19 Apr 2024

Menopause is the cessation of ovarian function in the female life cycle. It is most often diagnosed in menstruators over 45 years based on a person’s symptoms and changes in cycle. The diagnosis is obvious if a person has had their ovaries removed, or damaged in some altering way.

In some cases, a “symptom score card” can be used to determine and track the symptoms a person is experiencing which can then indicate their need for a specific treatment or plan with their medical care team.

Some doctors utilize FSH testing to help diagnose, while many others state that this is not a reliable indicator of perimenopause, as hormones are fluctuating from day to day. Investigations should be done on those people who have had a hysterectomy, new or changing symptoms due to illness, or if these issues are experienced in those women under 45.

Symptoms

Menopause management is different for each individual and each should have a comprehensive exam done to verify and record all symptoms. Some of the different management options include lifestyle measures, non-pharmacological, contraception, non-hormonal, and menopausal hormone therapies.

Not all people will need to be treated for their menopause. In some cases, symptoms are mild and manageable.

  • Menopausal hormone therapy.
    • Estrogen is the most effective treatment for hot flashes
      • But it not recommended for those with a history of certain medical problems, breast cancer, heart disease, or stroke. Discuss this option with your doctor.
    • Used in combination with estrogen and progestin (except for those who do not have a uterus who need only estrogen).
    • Hormone therapy is available via pill (for the mouth), skin patch, vaginal ring, skin gel, skin cream, or skin spray.
    • Hormone therapy may also help to relieve hot flashes, vaginal dryness, depression, and other mood problems.
      • Some who are struggling with mental health, depression, or anxiety may also require treatment for these issues separately from the hormone therapy.
    • If standard estrogen treatments do not work, as your doctor about vaginal estrogen therapy, which is a lower dose of other estrogen support medications. This is available as a cream, tablet, or flexible ring that inserts into the vagina.
  • Non-Hormonal Treatment Options
    • Antidepressants-
      • SSRIs. The selective serotonin receptor inhibitors are a class of antidepressants used most to treat hot flashes. In the United States, Brisdelle (a form of paroxetine) is approved for this use. Others used for this condition are citalopram and escitalopram. If you are taking tamoxifen for breast cancer, do not take paroxetine. Discuss these options with your doctor.
      • Other antidepressant options. These do help to treat hot flashes but also come with extra side effects. Discuss any or all these options with your doctor.
        • Fluoxetine (brand name: Prozac) and sertraline (brand name: Zoloft) do not work as well as the other antidepressants listed.
        • Gabapentin — Gabapentin (sample brand name: Neurontin) is a medication that was developed to treat seizures. It also relieves hot flashes in some people. It may be taken as a single bedtime dose (if hot flashes are most bothersome at night) or can also be taken during the daytime.
        • Oxybutynin — Oxybutynin is a drug that is usually used to treat overactive bladder and urinary incontinence. It also has been demonstrated to be effective for treating hot flashes. The most bothersome side effect is dry mouth.
        • Progesterone — The injectable progestin birth control hormone medroxyprogesterone acetate (brand name: Depo-Provera) helps to reduce hot flashes about as well as estrogen; however, it is not commonly used due to side effects such as irregular vaginal bleeding, acne, headache, and depression.
        • Plant-derived estrogens (phytoestrogens) — Plant-derived estrogens have been marketed as a “natural” or “safer” alternative to hormones for relieving menopausal symptoms. Phytoestrogens are found in many foods, including soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Supplements containing isoflavone, a type of phytoestrogen, can be purchased in health food stores.
        • Herbal treatments — Several herbal treatments have been promoted as a “natural” remedy for hot flashes. Many people use black cohosh for hot flashes, but clinical trials have shown that it is not more effective than placebo. There have been concerns that black cohosh could stimulate breast tissue like estrogen, increasing the risk of recurrence in people who have had breast cancer. However, there is no convincing evidence that it is harmful, even in people with breast cancer. Still, some experts suggest that people with breast cancer avoid black cohosh until this has been studied more extensively. Do not begin any new herbal treatment without discussing with your doctor.
        • Mind-body and other treatments — Stress management, relaxation, deep breathing, and yoga might be helpful for some people, but study results have been inconsistent; however, these approaches are not likely to be harmful and may have other benefits. Other approaches such as hypnosis, stellate ganglion blockade (numbing of a nerve in the neck with an injection), and acupuncture have also not been proven to reduce hot flashes, although some people find them helpful (possibly due to a placebo effect).

Treating Vaginal Dryness

There are many treatment options available, both prescription and natural, that can help with dryness of the vagina and outer genitalia.

  • Low-dose vaginal estrogen is a very effective treatment for vaginal dryness or pain (dyspareunia) with intercourse or physical intimacy due to menopause. This treatment can be sustainable for years as it only releases minimal amounts of estrogen into the bloodstream. Discuss this option with your doctor.
  • Daily Moisturizer. Consider trying a more holistic option to help to naturally restore vaginal moisture. Using a daily moisturizer helps to keep extra chemicals and hormones out of your body altogether, while rejuvenating the vaginal tissues every day.
  • Dilator therapy. The use of dilators, with lubrication, can also help to restore natural vaginal function, pliability, and moisture. Dilators are used to help to stretch, open, and widen the vaginal canal and tissues making for less painful gynecologic exams, insertion, and intimate activities.

Citations:

Centers for Disease Control and Prevention

National Institutes of Health and Human Services

World Health Organization