EXPERT COLUMN: WOMEN OVER 50

Making Menopause Tolerable: Remedies You Should Know About

Cheryl Slomkowski, PhD @cherylslomphd
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June 16, 2017  | Last Updated: June 16, 2017

 

Nearly every menopausal woman will experience lifestyle-compromising symptoms, many of which can be unendurable. The list can seem daunting – hot flashes, night sweats, anxiety and depression, sexual function problems, sleep disturbances, fatigue, impaired memory and concentration, low bone density and fractures, and weight gain. So this is not exactly hangnail territory, and many of these problems are now estimated to last for 5 years or more.

That said, it’s not all gloom and doom. The days are gone when we are expected to throw up our hands in surrender to biology. There is a remedy out there to alleviate almost every symptom for almost every woman, offered with less risk than the prior generation of treatments.

 

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Don’t believe it? Here are just a few effective match-ups:

  • How to stop hot flashes? Hormone therapy and antidepressants.
  • Mood changes? Low-dose antidepressants.
  • Painful intercourse? Estrogen cream or tablet.

It behooves women to apprise themselves of the available treatments and make decisions with their doctors about what is their best path to relief. Even those who cannot tolerate estrogen supplements have some options nowadays. There are five recognized FDA-approved treatments for menopausal symptoms, plus some less established but promising antidotes to the most bothersome and intrusive bodily changes that occur. The approved effective treatments are:

  1. Postmenopausal hormone therapy (HT). This treatment is usually well-tolerated in new dosages of estrogen alone and estrogen plus progesterone for women with a uterus. Estrogen alone is generally associated with fewer risks, but HT and menopausal treatments in general are becoming more individualized and personalized.
  2. Vaginal estrogen. Creams or suppository tablets aid in thickening vaginal tissue making sexual intercourse more comfortable.
  3. Low-dose antidepressants. These have been used effectively in the treatment of both the mood changes associated with menopause, such as anxiety and depression, as well as with hot flashes.
  4. Gabapentin. This is a medication originally approved to treat seizures, but has proven to be effective to reduce hot flashes. It is an alternative to estrogen therapy and for those with migraines.
  5. Osteoporosis medications. Several medications are available to prevent or treat bone loss and risk of fractures.

There are also non-hormonal interventions that are not FDA-approved, but frequently prescribed off-label. These can be especially important where HT is contraindicated, such as a history of breast cancer, endometrial cancer, cardiovascular disease, severe active liver disease, or migraines. Many women for whom traditional HT has not worked are turning to bioidentical hormone pellet therapy. These are time-released pellets of human hormones, or non-FDA-approved compounded bioidentical HT (CBHT or BHT). A woman’s unique symptoms and hormone levels are determined, and then a personalized BHT program is designed for the patient. Usually some combination of estrogens and testosterone, in the form of rice-grain sized pellets, are inserted under the skin (usually the buttocks). These hormones are slowly released into the bloodstream, ideally mimicking what the ovaries once did. It is important to reiterate that this treatment, while called “bioidentical,” has not been established to be the exact equivalent of human hormones. The definition can mean non-artificial, compounded, plant-derived, or chemically identical to the human hormone structure.

It is acknowledged that any form of treatment can come with side effects and risks. Thus it is imperative that every woman must evaluate the risks and benefits of any treatment and discuss with her doctor what is the safest, most effective approach for her.

Today there is a medical treatment available for almost every woman for the vast majority of problematic symptoms of menopause. If you want relief, you must resolve to be an intrepid researcher and make an informed, specific plan with your doctor. Remedies for the trials and tribulations of menopause are not only achievable, but – dare I say? – are prudent and desirable.

 

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