Menopause

Menopause is a naturally occurring biologic process in women.  It is defined as the permanent end of menses and fertility occurring 12 twelve months after a patients last menstruation.  This happens when the female’s ovaries stop producing eggs and her body produces fewer hormones (estrogen and progesterone).  Menstrual periods generally become either more closely or more widely spaced, but may even come to a sudden stop.  An irregularity in menstrual cycles can occur for one to three years.  The onset typically occurs between the ages of 45 and 55.  Even though it is a natural process and not a medical illness, it still can have dramatic effects on a women’s mental and physical health.   These effects vary dramatically from one patient to another and are caused by the changes in the estrogen and progesterone. 

The symptoms of Menopause usually begin with hot flashes or sweats that are usually at their worst for the first year or two.   Other common symptoms include skin flushing, racing heart, and insomnia (trouble sleeping).  This change in hormones may also cause forgetfulness, mood swings, decreased sex drive, anxiety and even depression in some women.  It is important that women see their physician in the years prior to menopause, also known as perimenopause, so they learn what is expected and look for any preventative healthcare options.  Physicians can use blood and urine tests to measure changes in hormones and recommend the best treatment.

                Some things patients can do on their own to help manage the symptoms are reduce intake of caffeine, alcohol and spicy foods.  Getting regular exercise and performing relaxation techniques such as yoga can also decrease the severity.  Although for many women, these actions are simply not enough and prescription treatment is needed in addition.  The most common treatment used for the symptoms of Menopause is hormone replacement therapy.  Essentially hormone replacement therapy tries to mimic the natural human body’s production of those hormones to reduce those symptoms that are associated with dramatic swings in concentrations.  A slower reduction through prescription hormones can decrease severity of hot flashes and night sweats along with other symptoms caused by Menopause.  These treatments are very patient specific and vary from patient to patient.  Many different formulations of hormone therapy can be formulated by compounding pharmacies to meet these individual needs.  Hormones of all strengths and concentrations can be put into oral capsules, topical creams or gels, vaginal creams, suppositories, topical drops, and sublingual lozenges.  There are also other prescription alternatives to hormonal therapy that may work for some women.  Patients have found benefit in reduction of symptoms with the use of anti-depressant, anti-hypertensive and also anti-seizure medications. As with any medical treatment there are benefits and risks that must be weighted by the patient and their healthcare team before starting a treatment for Menopause symptoms.