You can think of menopause in two stages: First is the perimenopause stage (around the time when your periods change). This is when you still have bleeding, but it is irregular with longer breaks between periods. Second is the post-menopause stage. (no periods for 1 year) Menopausal symptoms can happen at either stage. Some women start to feel symptoms even in their early 40s.
The most common symptom of menopause is “hot flashes”. You may feel sudden feeling of warmth over your face, neck, and chest and experience redness on your skin. You can feel like you are “overheating” and feel sweaty. These symptoms can last for up to 10 years after menopause and can cause disruptions in a woman’s quality of life. Women who have hot flashes may also have menopausal mood disorders. You might feel more irritable, agitated, anxious, or depressed.
Other common complaints of menopause are: difficulty sleeping, joint pains, headaches, vaginal dryness, or forgetfulness.
Menopausal symptoms can be treated with Menopausal Hormone Therapy (MHT) or Non-Hormonal Therapy.
The main goal of MHT is to relieve hot flashes. But the other symptoms like sleep disturbances, unstable moods/depression, and, in some cases, joint pains may also be helped by MHT (estrogen).
Menopausal Hormone Therapy (MHT) consists of estrogen alone (if a women had her uterus removed) or combined estrogen-progesterone therapy (for women with a uterus). There are different preparations of both estrogen and progesterone. Your doctor can discuss which is best for you.
Non-hormonal Therapies include SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors). These are antidepressants which have been shown to reduce hot flashes and improve mood disorders during menopause. Gabapentin can also improve hot flashes and sweating, especially at bedtime. A newer medication, Fezolinetant (Veozah) is an option for moderate-severe hot flashes. Non-hormonal therapies are good options if you prefer to NOT take hormones, or you have a medical reason PREVENTS you from using hormones.
Treatment options are based on your medical history and your preferences. Some of the factors to consider before starting MHT are: age, the severity symptoms, past medical problems, 10-year risk for heart disease and 5-year risk for breast cancer.
Don’t hesitate to speak with your primary care provider at City Care Family Practice if you are having difficulty managing your menopausal symptoms.
References:
1. “The 2022 Hormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause 2022; 29:767.
2. “Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging”. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ, STRAW + 10 Collaborative Group J Clin Endocrinol Metab. 2012;97(4):1159. Epub 2012 Feb 16.
3. Stuenkel CA, Davis SR, Gompel A, Lumsden MA, Murad MH, Pinkerton JV, Santen RJ. Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2015 Nov;100(11):3975-4011. doi: 10.1210/jc.2015-2236. Epub 2015 Oct 7. PMID: 26444994.
4. “The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. doi: 10.1097/GME.0000000000002200. PMID: 37252752.
