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MENOPAUSE DEFINITION:  the natural time in a woman’s life when her menstrual flow permanently stops due to loss of ovarian activity (estrogen drops and egg release stops).   The average age is 51 years.  Most women enjoy a healthy lifestyle for many years afterward.  Physical changes occurring around menopause should not prevent you from enjoying this time of your life.

PERIMENOPAUSE DEFINITION:  For several years before menopause, menstrual periods become irregular, about 30% of women develop hot flashes and night sweats during this stage called perimenopause or the menopausal transition.  A woman is said to be postmenopausal when she has not had a menstrual period for at least 12 months.

SIGNS AND SYMPTOMS OF MENOPAUSE:  Hot flashes, night sweats, vaginal dryness, poor quality sleep, fatigue, irritability, mood swings, difficulty concentrating, weight gain, muscle and joint soreness.  These symptoms may contribute to changes in libido (sexual interest).  Some women develop depression in response to menopausal symptoms. While not all women experience these symptoms, they are a leading driver of midlife women seeking medical treatment.

HOT FLASHES:  the sudden sensation of heat in the upper body, face, neck and chest typically lasting 1-5 minutes.  They are associated with sweating, flushing, anxiety and palpitations and occur in up to 85% of all women at some point during the menopausal transition.  They often begin several years before menopause and may continue for several (4-10) years after menopause. They are far more common at night, when they can cause night sweats and long term sleep disruption.

VAGINAL SYMPTOMS:  vaginal dryness, discharge, itching and/or painful intercourse. The menopausal vagina becomes more fragile and may tear, leading to pain and bleeding.  These changes may impair sexual function and have a negative effect on a woman’s quality of life, self-esteem, and sexual intimacy.

TREATMENT OPTIONS:  Consider treatment if symptoms are bothersome, disrupt sleep, or adversely affect quality of life.  Symptoms tend to be reduced by exercise.  Avoid foods and drinks that cause flushing such as alcohol, red wine, caffeine and very spicy foods.  Symptoms are also reduced by clothing choices, dressing in thin cotton layers, and keeping a fan and cold drink handy.   Social interaction and Mental stimulation may dramatically help manage stress and thereby reduce hot flash intensity.  Consider staying in air conditioning during hot weather.  Try to manage severe emotional stress which may precipitate hot flashes.

Hot Flash  Alternative Treatments.

Vaginal dryness (occurring alone) is best treated with lubricants (KY, Astroglide Gel, Replens) and/or low dose vaginal estrogen (cream, tablets, or ring) are very effective.  A new medication called Osphena (taken by mouth) is available to treat vaginal symptoms.

New Non-Hormonal Medications may reduce hot flashes when taken in low doses (Brisdelle, Paxil, Lexapro).

Estrogen (Bioidentical and FDA approved) is the most effective treatment available for hot flashes which may in turn improve sleep and secondary symptoms such as fatigue, irritability, mood swings, poor concentration and decreased sexual interest.   Treatment should be tailored to the individual woman’s medical history, treatment goals, personal attitudes toward menopause and toward medication use.  The absolute risks of using hormones are very low for most women but  the informed decision must be yours.

Hormone Therapy Information

DO THE BASICS WELL:   PLEASE do not lose sight of the fact that the key to healthier aging is to master life’s delicate balancing act – maintaining the body, mind and spirit.  There is no point when you suddenly “get old.” You’re not old just because you retire, go through menopause or become a grandparent. Don’t become distracted by details. Do the basics well.

Make health a top priority.
Eat right.
Sleep well.
Don’t smoke.
Expand your mind – read, communicate
Do what you enjoy.
Invest in and nurture relationships.
Set life goals.

For some women hot flashes, nights sweats, vaginal atrophy are so bothersome that they may choose to accept the low absolute risks of hormone therapy in return for quality of life. This is a very personal choice that each patient must make before receiving hormone replacement therapy.  Other women who are “doing fine” and perceive no need should probably NOT take hormone replacement therapy. Women with breast cancer, uterine cancer, heart disease, stroke, blood clots, migraines with aura should generally not take hormone therapy.