A woman furiously fanning herself or sticking her head in the freezer may seem comical, but hot flashes are no joke. They can happen instantly, leaving you sweaty, frustrated and embarrassed if they happen in public.
Hot flashes are the cliché symptom of menopause, but they are only one of a litany of changes you may experience.
Menopause is a natural biological process culminating in the end of the menstrual cycle. Health care providers consider you menopausal after going 12 consecutive months without a menstrual cycle. In the United States, the average age of menopause is 51.
Unfortunately, you may experience perimenopause, the hormonally chaotic phase leading up to the last period, years earlier. Perimenopause, which typically starts in a woman’s late 40s, but can start earlier, begins when the egg-producing sacs of the ovaries take a sharp decline. Without the usual signal from the ovaries, hormones like estrogen and progesterone spike and dip erratically.
During perimenopause, you may experience these signs and symptoms:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Chills
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
The severity of symptoms can vary wildly. Some women sail through menopause with ease, while others experience symptoms severe enough to affect their daily lives. Mark D. Wild, MD, FACOG, with South Carolina OB/GYN Associates, says, “I try to encourage women and educate them about the multiple available options to treat menopausal symptoms. Sometimes, we have to try several different regimens to see what works best for that individual patient. It is not a one-size-fits-all strategy.”
Many treatment options can help with menopausal symptoms. The best options often depend on the individual’s main symptoms and the severity of the symptoms. Treatment options range from lifestyle changes to hormonal and non-hormonal medicines and supplements.
Hormone Replacement Therapy Can Help
“Many over-the-counter products claim to help with menopausal symptoms. For most, data on effectiveness is limited. Some studies suggest soy products and black cohosh can help some women with vasomotor symptoms, such as hot flashes and night sweats,” says Dr. Wild.
Hormone replacement therapy has been widely studied and proven to lessen many menopausal symptoms, including hot flashes. It is important to discuss the risks and benefits with your provider before starting HRT. Your provider can also help you determine the safest and most effective combination and route of delivery, such as oral, transdermal or vaginal.
Most healthy women younger than age 60 are good candidates for starting HRT. Still, there are some contraindications, including a history of breast cancer, previous deep venous blood clot or stroke, coronary heart disease or unexplained vaginal bleeding.
In recent years, bioidentical hormones, structurally identical to the body’s naturally occurring hormones, have gained popularity. Dr. Wild notes, “The evidence is conflicting on whether they work better than standard HRT, but many women prefer them because of their similarity to naturally occurring hormones. I try to prescribe bioidentical hormones whenever possible, and fortunately, there are Food and Drug Administration-approved commercially available options. It is important to know that bioidentical hormone therapy carries most of the same risks as standard HRT, and it is essential to talk with your doctor or provider about your risks before starting any HRT.”
Battling the Menopausal Belly
Even women who have never struggled with their weight may notice their mid-section expanding during perimenopause. Evelyn D. Roland, DO, with Lexington Women’s Care Chapin, says, “The drastic drop in estrogen can certainly cause weight gain. Estrogen also controls the body’s fat distribution, so as estrogen levels drop, fat distribution can change with typical migration to the abdomen and waist. There is also muscle loss with lack of estrogen. Without muscle tone, some women may notice what appears to be more fat tissue.”
According to Dr. Roland, “Hormone therapy, for suitable candidates, may not only help with hot flashes, it could help to redistribute the visceral fat around the abdomen by repairing the imbalance. It may also regulate sleep and hot flashes, thereby encouraging a healthy lifestyle. Menopausal women must also commit to healthy eating and exercising, including weight-bearing exercise, to lessen the potential for weight gain,” says Dr. Roland.
Help for Vaginal Dryness
Vaginal dryness can be a problem for many perimenopausal and postmenopausal women. Because of the natural decline in your body’s estrogen levels during menopause, vaginal tissues become thinner and more easily irritated. Fortunately, many over-the-counter lubrication products can help. The most effective are water-based and unscented.
Vaginal estrogen, whether delivered in a tablet, cream or vaginal ring, is most beneficial in addressing the cause of vaginal dryness. Vaginal estrogen requires a prescription, so Dr. Roland encourages women to discuss this option with their provider.
“My advice is to find a physician to partner with you in this journey. Everyone will make this change differently; not everyone is a candidate for certain therapies due to other medical conditions. Many treatment options for menopause exist. Physicians want to support your quality of life, and the key is to find one who fits your needs, listens to your concerns and finds the best solution for you,” says Dr. Roland.
Menopause is a natural and inevitable phase of a woman’s life. It’s a time to celebrate the wisdom and maturity that come with age and embrace the next chapter of life with open arms. Understanding the symptoms, finding the right treatment options and embracing the journey with support and empowerment will allow you to navigate menopause with grace and resilience.
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| Evelyn D. Roland, DO Lexington Women's Care Chapin |
Mark D. Wild, MD, FACOG South Carolina OB/GYN Associates |
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