Coping with Menopause

What was once considered a taboo topic of conversation among women has become the focus of an off-Broadway smash hit – menopause.  And like in the on-stage production of Menopause The Musical, scenes of hot flashes, mood swings and sleepless nights play out daily in the lives of women from all walks of life.

So, what is menopause and how can women cope with this inevitable rite of passage that’s sure to change their lives?

What is menopause?

Menopause, according to medical textbooks and gynecologists, has occurred when a woman’s monthly menstrual cycle, or period, stops for at least a year, but not because of illness or pregnancy.  During menopause, a woman’s ovaries produce less of the hormones estrogen and progesterone, which are needed to reproduce.

What changes occur?

That change in the levels of hormones, the American College of Obstetricians and Gynecologists says, sets in motion symptoms like hot flashes, mood swings, vaginal dryness and insomnia.  The shift also diminishes the protective characteristics these hormones have on the body, which sets the stage for increased risk of cardiovascular diseases, bone loss and some cancers.

When does menopause start?

Joe Venditto, M.D., an obstetrician-gynecologist affiliated with South Miami Hospital’s Center for Women & Infants, says that natural menopause usually occurs between the ages of 45 and 55.  Yet the side effects of menopause, he says, may begin during the two- to five-year period leading up to menopause, known as perimenopause, or the transition to menopause.

What is ‘surgical menopause’?

Dr. Venditto also says women who undergo surgery to remove their ovaries will experience “surgical menopause,” which thrusts them into menopause without the normal progressive decrease of hormones that occurs with natural menopause.

“Natural menopause is much like going down a ski slope,” he said.  “With surgical menopause, it may feel more like jumping off a cliff.”

That swift passage into menopause sets the stage for more intense symptoms, says Julio Arronte, M.D., chief of obstetrics and gynecology at West Kendall Baptist Hospital.

“While about 75 percent of women will experience hot flashes during the first year of natural menopause,” he said, “the most intense hot flashes are reported by those women who experience surgical menopause, and they generally occur for longer than a year.”

What helps relieve symptoms?

Both Dr. Venditto and Dr. Arronte recommend eating right and exercising to manage the symptoms and health risks that occur with menopause.

“For most of my patients, the symptoms are tolerable,” Dr. Venditto said.  “When the symptoms affect the woman’s quality of life, we look at supplements and medications, including hormone replacement therapy (HRT), to manage these effects.”

In 2002, the Women’s Health Initiative abruptly stopped a study testing the effectiveness of hormone replacement therapy in pill form, because the risks of combining estrogen and progestin to minimize the side effects of menopause seemed to outweigh the benefits.  The study showed a modest increase in breast cancer and heart attack occurrences in women taking these pills longer than four years.  Subsequently, in 2004, researchers also halted the study of estrogen-only replacements from the Women’s Health Initiative, because an increased risk of stroke was shown in this group. Like many other clinical studies, these findings have since been challenged by newer research that indicates the original studies may have been flawed.

So, Dr. Venditto and Dr. Arronte recommend that women speak to their doctors about the best treatment options, based on the individual’s health history.  Patients with significant menopausal symptoms, who are at low risk for breast cancer, stroke and heart attack to begin with, can find relief from hormone replacement therapies now available, such as patches and gels, the doctors say.  Those treatments have been shown in their practices to improve patients’ quality of life.

Some herbal supplements, like black cohosh, claim relief of hot flashes, too, but these claims are not substantiated or regulated by the Food and Drug Administration.

What happens after menopause?

Once a woman has gone through a year without a period, she enters the classification of “postmenopausal,” Dr. Venditto says.

“In this stage of a woman’s life, preventive medicine is key,” he said.  He recommends postmenopausal women continue to have yearly Pap tests, if they have still have their uterus; annual mammograms; and bone density scans every two years.  He also suggests taking 1,500 milligrams of calcium and 800 IUs of vitamin D supplements daily to maintain bone health.

Dr. Arronte agrees and stresses healthy lifestyles for his postmenopausal patients.

“The best approach for coping with menopause is exercising two to three times a week, if your doctor says it’s OK to do so, and eating healthy,” he said.

And once you get your symptoms under control, share stories with your girlfriends and catch a funny show together.

Tags: Joe Venditto M.D., Julio Arronte M.D., menopause, South Miami Hospital, South Miami Hospital Center for Women & Infants, West Kendall Baptist Hospital