With your doctor, you should determine your individual health status and risk factors for developing diseases in later years. If therapy is needed, there are several options available: lifestyle modification, nonprescription remedies, and prescription therapies.
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Home treatment
The following home treatment methods can help alleviate symptoms and make the menopause transition easier to deal with:
Hot flushes:
Keep home and work place 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 hormones and prevent insomnia
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 moistur (avoid petroleum-based products such as Vaseline). It may also help to take a warm bath before intercourse. Regular sexual activity can help to improve natural lubrication, and keep the vagina moist and toned.
If sexual desire lessens during menopause, the cause may be physical - lower oestrogen levels sometimes cause physical changes in the sexual organs, making sex uncomfortable. Physical reasons for decreased sexual response should be identified and treated. Some women have decreased sexual desire because of changes in self-perception and lifestyle stresses. Counselling and support groups can provide useful strategies for coping with this, as well as with physical and emotional symptoms.
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 and 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 1000 milligrams per day before menopause and 1500 milligrams per day after menopause. 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 soymilk, 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.
In general, strive to live a healthy life-style, which includes stopping smoking, controlling weight and managing stress. Stress-reduction techniques such as massage and meditation, may help reduce some symptoms.
Many women find relief from short-term menopause-related changes with nonprescription remedies. Products such as vitamin E and vitamin B complex, and certain herbs such as black cohosh, appear to help some women. However, studies are needed to fully determine possible benefits and risks of herbal medicines.
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.
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.
Medication
Hormone Replacement Therapy (HRT)
Hormone usage involves taking replacement oestrogen (ERT), or both oestrogen and progestin (HRT), to relieve short-term symptoms and possibly reduce the risk of long-term diseases associated with menopause. There are benefits and risks to ERT and HRT, 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 - personal and family medical history, particularly of certain cancers, heart disease, stroke and osteoporosis.
Oestrogen only (ERT) should not be utilised if the uterus is still present as it may increase the incidence of endometrial (lining of the womb) pathology.
Other hormonal treatments
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: low-dose oral contraceptives, clonidine and belladonna-containing products.
Some prescription drugs may not help with short-term complaints, but may help prevent long-term effects of lower oestrogen levels. Drugs such as alendronate or raloxifene help prevent osteoporosis; several drugs can help prevent heart disease by controlling blood pressure and cholesterol.
Reviewed by 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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