time of hormonal fluctuations that results in irregular periods and vasomotor symptoms like hot flashes and night sweats, as well as (potentially) other systemic symptoms such as muscle and joint aches and pains and brain fog. Vasomotor symptoms are the result of your body’s decline in estrogen production.
Approximately 30% of women will navigate the menopause transition without natural cycles to follow. Women who have had a hysterectomy, women who have an IUD and thus scant or no bleeding, and women using contraception to suppress ovulation fall into this category. It may be more difficult to pinpoint the timing of menopause in these cases, but these women may still experience symptoms.
What are common symptoms of menopause?
The hallmark of perimenopause is hormone fluctuation, and this can occur with both regular menstrual cycles and irregular menstrual cycles. The hallmark of menopause (one full year without a natural period) is the fall of female sex hormones estrogen and progesterone.
This fluctuation and gradual drop in female sex hormones doesn’t just affect our reproductive organs. Our bodies are full of estrogen and progesterone receptors, and as hormone levels fall, many women experience new and different symptoms they may not realize are related to perimenopause or menopause. Some women experience a worsening of symptoms in the 1-2 years after their final menstrual period.
Some of the most common symptoms of menopause include:
- Vasomotor symptoms- hot flashes and night sweats
- Muscle and joint aches and pains
- Brain fog
- Sleep disturbances
- Weight changes- both redistribution of fat to the abdomen and weight gain
- Vaginal dryness and sexual discomfort
- Heart palpitations
- Libido changes
- Urinary changes
- Thinning hair
- Dry skin
- Mood swings
How do we approach menopause treatment?
The key to menopause management is the treatment of our symptoms. Menopause itself is an expected physiological event that does not require treatment.
Since menopause treatment is based on symptoms, bloodwork and testing are not necessary prior to initiating therapy. Hormone testing is just a snapshot of hormone levels at a particular time, which is not helpful when the transition is characterized by hormone fluctuation. Moreover, there is no correlation between serum hormone levels, dosage of treatment and symptom relief/response to treatment.
While some women breeze through the menopause transition without any complaints, for others, symptoms could be uncomfortable and even disruptive to their lives. Finding relief from their symptoms could significantly improve their quality of life. The goal of menopause management is to personalize treatment for each individual based on their symptoms, the intensity level of those symptoms, and their medical history.
Menopause Treatment Options
While menopause is not an abnormal or unexpected part of our medical history, that doesn’t mean women are resigned to suffer through it. There are simple ways to mitigate the symptoms. Menopause treatment for symptoms can consist of:
Hormone therapy
As women’s ovaries gradually stop making estrogen, medications that provide estrogen and/or other hormones can be used to relieve symptoms caused by this depletion.
Menopausal Hormone Therapy (MHT) is the gold standard for menopause symptom treatment. It is often referred to as hormone replacement therapy (HRT), but this term is a misnomer. MHT treats symptoms of menopause that arise due to the normal physiological absence of estrogen and progesterone. The medication is not “replacing” hormones because they are expected to be low in menopause.
MHT is FDA-approved to treat the vasomotor symptoms of menopause (hot flashes and night sweats), vaginal dryness, and the prevention of osteoporosis and fractures. Many women also find relief with muscle and joint aches, brain fog, and sleep disturbances–especially if their sleep disruption is rooted in night sweats. MHT is generally a low-risk treatment option, although it is not appropriate for women with certain medical conditions.
If you are interested in hormone therapy, I recommend you make an appointment with your OB/GYN to discuss whether you are a good candidate based on your symptoms and medical history. The treatment options are available in several forms, and your provider will help you decide what is right for you.
Non-hormonal medical therapy
There are two FDA approved non-hormonal medications for menopause symptoms. The first is Paxil, a serotonin reuptake inhibitor that targets a neurotransmitter in the brain. The second is Veozah (fezolinetant). Veozah is part of a new class of medications and it works at the KNDy receptors in the brain.
These medications are ideal choices for women who cannot use estrogen therapy, such as breast cancer survivors or those with a history of blood clots in their veins or arteries.
Two off-label medications include gabapentin and oxybutynin. These medications are FDA-approved for other indications and have also shown to help with vasomotor symptoms of menopause.
Vaginal estrogen. Topical vaginal estrogen treats dryness, burning and helps with pain with intercourse by delivering estrogen directly to the vaginal tissue. Consistent use will also help prevent urinary tract infections. It helps thicken vaginal tissue and provides increased lubrication.
Vaginal estrogen is not absorbed systemically by the body and may be used with no other endometrial/ uterine protection. It is very safe and may be used by women with a history of breast cancer and thrombosis.
Non-hormonal vaginal treatment
These options include lubricants (Astroglide, KY Jelly, Uber Lube) and moisturizers such as over-the-counter Replens. Another treatment option is Reveree, which is hyaluronic acid, and comes over-the-counter as a vaginal suppository.
Cognitive behavior therapy (CBT)
CBT is a form of biofeedback that includes education about how thoughts and feelings may affect physical symptoms. This also includes training about relaxation, breathing control, modifying triggers and identifying negative beliefs. CBT can also be used for other conditions such as anxiety.
Lifestyle changes
Sleep hygiene, diet, exercise, not smoking–these are the common sense lifestyle habits that will help all of us.
- Sleep hygiene: If you notice a major change in your sleep during perimenopause and into menopause, work on establishing a regular sleep routine. Be consistent with your own wake-up and sleep times, avoid alcohol and caffeine too late in the evening, and create a sleep environment that promotes healthy sleep. We recommend keeping the room dark, cool, and quiet. Learn more tips in Dr. Padmini Santosh’s blog post, How Women’s Hormones Can Affect Their Sleep – and Tips for Improving It.
- Diet and exercise: Establishing healthy habits can be beneficial for overall health and wellness, and may even contribute to weight loss. Ensuring you have adequate protein intake, adjusting carbohydrates to complex rather than simple, and eating enough fiber will help you stay full longer. Learn more tips in my blog post, Perimenopause and Fatigue:Tips for Boosting Your Energy Levels.
- Not smoking: Smokers experience menopause earlier than non-smokers. Smokers are also at higher risk for bone loss/osteopenia/osteoporosis than non-smokers.
Urinary incontinence may also accompany the menopause transition and menopause. The two forms of incontinence are stress (leaking with coughing, sneezing, jumping) and urge (leaking without warning or the urge to void and then leaking). The Urogynecology Center at VPFW offers consultation and evaluation of your symptoms and can work with you to find the right treatment option.
Can you find menopause treatment over-the-counter?
Short answer: There are no over-the-counter supplements that have been proven to help with menopause symptoms.
Over-the-counter supplements are available and should be used with caution, as they are not FDA-approved and have no regulation regarding safety and efficacy. Social media offers many avenues for supplements that may be expensive, though they have not been subject to rigorous clinical trials to evaluate their safety and efficacy.
Visit VPFW for More Information
I am often asked why I decided to pursue menopause certification by the Menopause Society. The last three years have been filled with large and somewhat unexpected career changes as I stopped practicing obstetrics. I enjoy continuity of care and the ability to provide education and treatment for this important transition in our lives. Learning about and sharing resources with our patients helps provide them with optimal care.
Along with my Gen X sisters, my family, professional life and health discussion topics have changed over the years. Bringing together the personal and the professional is very rewarding!
If you’re looking for information on menopause management, what to expect during menopause, or potential treatment options, please contact VPFW. We are happy to help!
To make an appointment with a VPFW provider, call us at 804-897-2100 or schedule an appointment online.
Resources
The Menopause Society (formerly known as the North American Menopause Society) www.menopause.org
The Menopause Society’s patient information about Menopause Hormone Therapy https://menopause.org/wp-content/uploads/professional/menonote-deciding-about-ht-2022.pdf
The Menopause Manifesto, book by Dr Jen Gunter drjengunter.com/the-menopause-manifesto/
The Vajenda, blog by Dr Jen Gunter, vajenda.substack.com/
“Should We All Be on Hormone Therapy? With Dr. Susan Davis AO” (Episode 187) Hit Play not Pause podcast, July 17, 2024 podcasts.apple.com/us/podcast/should-we-all-be-on-hormone-therapy-with-professor/id1533088916?i=1000662491724
