What is menopause?
Menopause is the time in a woman’s life when her ovaries stop producing estrogen, which means she stops having menstrual periods and is no longer able to become pregnant. It is often referred to as the “change of life.” Typically, menopause occurs between the ages of 45 and 55. It occurs gradually, taking anywhere from several months to several years. Menopause is considered to be over when you have not had a menstrual period for 12 consecutive months.
What are the symptoms?
As your ovaries produce less estrogen, your periods will become more irregular and eventually stop entirely. For nearly one in seven women, irregular periods are the only noticeable symptom of menopause. Most women, however, will experience one or more of the following symptoms as their estrogen levels decrease:
- hot flashes (a sudden sensation of heat, sometimes accompanied by a flushing or reddening of the face) - affects three out of four women
- urinary discomfort or bladder infections
- vaginal dryness, irritation, or itching, and possibly painful intercourse
- disturbed sleep
- nervousness, irritability, or depression
How can I treat menopause symptoms?
Learning about menopause will help you understand treatment options and how they may affect you. The decision to treat symptoms is ultimately your own, so it is important to understand the benefits and side effects of treatment. Treatment options include lifestyle modifications, herbal products, and hormone replacement therapy (HRT).
Lifestyle modifications may help you manage your menopause symptoms as well as improve your overall health. For example, adding soy products to your diet may reduce hot flashes, menopausal mood swings, and cholesterol levels.
You can also follow these guidelines to reduce your risk for osteoporosis, breast cancer, heart disease, and strokes:
- Quit smoking.
- Maintain a healthy diet.
- Exercise regularly. Before starting or modifying an exercise program significantly, talk to your doctor.
Black cohosh is an herb that is widely used in the treatment of menopause symptoms. Studies have demonstrated that it is effective in reducing symptoms. Check with your Peoples pharmacist before using black cohosh to find out about possible medical interactions with other drugs.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) is medication that replaces the hormones that decrease when you go through menopause. HRT involves daily doses of the female hormone estrogen or, more commonly, a combination of estrogen and progesterone. You should discuss HRT thoroughly with your doctor because the decision to use it is your own and should be based on your specific needs and concerns.
HRT comes in several forms:
- oral tablets
- skin gels
- vaginal creams
Ask your Peoples pharmacist or doctor about the advantages and disadvantages of each form.
HRT offers the following benefits:
- may relieve symptoms of menopause
- may reduce the risk of hip fractures
- may reduce the risk of colon cancer
It was previously believed that HRT decreased the risk of heart disease in postmenopausal women, but recent studies do not support this. In current users, HRT taken after menopause for more than five years increases the risk of coronary heart disease by 29% and the risk of stroke by 41%. If you have heart disease, talk to your doctor about whether you should continue taking HRT.
Possible side effects of HRT include:
- breast soreness
Taking progesterone with estrogen restarts periodic bleeding in most women. However, once menopause is complete, you can no longer become pregnant. If you experience irregular periodic bleeding, ask your doctor or Peoples pharmacist about other forms of HRT that may reduce the amount or frequency of your menstruation. If you experience postmenopausal vaginal bleeding, talk to your doctor. Such bleeding may or may not be the result of a serious cause.
If you have diabetes, HRT may significantly increase your risk of heart disease.
Should I use HRT?
A short-term course (up to two years) of HRT will probably help you if you have uncomfortable menopause symptoms.
A long-term course may help you if you have multiple risk factors for osteoporosis, which may include:
- early menopause
- family history of osteoporosis
- low calcium intake
- physical inactivity
- smoking tobacco
When deciding whether or not to take a long-term course of HRT it is important to take into account the benefits, side effects, and risks already discussed.
HRT and osteoporosis
Because HRT may cause unwanted side effects, you should discuss other options to treat or prevent osteoporosis with your doctor first. If you are considering taking HRT for a prolonged period only to prevent or treat established osteoporosis, the benefits may be outweighed by the risks of cardiovascular disease, stroke, and invasive breast cancer.
When menopause starts, a woman’s body starts to lose calcium. When you start menopause, increase your calcium intake to 1500 mg a day to help strengthen your bones and reduce your risk of osteoporosis. You should try to get calcium naturally, through your diet, but use supplements if you find this difficult. Taking 400 IU of vitamin D a day will help your body absorb calcium. Women over 50 should get a total of 800 IU of vitamin D3 a day from all sources.
HRT and breast cancer
The risk of breast cancer does not increase with short-term HRT use (four years or less). Long-term use, however, may increase your risk by as much as 25%. If you are using HRT, have a mammogram at least every 12 to 24 months, or as directed by your doctor. If you have been previously treated for breast cancer, you should talk to your doctor about the benefits and risks of HRT and use it cautiously.
The risk of uterine cancer is almost negligible as long as you use HRT as directed and it includes progesterone. Progesterone is not necessary for women who have had a hysterectomy because they no longer have a uterus.
Talk to your doctor when making your decision if you have risk factors for breast cancer, including one or more of the following:
- sister or mother who has breast cancer
- early menstruation (before age 12)
- late menopause
- heavier than ideal body weight
- giving birth after age 30 or never giving birth
- a breast biopsy suggesting increased risk
Women who should not use HRT
You should not use HRT if you have any of the following health conditions:
- active liver disease
- blood clots diagnosed by your doctor
- a history of unexplained vaginal bleeding
Where can I find out more about menopause?
For more information about menopause or other health issues:
- talk to your Peoples pharmacist
- read People First, a health magazine of practical information available free from your local Peoples Drug Mart or Peoples Pharmacy
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