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Coping with MenopauseMenopause is a time of many changes for women. New research is gradually stripping away old myths and adding knowledge about the best ways to preserve health and function in the postmenopausal years.
The most crucial fact of menopause is the absence of high levels of the hormones estrogen and progesterone. The replacement of estrogen, in particular, appears to reverse or stabilize many of the degenerative processes occurring after menopause. But whether an individual woman should take replacement hormones is a question that has to be answered by careful consideration of her own health risks. She has to know what risks could be lessened by this treatment and what risks could be heightened.
What we doctors have learned is that although many women are enthusiastic about taking ERT (Estrogen Replacement Therapy) or HRT (combined estrogen and progesterone therapy), many women are not. If started on HRT, many women simply stop it on their own.(1) The most commonly cited reason that I hear is the fear of an increased risk for breast cancer. Even though replacement hormones can have a significant effect on decreasing risks of death from heart disease or disability from osteoporosis, the fear of breast cancer carries the day. So ERT/HRT should not be an automatic prescription written at the time of menopause.
I have found that the most useful approach is to evaluate the various risks and problems my patients are experiencing and then to use the current best regimen that is most satisfactory. I explain menopausal changes and consequences and determine individual risk. I also discuss what are NOT inevitable consequences of menopause.
Mental SymptomsSignificant mental problems are not necessarily part of menopause. In fact, some women don't get any mental or psychological symptoms, and not all of the symptoms that occur during menopause are caused by menopause. Anxiety and depression are common in women, more common than in men. Major episodes of these conditions happen throughout life, including menopause. The last thing I would want to do is to attribute my patient's symptoms to "the time of life" rather than evaluating the symptoms and recommending appropriate treatment.
No precise determination has been made of the degree to which hormone changes are responsible for the reputed mood swings of menopause. A very common cause of irritability and changing mood is sleep deprivation due to nocturnal hot flashes. Treatment for the hot flashes (called "vasomotor" symptoms) can reverse irritability and mood swings. Estrogen is, hands down, the most effective remedy. Phytoestrogens in foods (soy, yams) and vitamin E can be helpful. The drug clonidine (Catapres®) can also relieve symptoms.
Sexual ActivityAnother untrue assumption is that, at menopause, your sex life is over.
Give up this idea and you'll improve your sex life, for the truth is that the declining levels of hormones are probably the least important factor affecting your sex life. But, remember, there can be some problems. Without estrogen, thinning of the pelvic support structures and the vaginal lining will occur — but continued regular sexual activity will maintain vaginal tone and glandular secretions. Several OTC products like Replens® and Astoglide® can solve problems with lubrication.
Urogenital HealthThe atrophy that affects the vagina also affects the urethra (the tube emptying the bladder) and the supporting tissues of the bladder. The urethra loses its spongy, thick lining and appears more like a hollow tube. It is less able to stop urine flow at the end of urination and can contribute to an increased susceptibility to bladder infection. Urinary incontinence can also become a significant problem at this time.
Hormone replacement, which can be either systemic or local, in the form of a vaginal cream or ring, can reverse vaginal and lower urinary tract changes. Exercises for the pelvic floor, like the Kegel exercises are very helpful, particularly for women with urinary incontinence.
OsteoporosisEstrogen has a strong effect on maintaining bone health.(2) At menopause, there is a sharp decrease in bone mineral density (BMD) that lasts about five years, and, then, a steady, slow decline after that. The higher the bone density a woman has at the start of menopause, the better she can withstand this decrease. There are many factors that will make it likely that a woman has a low bone density that will put her at higher risk for osteoporosis and its complications. Genetic predisposition, dietary and exercise habits, use of tobacco, alcohol and medications, as well as specific illnesses, can all contribute.
Bones need building blocks, and an adequate diet is needed to maintain bone. Most women take in too little calcium over the years. Three servings of a dairy product (1000 mg of elemental calcium) premenopausally and five servings postmenopausally (1500 mg) are required to insure enough elemental calcium. Calcium supplements have to be evaluated for their elemental calcium content. Consult labels! Unless a woman is motivated to be on a very compulsive regimen, ingestion tends to be very sporadic. Weight-bearing exercise is also important.
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