Dr. Rakhi Gupta, gynecologist at Good Samaritan Hospital (Kim Hairston, Baltimore…)
Every woman will experience menopause, some in the normal course of aging and some before. It can bring on a host of symptoms in addition to hot flashes. But there are things that women can do, from improving their diet and exercising to finding the right treatment, explains Dr. Rakhi Gupta, a gynecologist at the Center for Women's Health at Good Samaritan Hospital. She answers some common questions about this life change.
What is menopause?
Menopause is a normal life change that occurs as women age, usually between their late 40s and 50s. Menopause is defined as the discontinuation of menstruation for one year or more. Women who undergo natural menopause often experience the process in stages: perimenopause, menopause and postmenopause.
If menopause occurs prematurely, can this be stopped?
Premature menopause can occur as a result of genetics, medical conditions, surgical therapies and treatment for cancer. Although the occurrence of premature menopause cannot often be controlled or changed, the resulting symptoms can be treated.
What do decreased hormones have to do with infertility?
Dysfunction in the natural hormonal cycle can result in infertility problems at multiple levels. Hormonal imbalances affect ovulation, the release of an egg from the ovary at midcycle, which is pivotal to fertility. Hormonal changes during the normal cycle are also involved with building up of the uterine lining in preparation for pregnancy. Diminishing ovarian function as women approach menopause affects hormone levels, thereby decreasing fertility.
Another aspect of fertility and aging in women is that as they get older, so do their eggs. Also, the overall number of eggs decreases with time. However, women who are perimenopausal and having menstrual cycles are still able to conceive, and should consider contraception if they do not wish to become pregnant.
When is hormone replacement therapy recommended, and when is it best avoided?
Dwindling ovarian function at menopause results in reduced levels of the female hormones estrogen and progesterone. Symptoms associated with this decline include hot flashes and decreased bone mineral density. Reduced bone density can, in turn, lead to osteoporosis.
Hot flashes are perhaps the best-known symptom of menopause. The occurrence of hot flashes varies in frequency and intensity from person to person and over time. They can be severe and frequent enough to interfere with daily activities and even with sleep. When this is the case, women may seek relief in the form of hormone replacement therapy (HRT). In general, the current practice is to use the lowest effective dose of HRT to relieve symptoms and to use it for the least amount of time necessary.
Some women are not good candidates for HRT due to the associated risks, which include the risk of blood clotting events and the increase in breast cancer diagnoses among long-term HRT uses. Women who probably should not take HRT are those who have a personal history of breast cancer, a history of blood clot or stroke, active liver disease, a history of heart disease or heart attack, and those who smoke.
Are there alternative treatments for symptoms of menopause?
Among prescription medications, certain antidepressants may be effective in relieving hot flashes. Medications for high blood pressure and for seizure disorder have been used for this purpose as well. For women who are close to menopause but still having menstrual periods, low-dose oral contraceptives can improve hot flashes and regulate cycles.
The term "bioidentical hormone therapy" describes a category of medications which are similar to the natural hormones made in a woman's body. This classification has often been applied to compounds custom-made by a pharmacist based on a doctor's order for a specific patient. These products have not been shown to be better or safer than medications approved by the Food & Drug Administration.
Phytoestrogens are plant-derived compounds which act like estrogens in the body. Sources of phytoestrogens include soy and herbs such as black cohosh, wild yam, dong quai, valerian root, and flaxseed. Unfortunately, studies have not shown much benefit for hot flashes with these products. Furthermore, we do not know enough about their risks.
Another alternative therapy for hot flashes is acupuncture. After each treatment, women have reported up to three months of relief from symptoms.
There are multiple lifestyle changes that women can make to improve hot flashes as well as their overall health. Regular exercise and weight loss can benefit hot flashes and improve bone strength, sleep patterns, and mood.
Smoking cessation is especially important for menopausal women for multiple reasons. Cigarette smoking can trigger hot flashes and is also linked to bladder problems and thinning of the bones.
What does research say about health problems linked to menopause and preventing or treating them?