Menopause - Symptoms and Treatment Options

Patricia A. Bowyer, M.D.

Menopause is the time in every woman's life when she stops having menstrual periods and it marks the end of a her reproductive years. By definition, menopause occurs when a woman has not had a period for 12 months or more. The average age of menopause is 50, but it can range from ages 41-59; most women go through menopause around the same age their own mothers did. By age 55, 95% of women have reached menopause. The several years that precede menopause is termed perimenopause, which can last for years, and is the cause of many problems typically associated with menopause.

Estrogen and progesterone, two female hormones, are produced primarily in the ovaries; at menopause, the ovaries stop manufacturing these chemicals. During perimenopause, estrogen and progesterone are produced erratically and this fluctuation produces a multitude of symptoms. Women experience changes in their menstrual cycles. Periods may be longer, shorter, heavier, lighter, more frequent, or may skip a month. The key is that there is a change from a woman's normal routine. She may also experience hot flashes, a flushing sensation that starts in the chest and travels up to the head, which are associated with nausea, perspiration, lightheadedness, palpitations, and anxiety. Hot flashes can last from minutes to an hour, and some women can have up to 30 episodes in 24 hours. When these occur at night, they lead to night sweats and insomnia. Hot flashes are caused by the brain trying to stimulate the ovaries to make more hormones. Other perimenopausal symptoms include mood swings, vaginal dryness, decreased libido, thinning of the skin, increased wrinkles, increased urinary tract infections, short-term memory loss, and decreased concentration.

Testing for menopause and perimenopause is limited. A blood test called FSH will show whether someone is in menopause. However, there are no reliable tests for perimenopause. Symptoms alone are usually used as a guide to diagnosis.

Perimenopausal symptoms will typically resolve in three to five years without any treatment. But several treatment options are available. The most common is to use low-dose birth control pills to provide the extra estrogen the perimenopausal body needs. Many women looking for a natural alternative to hormones turn to soy products which contain a plant estrogen (phytoestrogen) that can alleviate symptoms when taken at 25 - 50 mg per day. This is equivalent to a half-cup of soy nuts or one cup of soy milk. Soy preparations in the form of tablets, milkshakes, and nutritional food bars are available in pharmacy or grocery stores. Other sources of phytoestrogens are alfalfa, almonds, cashews, peanuts, apples, papaya, peas, tofu, and flaxseed. These therapies may take six to eight weeks to show any improvement in symptoms.

Lifestyle changes can improve perimenopausal symptoms. Regular exercise, eating a low-fat diet, decreasing caffeine intake, and relaxation techniques such as yoga and meditation can improve a woman's sense of well-being. Anecdotal evidence indicates vitamin B complex (200mg/day) and vitamin E (400 international units/day) may also help. Hot flashes are particularly bothersome, and tips to reduce these include: turn down the thermostat at home and work, avoid spicy foods, dress in layers, wear cotton fabrics, avoid hot beverages and avoid alcohol.

Menopause also has long-term effects on women. The risks of osteoporosis, Alzheimer's dementia, Parkinson's dementia, coronary artery disease, urinary incontinence, glaucoma, macular degeneration, and colorectal cancer increase. Treatment with hormone replacement therapy may help diminish some of these risks.

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