Menopause is defined to have occurred twelve months after a woman’s last period. In reality, this transition can last years – usually beginning in a woman’s mid-forties and extending to her mid-fifties. Fifty million women are estimated to be currently in menopause, and every female will be affected during her lifespan. While menopause is not a disease, it marks a significant change in health, energy, and quality of life for many women.
Unfortunately, many women “suffer in silence,” thinking that because this is a normal transition, they must accept many undesirable symptoms, which may include irregularity of the menstrual cycle, hot flashes, night sweats, and difficulty sleeping. Additionally, because of hormone and structural changes that affect the urogenital system, some women may experience urinary incontinence or an inability to control urine flow. Other symptoms include changes in sexual health, including a lack of interest in sexual activity or pain with sex.
Hormone changes during this transition also affect energy and nutritional metabolism, increasing obesity, heart disease, diabetes, and decreasing bone health, which can lead to increased fracture risk. Healthy nutrition and exercise become vitally important for women during menopause, when energy levels may be lower.
HORMONES AND MENOPAUSE
During menopause, ovarian follicles become depleted, and the estrogen and progesterone hormone levels decrease dramatically. The decreased estrogen levels decrease bone mineralization, increasing fracture risk. Recent studies have also shown the importance of estrogen in regulating blood pressure which can change the blood vessels’ ability to relax, which is why women are at a much higher risk for cardiovascular disease following menopause. Estrogen is also known to significantly affect neurotransmitters in the brain, affecting mood and cognitive function. Progesterone also affects sleep by stimulating a neurotransmitter called gamma-aminobutyric acid (GABA). Lower progesterone levels may result in reduced sleep quality. Testosterone levels also decrease during the menstrual transition, reducing energy and libido.
MANAGING MENOPAUSAL SYMPTOMS
The good news is managing menopausal symptoms is not only possible, but many options are available. First and foremost is maintaining a healthy diet and activity level. While metabolism slows during menopause, focusing on healthy, whole foods and avoiding highly processed, fast foods – which are not only calorically dense but contain endocrine disruptors that worsen menopausal symptoms – can control weight gain.
Regular physical activity, especially resistance weight training, is essential to maintain bone health and increase bone density. Regular aerobic exercise improves cardiovascular health by increasing the ability of the blood vessels to relax, lowering blood pressure. Nutritional supplements such as magnesium, theanine, GABA, and low doses of melatonin may improve sleep, lower stress, and reduce anxiety symptoms experienced during these hormonal shifts. Many patients have experienced improved symptoms of hot flashes and mood swings with the addition of medications called selective serotonin reuptake inhibitors, such as Celexa, Lexapro, and Paxil. Additionally, hormone replacement therapy can be very effective in alleviating symptoms.
HORMONE REPLACEMENT THERAPY
Hormone replacement therapy has been controversial since the Women’s Health Initiative (WHI) study started in the early 1990s with results published in 2002. The study was to evaluate the effects of hormone replacement with synthetic estrogen or synthetic estrogen plus progesterone hormone on cardiovascular disease in postmenopausal women; however, it was discontinued early due to concerns for increased rates of heart disease, stroke, blood clots, breast cancer, and dementia in women receiving hormone therapy, especially women sixty years of age and older who were more than ten years post-menopause.
Recently, however, follow-up data from the WHI released in 2020 led to a better understanding of the initial data. Today, hormone replacement therapy for women under the age of sixty who are experiencing significant perimenopausal symptoms should be considered and may offer improved cardiovascular and bone health in addition to improved quality of life. Many perimenopausal women on hormone replacement therapy also experience enhanced sexual health and well-being. Discussing hormone replacement with your physician before treatment is crucial, as some women with a personal or family history of breast or uterine cancer should not take hormone replacement therapy.
Hormone replacement therapy is available in many options: oral, topical, or implantable. Oral hormone therapy is commonly considered estrogen-only, Premarin, or a combination of estrogen plus progesterone, Prempro. Women who have not had a hysterectomy should not take an estrogen-only supplement due to concerns for hyperplasia of the endometrium and an increased risk of uterine cancer. Topical estrogen and progesterone are available and do not require metabolism by the liver, resulting in lower dosing and potentially reduced risk of blood clots.
Additionally, a growing number of specialty compounding pharmacies produce bio-identical hormone replacement therapies. These hormone replacements match the chemical nature of the hormones found in the human body and thus improve function and reduce unwanted adverse effects. Bioidentical hormones compounded from plant-derived products have been around for a long time; however, many ongoing studies are researching their safety and effectiveness.
Because these products are regulated differently than synthetic pharmaceuticals, working with your physician to identify a safe and reputable product is essential. As always, a healthy lifestyle and routine check-ups may help to recognize early menopause symptoms to increase quality of life and health.
Kendall Wagner, M.D. is a regular healthcare contributor to Do South® Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas