Menopause Treatment Options

By: April Merritt, MD

When you say the word menopause, women may look at you sympathetically while men may look at you with uncomfortable fear. The word menopause is quite benign, coming from the Greek word that literally means “monthly pause.”

What is menopause?

The true definition of menopause is when you stop having a menstrual cycle for 12 months. However, menopause usually means much more than just stopping your menstrual cycle. It can be accompanied by hot flashes, night sweats, vaginal dryness, decreased sex drive, irritability, emotional distress, dry skin and thinning hair. To make it even more interesting, you can have any variety of symptoms for years leading up to and after menopause, known as perimenopause.

You do not always have symptoms with menopause; a small number of women may have no symptoms. Menopause is a natural occurrence, or it can be set in motion by removal of the ovaries. Often, I get asked, “If it is a natural occurrence, then I should just naturally let it happen and do nothing. Right?” The answer depends on your severity of symptoms. Sometimes the symptoms are so frequent or great that it interrupts daily life. It is these times that you should know there is treatment. There is no reason for someone to suffer through the symptoms of menopause. So, what are your treatment options?



Treatment Options

1. Over the counter (OTC) or natural therapy. This option comes as a variety of therapies. There is black cohosh and don qui, together sold as “Estroven.” This combination can decrease hot flashes and night sweats. Another over the counter option is “icool”, a soy supplement that can also decrease hot flashes. Recently, Relizen began being sold in the U.S. This is a natural supplement made from Swedish pollen flower extract, which is marketed as saying it can decrease hot flashes and night sweats. If you walk through the grocery store, you can see a variety of “menopausal tea” that is meant to decrease symptoms as well. But what if you try these, and you are still suffering?

2. SSRI or Selective Serotonin Reuptake Inhibitor. Effexor is an antidepressant that, at low doses, can help hot flashes. As an upside, it can also help with moodiness and irritability associated with menopause. Not all antidepressants can be used in this manner; however, Effexor is one that can work.

3. Hormone Replacement Therapy (HRT). When discussing HRT, we usually mean estrogen and progesterone. Loss of estrogen is what causes the hot flashes and night sweats. If you replace it, it should eliminate the hot flashes. Progesterone is necessary if you are on estrogen and still have a uterus. The uterus will respond to estrogen and can build a lining, leading to bleeding. Progesterone is prescribed to protect the uterus and keep it from building up a lining. Progesterone can also help with sleep in some cases. The downside to HRT is that is not a benign treatment. It can have side effects like elevated blood pressure and blood clots in the leg. These are rare but can happen. Some women with a strong family history of breast cancer or personal history of breast cancer may not be eligible for HRT.

4. Testosterone Therapy. Why would the “male hormone” help you in menopause? We are made up of estrogen and testosterone. In our bodies, we have an enzyme called aromatase. Aromatase breaks down testosterone into usable testosterone (which can increase the sex drive) and estrogen (to help fight hot flashes). The best way to get testosterone is through pellets placed every three to four months; however, some women respond to testosterone cream as well.

The bottom line is we are all different, and we handle menopause differently. At Women’s Care, a provider can sit down with you to evaluate your symptoms and develop a treatment strategy customized for you. What works for one person may not work for another. We are here to help you find the treatment that fits your symptoms. Do not suffer because something that happens “naturally” is affecting you in a negative way. Contact your Women’s Care provider for help.