Menopause

Description

Alternative Names

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 accompanying anxiety as the sensation builds. In most cases hot flashes resolve within two years of menopause, although in some women they may persist 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. Once a woman has reached a menopausal state, however, depression is no more common than before, and women with a history of premenstrual depression often experience significant mood improvement.
• 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 some women with hot flashes.

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.

Acupuncture, hypnosis and biofeedback are all alternative ways to control pain. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body.

Many women also try herbal or so-called natural remedies. Some may have proven benefits, but others have no value and can have adverse side effects.

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

• Black cohosh (also known as Cimicifuga racemosa or squaw root) contains a plant estrogen and has been the herbal remedy most studied for menopausal symptoms. In one major review of alternative therapies for menopausal symptoms, black cohosh was the only one that showed any significant benefits. Black cohosh has been used for decades in Germany and appears to be safe, but because its actions resemble estrogen, 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. Interestingly, one 2002 study that reported significant reduction in menopausal symptoms from a cohosh preparation did not find that the agent produced any estrogen-like effects. Headaches and gastrointestinal problems are common side effects. At this time experts do not recommend taking it for more than six months.
• Flaxseed, like soy, contains phytoestrogens and is being studied for possible benefits. A study of women with high cholesterol levels reported that flaxseed improved menopausal symptoms and reduced some risk factors for diabetes. However, it had no significant effect on cholesterol levels. Others have reported beneficial effects on cholesterol, although more evidence is required to confirm any of these findings. Flaxseed has no effect on bone density, and long-term safety of flaxseed ingestion is not known. Animal and laboratory studies suggest flaxseed helps block growth factors involved with breast cancers.
• Dong quai does not act like an estrogen but appears to contain B vitamins, anti-inflammatory factors, muscle relaxants, and possibly progesterone-like substances. Although sometimes used for menopausal symptoms, most studies do not report any significant benefits. Dong quai should not be used with blood-thinning agents, such as warfarin. It may also increase the risk of skin cancers.
• 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. Some evidence suggests that kava may relieve anxiety in some people. It is not generally considered unsafe, however, there are reports of liver failure and death from this medication, with highest risk in those with liver disease. Other side effects include itchy, scaly skin, muscle weakness, and problems with coordination. It also interacts dangerously with certain medications, including alprazolam, an anti-anxiety drug. And it increases the potency of certain other drugs, including other sleep medications, alcohol, and antidepressants.
• Dehydroepiandrosterone (DHEA) is a weak male hormone secreted by the adrenal gland and is available over the counter. There are some claims that it improves psychological well being, mental function, and bone density. The hormone may, however, reduce HDL (the so-called good cholesterol) when taken in doses higher than 50 mg and its effect on cancer-cell growth is unknown, with some evidence indicating that high levels may increase the risk. In any case, DHEA is not regulated and brands vary widely in their content.