House Call: Menopause misery? Breakthroughs, hope and estrogen

Interrupted sleep, night sweats, low energy, painful sex, rapid changes in mood and emotions, anxiety and hot flashes – these are just some of miserable symptoms that I frequently hear about from patients who have been trying cope with menopause symptoms on their own.

I’ve had patients who said menopause symptoms made them feel like they were falling apart or with symptoms so severe that they were worried about a serious medical condition.

For many years, women suffering from menopause-related symptoms were often advised to ride out “the change” without treatment or remedy. There has been a lack of research, misinformation and inattention to the effects of hormonal changes from menopause. The response to menopause symptoms was often to tell patients that it’s just a natural part of life.

Thankfully, we’ve reconsidered, in part due to significant new findings about the safety and effectiveness of hormone replacement therapy which can show that benefits of HRT for the treatment of menopause symptoms may outweigh the risks.

Menopause may be a natural process, but there are safe, effective treatments that can stop suffering through years of symptoms and restore health. It is serious when symptoms from hormonal changes impact your life and health even if it isn’t life-threatening. Please bring up your symptoms with your clinician, there is hope for help.

What is menopause?

Menopause is officially diagnosed after a person has gone 12 months without a period, but many people have symptoms for years before that as hormones decline, called perimenopause. It’s a temporary state of adjustment. The symptoms can be off and on and change–sometimes frequently – over the perimenopause years as hormones fluctuate. Some people’s symptoms resolve over time, and some can have symptoms for many years after menopause.

The average age of menopause is 51, but some women can experience it much earlier or later, so it’s really a range. Menstrual periods may become irregular, longer or shorter, and heavier or lighter. Please note that you can still get pregnant when in perimenopause. Once your ovaries stop releasing eggs, menstruation stops (and pregnancy risk).

While some people have no symptoms at all, menopause can trigger a constellation of symptoms that wreak havoc on your well-being, life and sex life – hot flashes, depleted energy, disrupted sleep, vaginal dryness, lower libido, painful sex and risk for severe depression are just some of the more common issues. Symptoms can range from totally absent to merely bothersome to severe and life-altering.

How can I manage my symptoms?

Lifestyle changes can support women through perimenopause and beyond. A healthy diet, regular exercise and some simple tricks like keeping your bedroom cool can work for some people to manage symptoms. Some people find meditation and acupuncture helpful for riding out hot flashes and other symptoms. You might need to experiment a little to find out what works best for your body.

If your symptoms are more frequent, severe or interfering with your life and sleep, talk to your clinician about the options that align with your needs and health history. There are prescription and over-the-counter medications for vaginal dryness and painful sex including topical estrogen and non-estrogen lubricants. Treatments for disrupted sleep can be addressed both with lifestyle changes and with medication if needed.

Is hormone therapy safe?

New studies published in JAMA, the journal of the American Medical Association, show that for most women younger than 60 or within five to 10 years of menopause, hormone therapy has low risk and is a safe treatment for menopause symptoms.

Previously, many women were advised to forgo the therapy based on a study from two decades ago that is now considered flawed. The new analysis looked at women closer to the age of menopause and at the types of HRT and lower doses that are more commonly recommended now.

Hormone replacement therapy for menopause symptoms has been life changing for some of my patients. Typically, estrogen is prescribed in the form of a transdermal patch or a topical cream in combination with progesterone.

HRT helps reduce or resolve symptoms like hot flashes, vaginal discomfort, mood swings and insomnia. It can boost libido and energy levels. There are other benefits to estrogen such as reducing bone loss and reducing risk of some diseases like diabetes, osteoporosis and colon cancer. Like most medications, there are risks as well, particularly with long-term use, such as slightly elevated risk cardiovascular and breast cancer risks. HRT isn’t for everyone, but it is now considered a safe and effective option for many people.

Having 10 hot flashes a day, waking up multiple times a night, having pain during sex, and feeling low energy and mood are not something to just live with. Talk with your clinician about your choices for symptom relief and learn more about options like hormone replacement therapy.

With advances in effective treatments for menopause’s hormonal symptoms, clinicians have a greater range of options to offer. Combined with new research and a shift in culture toward women asking more questions and discussing menopause more openly, we’re making progress on helping women in menopause find renewed vigor in life.

David Ward is a family physician at Kaiser Permanente in Spokane.