Menopause and its Symptoms

Menopause is the beginning of a woman's second adulthood. Freed from childbearing and child rearing responsibilities, this should be a great time in a woman's life. It is a normal part of the female life cycle, but just like other normal events like menstruation, pregnancy, and lactation there may be issues that need medical assessment and intervention. For many women, menopause is a time to reinvent themselves and seek new opportunities and creative outlets. Many women, like Margaret Mead, have described a "postmenopausal zest with renewed focus and energy". However, women at mid-life can experience very disruptive symptoms and just because a woman is a woman, doesn't mean she needs to be a martyr and suffer with menopausal symptoms.

Menopause symptoms may include hot flashes, hot flashes causing sleep disturbance, vaginal dryness, loss of bone, muscle, and collagen in the skin. Unfortunately in the last four years, the media have excessively emphasized the risks of menopausal hormone therapy. The only current FDA-approved option to treat hot flashes is hormone therapy. Women have many choices for treating menopausal symptoms but these choices need to be individualized.

Hormone therapy is also indicated to maintain or treat osteoporosis particularly in women who have menopausal symptoms or other reasons to take hormone therapy. Estrogen is generally the only option that will restore the vaginal integrity and for women who only have vaginal or genitourinary symptoms, there are many products that can be delivered locally to the vagina in the form of pills, vaginal rings, or creams.

After all the hoopla of the Women's Health Initiative (which was not a menopausal study, rather a large preventive study in women much older and several years past the typical age of menopause) there has been the recommendation of using the lowest dose of hormones for the shortest period of time consistent on why the hormones are being prescribed. This is really true for any medical condition but the wording of these recommendations, unfortunately has left many women and their physicians hesitant to use hormone therapy even when indicated. All prescription treatments (including also alternative options and over-the-counter treatments) all have potential risk. The risk of hormone therapy for many otherwise healthy menopausal women in general is very low. Some women choose to take hormone therapy because in addition to sleeping better they also notice improvements in skin and hair. This is not an FDA-approved reason, but hormone therapy has definite positive effects on the hair, skin, and collagen.

Half of women lose bone at the time of mid-life and the other half don't. This is a silent process and there are other options besides hormones that can help maintain the bone density. Calcium, and vitamin D are absolutely necessary but not always sufficient alone and for women who feel great after menopause and do not need hormone therapy to control symptoms, they should have a bone density to check their bone status. Furthermore, postmenopausally, most all women have changes in the genitourinary system with thinning of the vagina, decreased blood flow, and increase in the vaginal pH. This is not always symptomatic but can be gradual over time and many women experience overactive bladder, increasing vaginal infections, decrease in lubrication, possible bladder infection and sexual dysfunction. Many women may end up gradually giving up sexual activity thinking that this is a normal part of aging. There are localized treatments that do not have systemic effects and even in breast cancer survivors we many times can offer local vaginal estrogen therapy to restore the integrity of the vagina.

Importantly, the last menstrual period or menopause should be an excellent time for women to re-evaluate their health status, make sure that they are up-to-date on all their health screenings, like Pap smears, mammograms, colon cancer screening, blood pressure check, cholesterol ratios, immunizations, and dietary lifestyle and exercise habits. It is a good time to take stock of your health and plan for the second phase of your adult life with enthusiasm and vigor. The North American Menopause Society is excellent source of information about mid-life health, as well as helping to find menopause specialists.

For more information on menopause, download the Free Guide to Managing Menopause.


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