The menopause process
Laura Kaye described the menopausal symptoms, starting with perimenopause, the irregular bleeding, sweats, and irritability that can last from two to ten years. Postmenopause begins when a woman has gone a year without a period. Ovulation may still happen, but it’s irregular, she said.
The average age for the onset of post-menopause is 51, although it can happen anytime between age 44 to 58. The sweats and hot flashes are caused by drops in estrogen, which can happen briefly or last a long time, depending on the woman; some people adjust fine to the hormonal changes, while others suffer, Kaye said.
The best type of hormonal replacement therapy in the perimenopause stage is a low-dose birth control pill, she noted. (Birth control pills today are far less powerful than they were when introduced in the 1960s, she said.) The need for hormonal replacement is less in the postmenopausal stage, she added. Estrogen therapy is not recommended for postmenopausal women with a history of breast cancer.
Estrogen is taken with progesterone, which increases the risk of uterine cancer. Kaye recommend the lowest doze of progesterone, which is normally taken for two to three years and five years at most.
Kaye said exercising, including weight-bearing routines to help offset the risk of osteoporosis, helps with the symptoms. Yoga, running, biking, avoidance of alcohol, and reduced caffeine intake are also recommended as ways to mitigate symptoms. Dressing in layers, using fans and keeping a cool drink handy are strategies that provide relief from hot flashes.
Kaye noted that non-regulated herbal and other non-medicinal natural remedies should be used with caution. Black cohosh can be effective, she noted, while flax seeds have been shown to reduce hot flashes and elevate mood and has no bad side effects. Antidepressants in low doses might also be effective.
The safety of hormones concocted from soy and plant extracts is unknown, Kaye said. (Pharmaceutical estrogen is not just synthetic, but also made from pregnant mare’s urine, she noted, to a few squeals.)
Compounded pharmaceutical products, which may take the form of a cream, gel or lozenge customized for the patient, are best obtained from an accredited compounding pharmacy, Kaye said.
The postmenopausal phase of a woman’s life can actually be an exciting time, Kaye concluded, with more time for travel, hobbies, fitness, relationships and introspection.
