Published Wednesday, February 12, 2014
by C. Nicole Swiner, Columnist
By the age of 50, most women have experienced or are experiencing menopause. This feared phenomenon is a natural progression of a women’s menstrual cycle, and after a full year without a period, we consider it done.
However, the stopping of menses is just one of the many effects menopause causes, and almost every woman is familiar with the others but may not know of all of them. I’m talking about the feared hot flashes, along with mood changes, weight changes, vaginal dryness and irritation, hair loss, decreased sexual desire and memory difficulty, to name a few. As a doctor that treats women of every age, I blame almost anything on menopause.
“Doc, why am I starting to get acne again at 50?” Menopause. “Why am I gaining weight and I exercise every day and eat the same amount of food? Menopause.
Most women welcome this natural change of life, if for nothing else than the fact of not having to worry about a menstrual cycle. However, I do have patients and friends who are fearful, as it signals the end of child bearing. For others, it’s an issue to explain why they are breaking out their handheld fans or plugging in fans at work when everyone else is cold.
Because there can be other causes for these symptoms, such as thyroid disease, iron deficiency or even depression, I like to test a woman’s hormone levels to judge where she is in her cycle of life. I test FSH and LH levels, which can correspond to a lady’s estrogen and progesterone level, respectively. If perimenopause (meaning near menopause) or menopause is confirmed, then treatments can be considered.
There are many ways I treat these symptoms – both natural and pharmaceutical. I generally like to start with offering natural treatments as they are widely available and have less side effects. Supplements such as soy, evening primrose oil, black cohosh and wild yam extract are available in almost every store now. Each one works differently for each woman. You have to try a couple of weeks on each to see which works best for you. Somehow, these natural replacements stimulate estrogen or behave like estrogen in the blood stream.
The same is true for a product called Estroven, which has a combination of these types of supplements, primarily soy or black cohosh, which is also over the counter. Side effects are minimal, but there are some cases of vaginal bleeding, which we have to carefully monitor and evaluate. There also aren’t many contraindications to trying them since they are natural. These products can be purchased on your own, or you can go to a pharmacy that performs bioidentical hormone treatments that can mix up and prescribe a specific formulation just for you. Testing can be done there via the blood or saliva, and your own recipe is made for you. This is usually a cash-only service and not covered through insurance, but it’s often very beneficial.
Another class of medications to consider if natural isn’t the way is for some of the antidepressants and anti-anxiety medicines. Surprisingly, medicines such as Effexor and Zoloft are used to treat symptoms of menopause and have proven to be helpful. The dopamine, serotonin or epinephrine released by these medicines are “feel good” hormones that fight the hot flashes and mood changes that occur with the change of life.
There are other medicines that have been proven to help in other categories not generally thought to help hormones like clonidine. Clonidine is a type of blood pressure medicine that dilates the blood vessels and somehow reduces night sweats.
Lastly, there are the hormone replacement treatments that are still widely used. You may have heard of Premarin or Prempro. We still use these for menopausal symptoms, but try to limit the amount of time to a year, if possible, to reduce the potential of side effects. The most worrisome of these negative effects are heart attack, stroke and some cancers. A patient’s personal and family history, as well as the presence or absence of their gynecological organs, need to be weighed to make sure she is a good candidate to use these medicines.
All in all, there are many ways to make this transition smoother, and you don’t have to suffer in silence. Ask your doctor which category of medicine is right for you.
Dr. C. Nicole Swiner works at Durham Family Medicine, where she treats newborns to elderly patients. She and her colleagues are accepting new patients and can be found at http://www.durhamfamilymedicine.net.