Your Menopause Symptoms—Your Personalized Treatment Options
“I expected to be emotionally stable,” says Stephanie W., discussing her path through menopause. “I wasn't prepared for rages. I'm basically a person who counts to 10 before responding. However, I found that I was suddenly spouting off like Mount Vesuvius at my husband over little issues that barely bothered me before.”
As women’s reproductive systems near retirement, hormone levels – both feminizing estrogen and libido-charging testosterone – begin to dip. Night sweats, hot flashes, changes in period cycles and decreasing libido can be telltale signs of peri-menopause, the transitional years into menopause.
“Remember that menopause doesn't occur in a vacuum,” explains Virtua obstetrician/gynecologist Michele Godorecci, MD. “A woman doesn't suddenly wake up one day and go through it. Subtle hormonal changes may occur as early as the late 30s and early 40s for some women. Some are sensitive to these changes and some are not.”
The most important thing for a woman to remember is that when it comes to treatment such as hormone replacement therapy (HRT), there is no one-size-fits-all therapy, says Dr. Godorecci. Women have different needs depending on where they are in the process, and these needs could change as symptoms intensify.
For Stephanie W., handling hot flashes meant lowering the thermostat at night so she could get a good night’s sleep, but she opted to skip hormonal therapy due to fears of side effects. “When I was going through menopause, there was a lot in the news about the harmful effects of hormone replacement therapy. I never felt that my symptoms were that bad – although my husband might disagree – but I did not take anything for them,” she says.
The old consult-your-doctor-before-starting-treatment is never truer than during menopause, as women have many therapy options – including the take-nothing approach. If you do think you need something to help you along, Dr. Godorecci suggests you discuss these options with your doc:
Oral contraceptives: the hormones in oral contraceptives can help women early on in menopause when they still have frequent menses.
HRT (estrogen): estrogen therapy relieves the night sweats, hot flashes and vaginal dryness.
HRT (testosterone): dropping testosterone levels, and the subsequent decline in libido, may benefit from hormonal therapy as well. “A little testosterone can go a long way in improving energy,” says Dr. Godorecci, explaining that it increases endorphins which can energize a woman and make her more apt to exercise. Many women complain about lethargy and exhaustion during perimenopause, and are misdiagnosed with depression and chronic fatigue. “It also helps build bone density. There are many ways of giving it – oral, topical and injectable. It too can have side effects and too much can cause adverse outcomes such as acne, facial hair growth and male-pattern baldness.”
Bioidentical hormones: estrogen and testosterone pellet therapy, like Virtua’s bioidentical hormone therapy Exuberan, mimic the hormone molecules in a woman’s body. The human body has three different estrogens, the most utilized being estrodiol. Bioidentical and bioequivalent estrogens are used to mimic the effects of these natural estrogens and eliminate some of the side effects that women experience with non-bioidentical estrogens. It is important to note that ANY estrogen, bioidentical or not, has side effects and risks. There has never been any randomized, prospective study that proves one is safer than another.
Natural remedies: herbs and supplements such as black cohash, red clover and soy can diminish hot flashes. The glitch with soy is that in order to activate it, a woman needs to digest it properly and the enzymes that allow this decrease with age. Therefore, it’s important to find a soy supplement that has digestive enzymes included.
Lifestyle: diet and exercise certainly are an important part of any healthy lifestyle, and that continues through menopause. Weight gain is common during these years, and it can be harder to lose extra pounds. Weight distribution also changes, and a woman may notice weight gain in her abdomen and belly instead of her hips, buttocks and thighs.
HRT and other treatments do not help address weight gain, so women must be diligent about exercise and diet to maintain a healthy BMI. Cardiovascular workouts four times a week, for 30 to 60 minutes each, along with weights to tone muscles and maintain bone strength, are very important during menopause.
Vitamin D and calcium: Menopause accelerates the bone loss secondary to the drop in estrogen. Osteoporosis and bone weakening increase the risk for broken bones. Calcium and vitamin D supplementation are imperative for bone health.