Menopause

Updated 18 February 2016

Treating menopause

Individual health status and risk factors for developing diseases in later years and goals to be achieved in health prevention should be determined with the help of a doctor. If therapy is needed, there are several options available.

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All women who have reached the menopause have NO oestrogen. Whether they choose to use menopause hormone therapy (MHT) for symptoms like dry vagina, hot flushes or mood changes depends on their perception of self and how much menopausal symptoms interfere with their quality of life. 

Not all women who are menopausal need to have use MHT; in fact, only about one in four women really needs hormone therapy for relief of menopausal symptoms, so it is important to discuss this issue with your doctor to determine if you would benefit and so he/she can prescribe MHT at the lowest most effective dose individualised to your specific symptoms. However, the mainstay and management of all women during this transitional life should include lifestyle and stress management. 

There is an argument menopause is a physiological and normal event and should therefore not be treated as an illness, in other words with medication. While this is true, it is also worth considering that women now live for many years beyond the menopause and that these changes in life expectancy are relatively recent.

It has been established that there are risks associated with living for many years with low levels of oestrogen in the body. These risks most importantly affect the bones and the heart.

There are different types of intervention, depending on the individual symptoms and needs of each woman.

Menopause is not managed according to a formula. Each woman should be evaluated as an individual and will often have selective investigations to establish whether she is: 

In general, strive towards a healthy lifestyle, which includes stopping smoking, controlling weight and managing stress. Stress-reduction techniques such as massage and meditation may help reduce some symptoms.

Hot flushes:

Keep your home and workplace cool; wear loose clothing in layers that are easily removed; drink plenty of water and juice. Avoid caffeine, alcohol and spicy foods if they bring on hot flushes; exercise regularly to help stabilise insulin and endorphin levels

and prevent insomnia and avoid confined spaces and hot, humid weather, if possible.

Vaginal dryness: 

Short-acting, water-based vaginal lubricants (such as K-Y Jelly) can be used immediately before sexual intercourse to supply moisture (avoid petroleum-based products such as Vaseline). You could also consider using a local oestrogen vaginal cream.

Mood changes:
 Discuss your symptoms with other women or perhaps a therapist if symptoms are very problematic. Ask others for consideration and understanding during this period of transition.

Decreased sexual desire:

identify and address the primary cause should be identified and treated. It may be physical changes (such as vaginal dryness) or low self-perception and lifestyle making sex uncomfortable. 

Incontinence problems can often be improved by doing regular Kegel exercises (pelvic muscle-strengthening exercises). Contract the pelvic muscles as if trying to close the vaginal opening. Hold the contraction for a count of three then relax. Wait a few seconds and repeat. Fast Kegels (squeezing and relaxing muscles as quickly as possible) can also help. Performing several Kegels per day (try for 50) can improve bladder control and may enhance sexual pleasure.

A healthy diet

is extremely important to help reduce the risk of osteoporosis and heart disease. Adopt a low-fat, high-fibre diet rich in fruits, vegetables and whole grains, and get adequate vitamin D and calcium for strengthening the bones. Eat calcium-rich foods (such as dairy products) or take a calcium supplement, so your daily intake is 1 000 milligrams per day before menopause and 1 500 milligrams per day after menopause. Eat calcium-rich foods (such as dairy products) or take a calcium supplement so your daily intake is
1 000 milligrams per day. '

 Eating foods high in plant oestrogens (phytoestrogens) may alleviate menopausal symptoms and lower cholesterol levels. Good sources include lima beans, soybeans and soy products (such as soy milk, roasted soy nuts, soy burgers and tofu), nuts, seeds, fennel, celery, parsley and flaxseed oil.

Regular exercise 

helps to keep weight down, improve sleep, strengthen bones and lift mood. Weight-bearing exercises such as walking may also help prevent osteoporosis.

Chart your progress:
Being attuned to bodily changes helps make perimenopause less confusing. Monitoring your menstrual cycle for several months and keeping track of your symptoms will give you a greater sense of control, as well as useful information to discuss with your doctor.

Along with a good understanding of your body and the changes it is going through, a positive attitude about perimenopause and menopause is important for dealing with any difficulties it may bring. 

Prescription medication 

Prescription medication used for the treatment of menopause includes hormonal therapies. Prescription medication may include one or more of the following:   

Hormone therapy: 

Hormone therapy (HT) involves taking low dosages of oestrogen (oestrogen therapy or ET), or low dosages of both oestrogen and progestin (known as combined oestrogen-progestogen therapy or EPT) to relieve short-term symptoms and possibly reduce the risk of long-term diseases associated with menopause. There are benefits and risks to ET and EPT which may differ for each woman. The decision to use hormones, as well as dosages, routes and duration of use must be based on your individual risk-factor profile: your personal and family medical history, particularly of certain cancers, heart disease, stroke and osteoporosis.

For example, although oestrogen-only therapy does not increase the risk of breast cancer and may decrease heart disease risk, it is only an option for women who do not have a uterus, or for women who have had a progestogen intra-uterine device (Mirena) fitted. That is because it increases the risk of endometrial (lining of the womb) cancer.

The hormone testosterone is sometimes prescribed to help when menopause has a negative effect on sex drive, particularly in the case of surgical menopause.

Other prescription medicines are also options for certain short-term menopause-related changes. These include

low-dose oral contraceptives, Clonidine (a mild blood pressure medication), Venlafaxine (an anti-depressant) and Gabapentin (an anti-epileptic drug). 

Some prescription drugs may not help with short-term complaints, but may help prevent long-term effects of lower oestrogen levels. These include:

- Anti-osteoporotic medication such as alendronate, risedronate, zolendroic acid, sodium ranelate or raloxifene) help to slow or reverse bone loss in osteoporosis; 

Several cholesterol-lowering or antihypertensive drugs can help prevent heart disease by controlling blood pressure and cholesterol. 


The main ways in which HT is given are

- Oral – by mouth 

- Across the skin – percutaneous/transdermal– as gels or patches As implants 

- as a nasal spray (not available in SA) 

- in a hormone-impregnated intrauterine device 

- via the vagina as creams, foams, pessaries or oestrogen-impregnated rings (NuvaRing) 

Read more: 

What is menopause? 

symptoms of menopause  

Causes of menopause 

 

Reviewed and updated by Dr Dr Carol Thomas MBChB (UCT) FCOG (SA) MMed (O&G) (UCT), Specialist Gynaecologist in private practice, Cape Town, Secretary South African Menopause Society and Director of the WomanSpace. March 2015.

(Previously reviewed by Dr Mike Davey, President of the South African Menopause Society, and Prof B. Schaetzing MD, FCOG (SA), FRCOG, PhD. Part-time Consultant, Dept of Obstetrics & Gynaecology, Faculty of Health Sciences, University of Stellenbosch)














 

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