Menopause is not a single event
but rather a transition that could span up to a decade—and can
even start as early as the mid-30s. This transition begins with
perimenopause, when a woman may still have her period, but may
have hot flashes or experience changes in the menstrual cycle.
The body may also begin changing shape and adding weight,
especially around the stomach and mid-section. Other symptoms
can include anxiety, depression, fatigue, vaginal and bladder
problems and lack of libido.
“These first changes may be
very subtle and difficult to recognize,” explains
Michele McDermott, M.D., an endocrinologist with The Austin
Diagnostic Clinic (ADC). Dr. McDermott is the director of the
Menopause Center at ADC, which provides an innovative and
individualized approach to providing services for women in
midlife. “It’s important, however, to take note of them and to
talk to your doctor about any changes you are experiencing. The
transition from perimenopause into the first few years of
menopause is when managing symptoms can be most beneficial.”
Measurement of estrogen and follicle stimulating hormone (FSH)
in the blood may help to identify the onset of perimenopause,
but is not nearly as sensitive as a woman’s perception of
changes in her body. These hormones fluctuate greatly in the
years preceding menopause and may not fall in to the
postmenopausal range until a woman has experienced symptoms for
several years.
Navigating the treatment maze
Since the average onset of menopause is at age 50, many women
today can live nearly half of their lives post-menopause. For
this reason, it’s more important than ever to treat and control
the symptoms so that they don’t interfere with daily work and
lifestyles.
Hormone replacement therapy (HRT) was once the standard for
treating menopause symptoms. But since 2002, a series of
long-term studies have concluded that the risks of hormone
replacement may outweigh the benefits. Women using combination
estrogen-progestin were found to have higher rates of heart
disease, breast cancer, stroke, blood clots and dementia. For
women taking estrogen-only therapy (usually taken by women who
have undergone surgical menopause, such as a hysterectomy),
researchers found a slight increase in strokes. But Dr.
McDermott cautions that these studies do not mean HRT is risky
for all women.
“These studies tested the benefits and risks of HRT in older
women and its effects on the conditions of aging,” she says.
“Hormones are still a safe and effective option as a short-term
treatment in younger women. Your doctor can help you decide if
they are right for you.”
Many women have started taking over-the-counter herbal
treatments for symptoms, including black cohosh for the
treatment of hot flashes. Others have found that antidepressants
such as Paxil are effective at controlling symptoms such as hot
flashes and mood swings. While there can be benefits with these
treatments, Dr. McDermott recommends proceeding with caution and
only under the watchful eye of your physician.
“Herbs can be just as powerful as prescriptions, but they aren’t
regulated. They may also interfere with other medications that
you are taking,” she explains. “And although there are some
proven benefits to using antidepressants, more research is
needed before they can be officially approved safe and effective
for menopausal symptoms.”
Perhaps one of the best ways to feel good throughout menopause
is to follow a healthy diet and exercise plan. A German study of
early postmenopausal women found that those who performed an
hour of aerobic and strength-training exercises four days a week
had fewer migraines, mood swings and sleepless nights than less
active women.
Paula Starche, M.D., also an ADC internist at the Menopause
Center, adds that eating well and exercising can combat
osteoporosis as well.
"Osteoporosis is one of the biggest risks to women who stop
long-term HRT treatment,” says Dr. Starche. “When women go off
HRT, they immediately start to lose bone mass and their risk for
osteoporosis becomes similar to what it was when they weren’t on
hormones. Getting at least 1,500 milligrams of calcium a day and
doing weight-bearing exercises such as walking, jogging and
dancing is necessary to help prevent osteoporosis.”
And the benefits to eating well and exercising don’t end there.
“One of the most important factors that needs to be addressed by
women facing menopause is weight—60 percent of post-menopausal
women are obese,” says Dr. McDermott.
By addressing each individual symptom of menopause—from hot
flashes to migraines—the full effect of menopause on your health
and well being can be reduced. Recognizing and taking control of
these symptoms can help you feel good for years to come.
