Menopause: NWHIC


Article title: Menopause: NWHIC
Conditions: Menopause
Source: NWHIC


What are the body changes involved in menopause?
What are the symptoms of menopause?
What is hormone replacement therapy (HRT)?
Are there treatments other than HRT for the symptoms of menopause?
What are some practical things women can do to help deal with the symptoms of menopause?
What other steps can women take to help prevent osteoporosis and heart disease during menopause?

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What are the body changes involved in menopause?

Many women wonder and worry about what will happen when they reach menopause, but in fact it can be a liberating experience! We know that menopause marks the end of the time in life when you can become pregnant, but it can also represent a new beginning - a time to focus on yourself and your needs. The first step is to learn all you can about the physical and emotional changes that may be ahead for you. The transformation into the beauty of mid life usually doesn't happen all at once. In perimenopause, or the transition period to menopause, the production of the female hormones estrogen and progesterone begin to fluctuate, causing a variety of symptoms, including hot flashes and mood swings. During this time, a woman may or may not have a period. These changes can begin as early as age 35 or as late as 59. In younger women who are having menopausal symptoms, and in women who have had a hysterectomy but still have one or both of their ovaries, a blood test called an FSH level, or follicle stimulating hormone level may be useful to confirm menopause. If you have your ovaries removed or undergo some cancer treatments, you may experience rapid onset of menopause, and may need special management of your symptoms. Menopause starts when the estrogen production falls permanently to very low levels and menstrual periods stop for good.

What are the symptoms of menopause?

While many women have little or no trouble with menopause, others have moderate to severe discomfort. Some women may experience troublesome symptoms during perimenopause and menopause. Hot flashes, caused by fluctuating hormones, have become the hallmark symptom of menopause. Hot flashes are a sudden flush or warmth, often followed by sweating. This is caused by hormonal changes and their effect on your body's natural regulation of its temperature. It is good to try to have a sense of humor as you constantly feel the need to shed clothing to cool off, but in fact hot flashes can cause serious discomfort and sleepless nights for some women.

Other classic symptoms of menopause that you might experience:

  • Sleep problems;

  • Depression and mood swings;

  • Vaginal problems, including vaginal dryness and irritation that can cause pain during intercourse and gynecological exams, as well as frequent vaginal infections;

  • Urinary problems, including burning or pain when urinating, or stress incontinence, the weakening of tissues in the urinary tract which causes urine to leak when sneezing, coughing, or laughing;

  • Memory loss;

  • Changes in sex drive and sexual response;

  • Weight gain;

  • Hair loss; or

  • "Spotting" and abnormal bleeding (usually normal, but should be reported to your doctor).

Some women find that they gain weight or that their hair thins after menopause. Some symptoms, such as memory problems or feeling sad could have causes that are unrelated to menopause. If you are having these symptoms, it is important to discuss them with your health care provider. And although changes in bleeding are normal as you near menopause, abnormal bleeding should also be reported to your health care provider, since this could be a sign of other problems.

A lack of estrogen during menopause also causes the bones to lose calcium and become weaker, putting women at risk for severe bone loss or osteoporosis. (Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,500 per day.) A lack of estrogen also causes an increased risk of developing heart disease.

What is hormone replacement therapy (HRT)?

HRT refers to the use of prescription drugs to "replace" the hormones that the ovaries quit making at the time of menopause. For many years, to relieve the symptoms of menopause, health care providers prescribed estrogen replacement therapy (ERT). The most common brand name of ERT is Premarin. It was discovered, however, that taking ERT alone raised the risk of cancer in the lining of the uterus (endometrial cancer). Research showed that adding progestin, the artificial form of the hormone progesterone, prevented the overgrowth of cells in the uterus (called hyperplasia) which dramatically reduces the risk of endometrial cancer. Women who do not have a uterus can take ERT alone. ERT usually is taken by pill or skin patch. Hormone replacement therapy (HRT) refers to a combination of hormones used to treat menopausal symptoms, usually estrogen with progestin. Progestin/Estrogen Replacement Therapy is sometimes abbreviated as "PERT." HRT is most always taken by pill.

In general, HRT is a safe and effective way of managing menopausal symptoms and preventing osteoporosis. HRT is generally NOT recommended for women who have the following conditions:

  • Vaginal bleeding of unknown cause;

  • Suspected breast cancer or a history of breast cancer;

  • History of endometrial cancer;

  • History of or active venous thrombosis (blood clots in the veins of the legs or in the lung);

  • Chronic disease of the liver.

Because there are both benefits and risks associated with taking HRT, every woman should consider these in relation to her own health and thoroughly discuss these issues with her health care provider. HRT may protect against risks of heart disease, stroke, and osteoporosis. Preliminary evidence shows that it also may be helpful in preventing Alzheimer's disease, colon cancer, and macular degeneration (age-related vision loss). However, HRT may not be the right choice for everyone since it may cause side effects such as unusual vaginal bleeding, headaches, nausea, vaginal discharge, fluid retention, and swollen breasts. HRT also has been linked to an increased risk in breast and endometrial cancers in some women. Doctors may prescribe different schedules for taking HRT. A woman should discuss the possible benefits, risks, and side effects with her doctor before making a decision. It's also important to know that HRT is not a one-time decision. Pros and cons should be considered in several stages: first, at the time of menopausal symptoms, as a short-term therapy for relief of symptoms; and later, as the symptoms fade as a longer-term regimen for prevention of osteoporosis. Click here for more information on HRT.

Are there treatments other than HRT for the symptoms of menopause?

Some women decide not to take HRT or ERT to relieve the symptoms of menopause, and turn to herbal remedies or to certain estrogen-like chemicals in plants (called phytoestrogens) for help. There are many over-the-counter and natural remedies to help women with menopausal symptoms, such as black cohosh, ginseng, dong quai, and evening primrose. There is limited, and sometimes conflicting, research on the safety and effectiveness of many of these popular herbal products that claim to help menopause. Discuss herbal remedies with your health care provider before taking them. You also should tell your provider if you are taking any other medications, since some of the herbal products can have harmful interactions with other drugs. Recently, the American College of Obstetricians and Gynecologists (ACOG) issued the following guidelines on the most popular "alternative" medicines for menopause:

1. Soy and Isoflavones (plant estrogens found in beans, particularly soybeans) - High isoflavone intake (about 50 grams of soy protein per day) may be helpful in the short term (2 years or less) to relieve hot flashes and night sweats. Taken over the long term, it also may have good effects on cholesterol and bones. While safe in dietary amounts, the consumption of extraordinary amounts of soy and isoflavone supplements may interact with estrogen and may be harmful to women with a history of estrogen-dependent breast cancer and possibly to other women as well.

2. St. John's wort - May be helpful in the short-term (2 years or less) to treat mild to moderate depression in women (when given in doses of less than 1.2 milligrams a day.) A recent study showed it is not effective in treating severe depression. It also can increase skin sensitivity to the sun and may interfere with prescription antidepressants.

3. Black cohosh - May be helpful in the short term (6 months or less) to treat hot flashes and night sweats. It seems to be extremely safe, although studies have been small and brief, none longer than six months.

4. Chasteberry (also known as monk's pepper, Indian spice, sage tree hemp, and tree wild pepper) - This may inhibit prolactin, a natural hormone that acts on the breast. It is touted for breast pain and premenstrual syndrome. There are very few studies in menopausal women. A study of women with premenstrual syndrome found they reported improvements in mood, anger, headache, breast fullness, but not bloating and other symptoms.

5. Evening primrose - This plant produces seeds rich in gamma-linolenic acid, which some experts believe is the nutritionally perfect fatty acid for humans. Although evening primrose capsules are taken for breast pain, bladder symptoms and menopausal symptoms, there is little or no evidence that they work. The one high quality study of effects on hot flashes found that evening primrose was no better than placebo.

6. Dong quai - A study aimed at reducing hot flashes found that dong quai was not better than placebo - although the 4.5-gram dose used in the study was lower than that typically given in Chinese medicine. The herb is potentially toxic. It contains compounds that can thin the blood, causing excessive bleeding, and make the skin more sensitive to sun, possibly increasing skin cancer risk.

7. Valerian root - This has traditionally been used as a tranquilizer and sleeping aid. But the U.S. Pharmacopoeia, which sets manufacturing standards for medicines, does not support its use, and there have been reports of heart problems and delirium attributed to sudden withdrawal from valerian.

8. Ginseng - Most of the many types of ginseng (including Siberian, Korean, and American, white and red), are promoted for relieving stress and boosting immunity. A study of menopausal women by the leading ginseng manufacturer found the product did not relieve hot flashes but did improve women's sense of well being. Analyses of ginseng products have found a troubling lack of quality control: some contained little or no ginseng, contained large amounts of caffeine, or were tainted by pesticides or lead.

9. Wild and Mexican yam - There are no published reports that show wild and Mexican yam cream is effective in helping menopausal symptoms. The hormones in wild and Mexican yam do not have any estrogenic or progestational properties, so they are not expected to help women with these symptoms.

What are some practical things women can do to help deal with the symptoms of menopause?

There are things you can do to help relieve some menopausal symptoms.

  • Hot Flashes - Hot flashes are sometimes brought on by specific things, such as a hot environment; eating or drinking hot or spicy foods, alcohol, or caffeine; and stress. You can try to decrease hot flashes by avoiding these triggers. Dress in layers and keep a fan in your home or workplace. Some women find that a program of regular exercise brings relief of hot flashes and other symptoms.

  • Vaginal Dryness - You can help vaginal dryness and irritation by using an over-the-counter vaginal lubricant. There are also prescription estrogen and replacement creams that your doctor may recommend to help relieve vaginal dryness and pain intercourse. If you have spotting or bleeding while using estrogen creams, you should see your health care provider.

  • Difficulty Sleeping - One of the best ways to get a good night's sleep is to participate in regular exercise - such as walking 30 minutes a day. However, avoid vigorous exercise too close to bedtime. Also avoid alcohol, caffeine, large meals, and working right before bedtime. Many women find that they sleep better after drinking something warm, such as herb tea or a glass of warm milk. Try to keep your bedroom at a comfortable temperature. Also avoid napping during the day, and try to go to bed and get up at the same times every day.

What other steps can women take to help prevent osteoporosis and heart disease during menopause?

Besides taking HRT, women can help prevent osteoporosis and heart disease by making sure they get enough calcium, doing regular weight-bearing exercises, and eating a low-fat balanced diet. Other healthy behaviors to prevent disease include stopping smoking and drinking alcohol only in moderation.

For more information...

National Cancer Institute
Phone: (800) 332-8615
Internet Address:

National Institute on Aging
Phone: (800) 222-2225, (800) 222-4225 (TTY)
Internet Address:

American College of Obstetricians and Gynecologists
Phone: (800) 762-2264
Internet Address:

Melpomene Institute
Phone: (651) 642-1951
Internet Address:

National Osteoporosis Foundation
Phone: (202) 223-2226
Internet Address:

North American Menopause Society
Phone: (440) 442-7550 Internet

The Hormone Foundation
Phone: (800) 467-6663
Internet Address:

This information was abstracted from fact sheets prepared by the National Institute on Aging and the National Cancer Institute, from the Centers for Disease Control and Prevention's (CDC) booklet, "To Be or Not to Be - On Hormone Replacement Therapy," and from ACOG's Practice Bulletin, "Use of Botanicals for Management of Menopausal Symptoms."

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Publication Date: June 2001


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