Wellness Watch is a health information and advice column from OhioHealth.
“Stop the roller coaster, I want to get off!”
That’s how many women feel about menopause and the changes that come with it: hot flashes, night sweats, mental confusion and intense mood shifts.
“Women don’t feel like themselves. They want to feel better, and they want to feel heard,” said Dr. Jody Gerome said. Gerome is an obstetrician/gynecologist with OhioHealth Physicians Group and Heritage College Obstetrics and Gynecology in Athens.
Menopause occurs when a woman’s ovaries stop producing estrogen, and she goes 12 consecutive months without a period. Perimenopause can begin eight to 10 years before menopause.
Although menopause is a natural process and not an illness, the accompanying symptoms can make life miserable for some women, and put them at greater risk for bone loss and heart and vascular disease.
For the past 25 years, women have been receiving mixed signals on how to best treat menopausal symptoms, Gerome said. That is changing as knowledge and science have shed new light on menopause and the use of menopausal hormone therapy, or MHT.
Historically known as hormone replacement therapy, MHT restores the hormone estrogen, which declines as a woman goes through perimenopause and menopause. Progesterone often is added to protect the uterus from developing cancer.
Hormone therapy was the go-to treatment for menopausal symptoms until 2003, when reports from a national study found links between hormone therapy and breast cancer and cardiovascular disease, particularly stroke. HRT usage plummeted, leaving women with questions and no immediate answers.
Last November, the U.S. Food and Drug Administration removed warnings from hormone therapy drugs to indicate they are safer to use than originally thought.
Prior reports from the studies “likely undersold the benefits and oversold the risks,” Gerome said.
For example, some women in the original studies were in their 60s and 70s, which put them at higher risk for cancer and cardiovascular disease to begin with, she said. Also, the hormone doses were higher and less individually tailored than they are today.
After years of being “largely ignored” in healthcare, women now are the focus of more research and treatment, Gerome said. “When we know more, we do better.”
For example, leading women’s health groups now recommend that women use gels, patches and vaginal inserts because the body processes them differently than the pill form of MHT, which lowers risk, Gerome said.
“Hormone therapy can be safe for most women seeking treatment for their symptoms,” she said. “Its safety is similar to birth control pills in most situations.”
The FDA recently approved two new drugs to expand treatment options, including a lower-cost generic version of one medication, and another non-hormonal treatment for severe hot flashes and similar symptoms.
Many over-the-counter products and so-called bioidentical hormones also are on the market, but Gerome warns women to be cautious.
“Many of these are highly unregulated, so there may be inconsistencies between batches,” George said. “If you can use an FDA-approved product, it generally is safer.”
Women also have access to a growing set of guidelines to help them navigate the menopause journey, including:
- Avoiding or limiting caffeine and alcohol.
- Not smoking — smoking is known to have harmful effects on arteries, which can lead to heart disease.
- Stress-reduction techniques and physical activities such as walking, yoga and swimming.
- Talking with other women who are in menopause or who have gone through it.
- Eating a diet with foods that function like estrogen, such as soy, flaxseed and beans.
- Prescription medications that do not contain hormones.
- Supplements and other medications to prevent bone loss and cardiovascular problems.
It’s important for women to have a trusted medical adviser with whom they can discuss the more intimate aspects of menopause, such as vaginal dryness, pain with intercourse and loss of sex drive. Many women experience memory loss, lack of focus and confusion, also known as “brain fog.” This can cause them to worry if they are in the early phases of dementia.
Learning that these things are a normal part of menopause in itself can provide a sense of relief, Gerome said.
“Reach out to your trusted healthcare professional. We can help, please ask.”
