Menopause treatment

The symptoms

The most prominent symptoms of menopause tend to be the following:

• Hot flashes and night sweats. Women often experience hot flashes as an intense build-up in body heat, followed by sweating and chills. Some women report an accompanying anxiety as the sensation builds. In most cases hot flashes resolve within two years, although in some women they may occasionally recur for years.
• Heart pounding or racing can occur, with or independent from hot flashes.
• Difficulty sleeping. Insomnia is also common during menopause; it may be caused by the hot flashes or it may be an independent symptom of hormonal changes.
• Mood changes. Mood changes are most likely to be a combination of sleeplessness, hormonal swings, and psychologic factors as a woman undergoes this intense passage in her life. Depression, however, is no more common after menopause than before, and, in some studies the majority of women finds it a positive experience and welcomes it with relief and as a sign of a new stage in life. One study found no link between menopause and a woman’s state of mind. In fact, middle-aged women overwhelmingly report satisfaction with their home and work lives.
• Sexuality. Sexual responsiveness tends to decline in most women after menopause, although other aspects of sexual function, including interest, frequency, and vaginal dryness vary. It is useful to remember that the symptoms of menopause eventually go away.
• Forgetfulness. This appears to be one of the few symptoms that are common across most cultural and ethnic groups.
• Urine leakage.
• Vaginal dryness.
• Joint stiffness.

Women from different ethnic and or cultural groups report different menopausal symptoms. For example, in one study hot flashes occurred in about 30% of Caucasians and 45% of African Americans. Hispanic women tended to complain of urine leakage, vaginal dryness, and heart pounding. Japanese and Chinese women experienced far fewer menopausal symptoms, except for forgetfulness. All groups complained about this symptom.

Over-the-Counter Medications

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) include the common painkillers aspirin and ibuprofen (Advil, Motrin) among many others, and they may be sufficient for relief of menopausal symptoms. Taking aspirin or any NSAID on a regular basis can increase the risk for gastrointestinal bleeding, and therefore any decision to take such medications regularly should be discussed with a physician.

Lubricants for Vaginal Dryness. For vaginal dryness, moisturizers, and non-estrogen lubricants, such as KY Jelly, Replens, and Astroglide are available. (Frequent sexual activity helps preserve the lining of the vagina and maintain an acidic environment to protect against infection.)

Vitamin E. Vitamin E supplements may help women with hot flashes.

Hormonal Agents for Menopausal Symptom

Hormone Replacement Therapy (HRT). In one study, 80% of women taking hormone replacement therapy reported symptom relief, compared to 30% of women who took a placebo (an inactive agent). HRT can alleviate bothersome symptoms associated with menopause, including the following:

• Vaginal atrophy leading to dryness.
• Hot flashes.
• Sleep problems.
• Mild depression.

Oral hormonal medications and skin patches are equally effective in reducing hot flashes, mild depression, and sleep problems. Progestins may sometimes be prescribed alone for hot flashes and other acute menopausal symptoms, though they can cause side effects, such as mood swings, bloating, and breast tenderness. Estrogen creams, rings, or vaginal tablets restore vaginal elasticity and lubrication and improve sexual pleasure.

HRT does not prevent certain other problems associated with menopausal changes such as thinning hair. Furthermore, according to a 2002 study, if women do not have hot flashes, taking HRT does not improve their quality of life. In fact, women in the study who did not have hot flashes and took HRT generally had a worse quality of life, including fatigue and decline in physical functioning. (All the women in the study had heart disease, and it should be noted that HRT is no longer recommended for such patients.)

Oral Contraceptives. Oral contraceptives (OCs) generally use more potent forms of estrogen than those used for HRT and had not been thought suitable for replacement therapy. However, during the months before menopause, when periods may be irregular but contraception is still needed, low-dose forms of OCs may reduce the risk for bone loss and alleviate early menopausal symptoms, such as hot flashes.

Other Prescription Agents

Bellergal. Bellergal is the only non-hormonal drug specifically approved for hot flashes and other menopausal symptoms. This drug contains phenobarbital and belladonna and can be addictive. It relieves symptoms about half the time.

Gabapentin. One small study suggests that gabapentin (Neurontin, a drug used for many neurologic conditions) may alleviate hot flashes. More research is needed. The drug is expensive and may cause sleepiness, dizziness, and clumsiness.

Alternative Therapies

There are many unproved methods for alleviating menopausal symptoms, some more effective than others. Acupuncture, meditation, and relaxation techniques are all harmless ways to reduce the stress of menopause and some people report great benefit from these practices. Many women also try herbal or so-called natural remedies. [ See Box Warnings on Alternative and So-Called Natural Remedies]

Warnings on Alternative and So-Called Natural Remedies

It should be strongly noted that alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the body’s chemistry can, like any drug, produce side effects that may be harmful. Even if studies report positive benefits from herbal remedies, the compounds used in such studies are, in most cases, not what are being marketed to the public. There have been a number of reported cases of serious and even lethal side effects from herbal products. In addition, some so-called natural remedies were found to contain standard prescription medication. Of specific concern are studies suggesting that up to 30% of herbal patent remedies imported from China having been laced with potent pharmaceuticals such as phenacetin and steroids. Most problems reported occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals.

The following agents are sometimes use for menopausal symptoms and carry certain risks:

• The herb Cimicifuga racemosa (also known as black cohosh or squaw root) contains a plant estrogen and has been the herbal remedy most studied for menopausal symptoms. Some studies report that it may relieve menopausal symptoms. (Most use the brand Remifemin.) In a study of breast-cancer survivors, however, black cohosh was no more effective than a placebo in alleviating hot flashes. Headaches are common with black cohosh. Black cohosh has been used for decades in Germany and appears to be safe, but because its actions resemble estrogen, it should not be take with HRT and well-conducted clinical studies are needed to confirm both long-term safety and effectiveness. One study, for example, reported an association between black cohosh and cell proliferation in the uterus, which theoretically could increase cancer risk. At this time experts do not recommend taking it for more than six months.
• Dong quai has also been used, although one study found no additional benefits for menopausal symptoms compared to placebo (both reduced symptoms by 25% to 30%). Dong quai does not act like an estrogen, but appears to contain B vitamins, anti-inflammatory factors, muscle relaxants, and possibly progesterone-like substances. It should not be sued with blood-thinning agents, such as warfarin.
• Ginseng. Ginseng has hormonal qualities and should not be used with estrogen. It has also been associated with a hypoglycemia (low blood sugar) and a higher risk for uterine bleeding. In addition, a great number of ginseng products have been found to contain little or no ginseng. Of particular concern are reports of pesticide and other toxic contaminants in many ginseng products. In one analysis, only nine out of 22 brands did not contain major contaminants. Among the brands that did not contain contaminants were Celestial Seasoning, Centrum, Ginsana, Walgreen’s, and Root to Health American Ginseng.
• Kava kava. Some evidence suggest that kava kava may help reduce anxiety and depression without interfering with hormonal treatments. It should be noted, however, that kava kava has been associated with liver failure in some cases. It also interacts dangerously with certain medications, include alprazolam, an anti-anxiety drug.

The following website is building a database of natural remedy brands that it tests and rates. Not all are available yet. /www.ConsumerLab.com

The Food and Drug Administration has a program called MEDWATCH for people to report adverse reactions to untested substances, such as herbal remedies and vitamins (call 800-332-1088).

Source: http://www.umm.edu/patiented/articles/what_symptoms_of_menopause_their_treatments_000040_2.htm

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