One of the most impactful issues in a woman over 50's life is menopause and the symptoms that are commonly associated with it. Some women are lucky enough to breeze right through it with few, or almost no problems, but many of us have some significant issues.
Menopause usually begins in the late 40s to early 50s. It can begin earlier or later but the average age to become officially menopausal is around 51-52. You are generally considered menopausal after one year of no periods, and you should have no bleeding after that (if you do, get to your healthcare provider ASAP!).
Some common symptoms that women experience might include hot flashes, decreased libido, painful sex, trouble sleeping, mood swings, weight gain and "brain fog". Some women don't have specific complaints, they just "don't' feel like themselves."
People who have never experienced a hot flash do not understand how truly uncomfortable they can be. And at times, because people don't realize what hot flashes are like, they can be unsympathetic or inconsiderate. It isn't like you just get a little warm a few times during the day or night. Before I hit menopause, I didn't know you could literally want to put your head in the freezer. It truly can feel as though you are going to spontaneously combust, pass out and/or smother at the same time. You can shower and before your hair dries you might need to get back in because you are soaked in sweat. It is miserable, uncomfortable and at times embarrassing.
There is a broad range in how hot flashes may be treated in menopause. Treatment may depend on preference, health history or even insurance and financial concerns. Sometimes lifestyle modifications may help. Some treatments or products are geared toward the symptom, such as hot flashes, and some treatments are geared towards treating the cause (decrease in hormones). Some treatments are over-the-counter and others require treatment and prescriptions by a health care provider.
Lifestyle modifications that may help with hot flashes include:
Watching what you eat and drink. Studies suggest that alcohol, caffeinated beverages or spicy foods can trigger hot flashes, Look for your triggers and try to avoid them.
Smoking can increase hot flashes. Do yourself a favor and try to avoid or quit smoking. It might decrease your hot flashes AND lower your risk of other serious health conditions such as cancer, heart disease and strokes.
Dressing in layers and wearing clothes made of breathable fabrics may make you more comfortable. There are many more options available these days for clothing and lingerie, even jewelry and accessories designed with women having hot flashes and night sweats in mind. There are even wearable fans!
In the resource area of this website, there are links to some of the products that can make you more comfortable that I have tried.
Special linens, bedding and cooling pillows may help you tolerate night sweats. Sheets made from bamboo are cool and wick moisture away from your body.
Over the Counter Supplements and Medications for Hot Flashes and Menopausal Symptoms:
Many over the counter supplements and medicines are popular for hot flashes and other menopausal symptoms. People sometimes think that because supplements and over the counter medications do not require a prescription, they are alright for everyone, but this may not always be true. Keep in mind that the FDA regulates supplements differently than medications.
Supplements are regulated as food, so they don't take regulatory actions unless something goes wrong.
Over the counter medications are regulated and are medicines that are considered safe for the general public to take without seeing a healthcare provider. Even so, they can have contraindications, side effects, or drug interactions that people should know about before taking them. It's always best to talk to your healthcare provider about any supplement or medication that you are considering.
Some of the over-the-counter medications and supplements have been around for a long time. Black Cohosh is a flowering perennial plant that is a member of the buttercup family. It has been used since ancient times. It is used for many conditions, including hot flashes, other menopausal symptoms, even aches and pains that go along with perimenopause and menopause. Although scientific evidence shows mixed results, it is one of those remedies that many people swear by. I have used it and felt that it did markedly help my symptoms. But, there are people who should not take black cohosh products, such as people with liver problems, pregnant or breast-feeding women. If you do decide to use it, make sure that you get it from a reputable company and talk to your healthcare provider first.
Vitamin E is also used for hot flashes. There is scientific evidence that it can help hot flashes and night sweats. It may, however, cause bleeding if taken in higher than recommended doses.
Soy, red clover and some pollen derivatives are ingredients often found in over the counter treatments for menopause. Soy is a plant-based source of phytoestrogens and isoflavones that are thought to mimic your natural estrogen and therefore help menopausal symptoms. There are studies that do support its use for hot flashes. It can be found in some supplements and many foods. Some of the foods that contain soy include tofu and tempeh, soymilk, soybeans and eggs.
Often women do prefer to try an over the counter or natural hormone free approach to coping with menopausal symptoms. It is important to do your research and make sure that the products that you decide to use are from a reputable company with strict quality control and are appropriate for you. Always check with your healthcare provider to make sure that you choose something that is safe for your own personal health care status.
Prescribed Medications that may help with hot flashes and other menopausal symptoms
Estrogen and HRT (Hormone Replacement Therapy) are hands down the most effective treatments for hot flashes and other symptoms associated with menopause. They must be prescribed by a healthcare provider and are appropriate for many, but not all women. In the right patient, they can have significant health benefits. Women who have certain types of cancers, blood clots, strokes, heart attacks and certain other health conditions are not good candidates for
estrogen therapy. Women who have not had a hysterectomy should not take estrogen without taking progesterone or another medication called Bazedoxifine. This is to protect against cancer of the lining of the uterus (endometrium).
Hormone therapy, or HRT, comes in many forms. There are patches, pills, creams and pellets. It could be synthetic or bio-identical. Bio-identical hormones are plant-derived hormones that mimic the hormones that your body naturally would make. In my women's health care practice, we do prescribe hormonal therapy to appropriate patients, and many patients prefer the bio-identical hormone pellets. They are effective and easier than using multiple pills and creams. We source from a very well-known, reliable company that also offers excellent supplements. More information is available on our Foothills Center for Women website.
Hormone therapy always should be tailored for the patient's own individual needs and situation. It is not a one size fits all and should be thoroughly discussed with the healthcare provider so that both benefits and risks are understood.
Non-Hormonal Medications Used to treat Hot Flashes
For women who can't or don't want to take hormones, there are several prescription medications that are often used to treat hot flashes. Brisdelle is FDA approved for hot flashes. It is a low dose form of paroxetine, which is an antidepressant. Practitioners may also use other forms of antidepressants as well.
Veozah is a new non-hormonal medication used for hot flashes. This medicine works by blocking a pathway to your brain that helps regulate your body temperature. Because one of the potential side effects of this drug is elevation of liver enzymes, you must have a liver enzyme test before starting it and again during the course of treatment.
Other Menopausal Symptoms
Hot flashes are awful, but women also may suffer a myriad of other menopausal symptoms such as mood swings, weight gain, insomnia, painful sex, decreased libido and brain fog. These symptoms can significantly affect all aspects of a woman's daily life. Like with hot flashes, women may choose to treat the symptoms or the cause.
HRT can indeed help these symptoms as well, especially with the addition of testosterone replacement (yes women do have testosterone). This can really improve energy and libido if the patient and healthcare provider decide it is appropriate.
Many times, the same supplements that are used for hot flashes help other menopausal symptoms as well. Once again, it is important to do your research and choose a reputable company and clear it with your healthcare provider before starting anything over the
counter.
Painful sex and vaginal dryness can be a real problem in the menopausal women. These women may get thinning, cracking and dryness of the vagina that is caused by the drop in estrogen that goes along with menopause. Symptoms might also include itching, burning and an increase in UTI or vaginal infections.
Vaginal moisturizers, lubricants and vaginal estrogens can all be used to treat this symptom. Vaginal suppositories made from Hyaluronic Acid can be very safe and effective and are non-hormonal. Check out the resources page to find the link to order Revaree Hyaluronic Vaginal Dryness Suppositories.
Probiotics can help restore the proper balance of vaginal flora. If these over-the-counter treatments are ineffective, vaginal estrogen may be prescribed. Vaginal estrogen has the same contraindications as systemic hormone treatments, so it's not for everyone, but in those patients who can use it, it may help immensely. Vaginal estrogen is available in creams, tablets, suppositories and in a ring that slowly releases estrogen over time.
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