Managing menopause symptoms takes persistence

Aug. 26--Menopause can knock you for a loop.

Hot flashes, night sweats, anxiety and mood swings are all fueled by fluctuations in hormones, but not everyone takes the same ride.

"It's a big transition," said Tupelo gynecologist Dr. Laura Crecelius. "Menopause and perimenopause just don't feel good."

Every woman who lives long enough will go through menopause; the average age is 51, but symptoms can start years before periods stop. The ovaries run out of viable eggs and dramatically reduce the amount of estrogen they put out. It's those changes in estrogen that appear to cause the symptoms.

So what's a woman to do to keep her balance during "the change?"

Because of the increased risk of breast cancer, hormone replacement therapy isn't as attractive a choice as it once was, but it is still a viable short-term option for women under certain conditions, Crecelius said.

A number of studies, including one published earlier in August, have found that soy products don't provide any help with hot flashes and night sweats.

For Romona Vaughn of Tupelo, yoga provided improved flexibility of body and mind for the past two years.

"I couldn't get on my knees," before she started regularly attending yoga classes two years ago, Vaughn said. "Now I can."

Yoga hasn't helped with hot flashes or night sweats, but she's less prone to aches and pains, said Vaughn, who will turn 65 in December, and hopes she's on the downhill slide of menopause.

"My rest is better," Vaughn said. "My peace of mind is better."

Vaughn's experience isn't isolated. Yoga is recommended by the Mayo Clinic to address menopause symptoms.

"For me, it's such a subtle thing, you might be stronger, more flexible," said instructor Robyn Gibson, owner of the Yoga Center. "You just seem to be able to handle things better. ... I don't know how people don't do yoga."

Once upon a time, doctors prescribed a course of action for menopause with little dialogue.

"It used to be rather paternalistic," Crecelius said. "Now the average menopausal patient is far better educated."

Menopause symptoms and experiences can vary so greatly, it's important to tailor a regimen to the individual, Crecelius said. Hot flashes are the best known of menopause symptoms; however, night sweats seem to cause the most trouble because of the sleep disturbances.

"There's plenty of women who have a period and then they're done," Crecelius said. "Plenty of them jump and start for years before it's all over."

Hormone replacement therapy is still available, but is used sparingly, because the extra estrogen can fuel estrogen-positive breast cancers. An average woman with no family history has a one in eight chance of developing breast cancer in her lifetime, so an increased risk is something to consider seriously.

"I'm not prescribing it nearly as often," Crecelius said.

Antidepressants and exercise help with some symptoms, but nothing has replaced the efficacy of hormone replacement therapy.

"Nothing is as good as estrogen is," Crecelius said.

Before hormone replacement therapy is prescribed, doctors and patients should have an in-depth review of the risks, benefits and pertinent health issues.

Women who do opt for hormone replacement therapy take shorter courses of the medications.

"It's a rare patient that stays on them beyond her 60s," Crecelius said.

Women who cast a critical eye on hormone replacement therapy also need to critically consider other remedies that mimic estrogen's ability to reduce hot flashes. If they work like estrogen, they likely activate the estrogen receptors connected to breast cancer, Crecelius said.

"You've got to keep your eyes open," Crecelius said. "I'm not sure anything is risk free."

The supplement black cohosh in some people can spark menstrual bleeding again, Crecelius said.

"It must activate estrogen receptors at least in some people," Crecelius said.

Women should make sure their health care providers knows about your supplements because there are the risks for drug interactions and side effects.

"If you're going to look at any supplement, look for drug interactions with your pharmacist," Crecelius said.

Don't forget

In addition to managing the more immediate symptoms of menopause, it's important to keep tabs on your skeleton. Women should have a bone density screening around the time of menopause.

"The rate of bone loss is most accelerated in the first five years of menopause," Crecelius said.

Those results dictate how frequently women need to be screened and if they need medication.

Weight-bearing exercise and increasing dietary calcium are good bets for any woman, Crecelius said.


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