DEAR DOCTOR: I’m 53 years old, officially in menopause — and officially miserable. I’ve got hot flashes, headaches, insomnia and crazy mood swings, and it’s making me depressed. My doctor means well, but he doesn’t really listen and keeps suggesting hormone therapy. Is this really my only option?
DEAR READER: Although we tend to talk about menopause in terms of the physical changes and symptoms that occur during this time of life, the experience affects us emotionally and psychologically as well. Like it or not, there’s long been a stigma attached to the ending of a women’s fertile years, which can make going through menopause an isolating time. The good news is that there are a number of approaches for managing menopausal symptoms.
Menopause is the stage of life when a woman has stopped having a monthly menstrual period. The ovaries have stopped releasing eggs, and the body is no longer producing the hormones estrogen and progesterone. Production of testosterone drops at this time, too. These hormonal changes often cause a range of physical symptoms.
From what we see in our practices, up to 80% of patients experience some degree of symptoms during menopause. These include hot flashes, flushing and night sweats, which are known as vasomotor symptoms, and they can cause great discomfort and distress. Additional symptoms can include the insomnia and mood swings that you have been experiencing, as well as urinary incontinence, vaginal dryness, changes to skin tone and elasticity, and a drop in sex drive. Anxiety, depression, headache and changes to the ability to concentrate can occur as well.
When it comes to hot flashes, hormone replacement therapy — which can be oral, topical or vaginal — is certainly effective. If this seems the best route for a particular patient, we always focus on using the lowest dosage for the shortest amount of time. Studies have shown that low doses of the antidepressants Paxil and Effexor can also offer relief. Their use in menopause treatment has been approved by the U.S. Food and Drug Administration. Other medications may provide some women with relief from hot flashes are gabapentin, an antiseizure medication, and clonidine, a high blood pressure medication. Although black cohosh, an herb sold as a dietary supplement, can be effective in relieving menopause symptoms, it can have adverse effects that range from mild — stomach upset and headache — to severe, including liver damage.
We help our patients explore nonpharmacological lifestyle interventions before moving to hormone replacement therapy. Acupuncture and yoga can improve sleep, concentration and mood. Mindfulness, relaxation, hypnosis and cognitive and behavior therapies can relieve stress, anxiety and fatigue. Foods like soybeans, chickpeas, lentils, flaxseed, grains and beans, which contain plant estrogens, may help. There is also evidence that sugar and sugary foods can worsen hot flashes.
Post-menopausal women are at higher risk of osteoporosis and heart disease, so a balanced and healthy diet becomes even more important. We are fans of MenoPro, a free app offered by the North American Menopause Society, which is designed to help you and your physician identify problems and make treatment decisions.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.