Menopause: A new step in life

Date updated: February 22, 2007 

Distributor

By Maryalice Yakutchik
Content provided by Revolution Health Group

Menopause means your menstruating days are over. Period.

Clinically, menopause is your last and final period. Colloquially speaking, menopause is a mid-life transition punctuated by hot flashes and night sweats instead of periods.

It's a time of life that gets a bit of a bad rap.

"We've convinced women that when you hit 50, your vagina is going to shrivel up, your skin will wrinkle, your bones will become frail and brittle, and life is over," says Tieraona Low Dog, M.D., adding: "That's patently, absolutely false."

The age of 51 – is when ovaries, on average, stop functioning, though menopause can occur anywhere from 45 to 55. When it happens, your body loses almost all of its estrogen, 90 percent of which is produced by the ovaries.

Symptoms
Menopause is the flip side of puberty. It doesn't require medical treatment. But lots of women are convinced otherwise, says Low Dog: "Women often come into my office saying: I'm not having any symptoms, but what should I take? What should I do?"

In fact, 30 percent of women won't experience any symptoms at all during menopause. You might be the 1 in 3 who is home free, or you might experience symptoms that range from mild, moderate to severe. Those are:

• hot flashes
• vaginal dryness
• irritability
• insomnia
• depression
• incontinence

Some women also complain about memory problems – "perhaps because they're tired from being up all night hot-flashing," says Redonda G. Miller, M.D., associate professor of medicine at The Johns Hopkins University School of Medicine.

Coping
If you're bothered by mild to moderate symptoms, Miller suggests making simple lifestyle modifications:

• wear layered clothing that can be peeled off in the event of hot flashes
• stay away from triggers; these differ from woman to woman and include everything from caffeine and spicy foods to alcohol
• practice paced breathing, meditation or relaxation
• exercise regularly
• take vitamin E; it can help with vaginal dryness
• eat more legumes and soy products

What about alternative treatments?
"Of all of them, black cohosh -- an indigenous plant -- has got the best evidence of benefit," Low Dog says. "You want to take the dose used in the trials: 40-160 mg a day."

Commission E, a German governmental regulatory agency composed of scientists, physicians and pharmacists, has produced the best body of literature regarding black cohosh. Commission E says black cohosh works, but advises against using it for more than six months because of possible liver toxicity.

You need to assess the risk-benefit of all treatment options, Low Dog advises: "Those things with less risk have less benefit."

Anti-depressants have also shown to be effective for some. And, finally, the most popular and controversial option is hormone replacement therapy (HRT). It has more risks -- and greater benefits -- than anything else.

Hormone-replacement therapy
"There's nothing in the alternative world that works as well as estrogen," Low Dog says. "That's just the way it is."

Says Miller: "It is hands-down the best treatment."

If you're miserable, meaning symptoms are interfering in your life, Low Dog and Miller advise taking the lowest dose of estrogen for the shortest time possible, defined as five years or less.

"Hormone therapy will decrease the frequency and severity of hot flashes by over 90 percent," says Miller.

But it has its risks. One undisputed risk is increased chance of blood clots and gallstones. Many experts -- perhaps the majority -- believe that HRT causes breast cancer. "If you asked the bulk of experts, they would say there is a link to breast cancer. I need more convincing data," Miller says.

Bone loss
Because of the risks associated with HRT, Miller doesn't prescribe it for the sole purpose of slowing bone loss that accelerates during menopause.

Instead, she recommends weight-bearing exercise. Resistance training is great, and so is walking. Also vital to maintaining bone density if you're not on HRT is taking 1200 mg of calcium and 400 IU of Vitamin D daily.

One final word from Low Dog: "You can't assume that any "natural" hormone is safer than the conventional estrogen," she says, adding the media does a great disservice to women when it says "natural" hormones are safer than estrogen."