Mastering menopause

As if getting older wasn’t challenging enough, now you’re heating up at the worst possible moments. Whether you’re approaching menopause or wrapped in its (very) warm embrace, knowing how to manage the symptoms will greatly improve your quality of life.

It happens to at least half the global population, yet it’s still a somewhat taboo subject. Women of different generations tend not to share their experiences, many bemoan the lack of media coverage of this stage of life and it’s rarely acknowledged or accommodated in the workplace. That’s why so many women are unprepared when menopause begins. For some, hot flushes are non-existent, for others they’re just the tip of the iceberg. Regardless, by understanding menopause symptoms and treatments, you’ll be better equipped for the challenges “the change” may bring.

 

What to expect

On average, affecting women around the age of 51, menopause is confirmed when a woman hasn’t had her period for a year – when her ovaries have stopped producing eggs. While menopause is experienced differently by different women, it’s associated with common symptoms caused by the decreased production of oestrogen and progesterone. As you enter perimenopause – the years or months preceding menopause, you may begin to have the following symptoms with varying degrees of severity:

  • Vaginal drynessOne of the most common, yet least discussed symptoms that can accompany menopause is vaginal dryness. This leads to sexual discomfort and a resultant decrease in libido. This dryness is caused by vaginal atrophy – the thinning, drying and inflammation of the vaginal walls. When the ovaries stop making oestrogen, the vaginal lining becomes thin and dry, with less lubrication. The dry vagina is also more prone to small injuries and infection.Yet treatment in the form of vaginal hormone therapy is effective and easily administered. The earlier you start this therapy, the more successful it will be. Vaginal oestrogen comes in the form of cream or tablets administered directly into the vagina and is found to be extremely effective. What’s more, says Dr Smith, whether it’s applied via the cream or the tablet, vaginal oestrogen works only in the vagina and is not absorbed into the rest of the body.“Regular hormone therapy makes no difference to the vagina so women need to use it locally. Only small doses of oestrogen are needed to treat the vaginal symptoms of menopause and the vaginal response to local oestrogen therapy can be quick and long-lasting, if used as indicated.” Speak to your doctor or pharmacist to determine the best option for you.Irregular periods
  • Vaginal dryness
  • Reduced sexual desire
  • Hot flushes, nights sweats and chills
  • Sleep problems
  • Mood changes and depression
  • Weight gain and slowed metabolism
  • Memory lapses
  • Drop in bone density

 

Once you’re officially in menopause and postmenopause, some of these symptoms may continue for up to four to five years, although their frequency and intensity tends to decrease as time passes.

 

The HRT debate

That’s why physician-supervised hormone replacement therapy (HRT), offsets natural drops in oestrogen, has arguably become the most common and effective treatment for most menopause symptoms. It’s especially effective in treating hot flushes and preventing bone loss. It is only used when a deficiency in female sex hormones has clearly been determined and should ideally begin at the onset of menopause. The more severe your symptoms, the more this treatment improves your quality of life.

 

There are two main types of HRT:

  • combined HRT (a combination of oestrogen and progestogen) – for women with menopausal symptoms who still have their womb. Oestrogen taken on its own can otherwise increase your risk of womb cancer.
  • oestrogen-only HRT – for women who have had their womb removed in a hysterectomy.

 

HRT also known as HT is available in the form of tablets, skin patches, a gel to rub into the skin or implants in the form of pellets (the size of a rice grain) which are inserted just under the surface of your skin by a doctor under local anaesthetic.

HRT has long been a topic of debate, with many claiming a link to cancer or weight gain but this is largely unjustified when administered correctly, say medical professionals. “There’s unnecessary stigma surrounding hormone treatment in my opinion,” says Dr Trudy Smith, a Johannesburg-based gynaecology oncologist, gynaecologist and obstetrician and president of the SA Menopause Society. “From a symptom control perspective there’s no doubt that hormone treatment definitely works. You need to use the lowest available dose that gives you symptom control.”

 

If you already have any of the following conditions, HRT is not advised:

  • Blood clots
  • Cancer (such as breast, uterine, or endometrial)
  • Heart or liver disease
  • Heart attack
  • Known or suspected pregnancy
  • Stroke

 

Before taking any form of HRT, it is essential to consult your doctor.

 

Prescription remedies

In women where it’s contra-indicated to use oestrogen, there are other options that you can discuss with your physician, says Dr Smith. “Selective serotonin reuptake inhibitors are commonly prescribed.”

Prescription antidepressants, particularly the selective serotonin reuptake inhibitors, can also effectively moderate moods. If mood swings or depression are beginning to diminish your quality of life, speak to your doctor.

Medications can also be prescribed to diminish a decline in bone density, lowering your chances of getting osteoporosis later in life.

 

Doing it naturally

From changing your diet, to taking supplements or homeopathic remedies, to undergoing alternative therapies, many swear by natural treatments to alleviate menopausal symptoms. For example, acupuncture and hypnosis, especially when it comes to symptoms like hot flushes are often recommended.

While women experience them differently, hot flushes generally engulf you with warmth or heat and often cause excessive sweating and end with chills. They can be accompanied by heart palpitations or feelings of anxiety, agitation or dread.

Everything from herbal teas to vitamin E have been touted as potential hot flush remedies. Even a tablespoon of organic apple cider vinegar diluted with a glass of water or juice is said to reduce flushes or at least lessen their effects. Avoiding foods or drinks that trigger hot flushes or mood swings, such as those that are spicy or contain excess caffeine or alcohol, is also advisable.

Commonly touted supplements for managing hot flushes and other menopause symptoms include:

  • Phytoestrogens: Compounds naturally found in plants, which can have oestrogen-like effects, can be consumed through natural food sources or supplements such as red clover extracts.
  • Black cohosh: Although some studies found that black cohosh may effectively alleviate hot flushes, the evidence is mixed.

 

Yet these supplements all lack sufficient evidence in terms of their long-term impact and effectiveness in treating menopausal symptoms.

When it comes to homeopathic medicine, doctors suggest exercising caution. “As scientists, we like to quote randomised placebo-controlled trials and we don’t have reliable ones in this area,” says Dr Trudy Smith. “The problem with natural and homeopathic remedies is that often a person we know says it works and therefore we think it must. What we do know with complementary alternative medicines (CAMS) is that there’s a large placebo effect – initially it works and then it doesn’t.”

However there’s no discounting the benefits of a healthy lifestyle when it comes to navigating menopause.

A healthy lifestyle

As menopause approaches, commonly recommended adjustments in diet and fitness include:

 

  • Taking supplements as well as eating food rich in calcium, vitamin D and vitamin B-12 is advisable, especially when it comes to maintaining bone health. Think dairy, green leafy vegetables, oily fish and eggs.

 

Bone health is a focus as research shows that women can lose up to 20% of their bone density in the five to seven years following the onset of menopause. The drop in bone density is caused by falling levels of oestrogen, which helps to preserve bone strength. Yet even though bone density is affected, your risk of osteoporosis generally remains relatively low until much later in life.

 

Supplements can also be useful for mood imbalances. Vitamin E supplements can help ease stress and may help reduce your risk of depression. B-6 supplements taken during and after menopause may help modify or prevent symptoms caused by low serotonin levels which include loss of energy and depression.

 

  • A healthy, balanced diet, rich in the abovementioned vitamins as well as in protein, fruit and vegetables is also vital. Avoiding foods with refined carbs and sugar is also beneficial and can stabilise the mood changes or feelings of depression that menopause can sometimes illicit. Drinking eight to 12 glasses of water a day can stimulate weight loss and help manage the dryness associated with decreased oestrogen levels. Eating regular meals is also important.

 

  • Regular exercise – Weight gain is commonly associated with menopause. Yet losing excess kilos and maintaining a healthy weight may alleviate other menopause symptoms and aid in preventing disease. One study of 17 473 postmenopausal women found that those who lost at least 4.5 kg of weight or 10% of their body weight over a year were more likely to eliminate hot flashes and night sweats. That’s why regular exercise – which includes weight bearing and resistance training for bone health – is recommended.

 

Stimulating endorphins, exercise also has a positive impact on lifting one’s spirits. Meditation and yoga are also valuable options when it comes to dealing with the mood fluctuations that can accompany menopause.

Sources: https://www.openaccessgovernment.org/menopause-the-last-great-taboo/100976/  /  https://www.healthline.com/nutrition/11-natural-menopause-tips#TOC_TITLE_HDR_12  /  https://www.ntxobgyn.com/blog/5-reasons-to-consider-a-hormone-pellet-implant-for-your-menopause-symptoms  /  www.dryvagina.co.za

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Copyright © Dis-Chem Pharmacies. All rights reserved.

It happens to at least half the global population, yet it’s still a somewhat taboo subject. Women of different generations tend not to share their experiences, many bemoan the lack of media coverage of this stage of life and it’s rarely acknowledged or accommodated in the workplace. That’s why so many women are unprepared when menopause begins. For some, hot flushes are non-existent, for others they’re just the tip of the iceberg. Regardless, by understanding menopause symptoms and treatments, you’ll be better equipped for the challenges “the change” may bring.

 

What to expect

On average, affecting women around the age of 51, menopause is confirmed when a woman hasn’t had her period for a year – when her ovaries have stopped producing eggs. While menopause is experienced differently by different women, it’s associated with common symptoms caused by the decreased production of oestrogen and progesterone. As you enter perimenopause – the years or months preceding menopause, you may begin to have the following symptoms with varying degrees of severity:

  • Irregular periods
  • Vaginal dryness
  • Reduced sexual desire
  • Hot flushes, nights sweats and chills
  • Sleep problems
  • Mood changes and depression
  • Weight gain and slowed metabolism
  • Memory lapses
  • Drop in bone density

 

Once you’re officially in menopause and postmenopause, some of these symptoms may continue for up to four to five years, although their frequency and intensity tends to decrease as time passes.

Vaginal dryness

One of the most common, yet least discussed symptoms that can accompany menopause is vaginal dryness. This leads to sexual discomfort and a resultant decrease in libido. This dryness is caused by vaginal atrophy – the thinning, drying and inflammation of the vaginal walls. When the ovaries stop making oestrogen, the vaginal lining becomes thin and dry, with less lubrication. The dry vagina is also more prone to small injuries and infection.

Yet treatment in the form of vaginal hormone therapy is effective and easily administered. The earlier you start this therapy, the more successful it will be. Vaginal oestrogen comes in the form of cream or tablets administered directly into the vagina and is found to be extremely effective. What’s more, says Dr Smith, whether it’s applied via the cream or the tablet, vaginal oestrogen works only in the vagina and is not absorbed into the rest of the body.

“Regular hormone therapy makes no difference to the vagina so women need to use it locally. Only small doses of oestrogen are needed to treat the vaginal symptoms of menopause and the vaginal response to local oestrogen therapy can be quick and long-lasting, if used as indicated.” Speak to your doctor or pharmacist to determine the best option for you.

The HRT debate

That’s why physician-supervised hormone replacement therapy (HRT), offsets natural drops in oestrogen, has arguably become the most common and effective treatment for most menopause symptoms. It’s especially effective in treating hot flushes and preventing bone loss. It is only used when a deficiency in female sex hormones has clearly been determined and should ideally begin at the onset of menopause. The more severe your symptoms, the more this treatment improves your quality of life.

 

There are two main types of HRT:

  • combined HRT (a combination of oestrogen and progestogen) – for women with menopausal symptoms who still have their womb. Oestrogen taken on its own can otherwise increase your risk of womb cancer.
  • oestrogen-only HRT – for women who have had their womb removed in a hysterectomy.

 

HRT also known as HT is available in the form of tablets, skin patches, a gel to rub into the skin or implants in the form of pellets (the size of a rice grain) which are inserted just under the surface of your skin by a doctor under local anaesthetic.

HRT has long been a topic of debate, with many claiming a link to cancer or weight gain but this is largely unjustified when administered correctly, say medical professionals. “There’s unnecessary stigma surrounding hormone treatment in my opinion,” says Dr Trudy Smith, a Johannesburg-based gynaecology oncologist, gynaecologist and obstetrician and president of the SA Menopause Society. “From a symptom control perspective there’s no doubt that hormone treatment definitely works. You need to use the lowest available dose that gives you symptom control.”

 

If you already have any of the following conditions, HRT is not advised:

  • Blood clots
  • Cancer (such as breast, uterine, or endometrial)
  • Heart or liver disease
  • Heart attack
  • Known or suspected pregnancy
  • Stroke

 

Before taking any form of HRT, it is essential to consult your doctor.

 

Prescription remedies

In women where it’s contra-indicated to use oestrogen, there are other options that you can discuss with your physician, says Dr Smith. “Selective serotonin reuptake inhibitors are commonly prescribed.”

Prescription antidepressants, particularly the selective serotonin reuptake inhibitors, can also effectively moderate moods. If mood swings or depression are beginning to diminish your quality of life, speak to your doctor.

Medications can also be prescribed to diminish a decline in bone density, lowering your chances of getting osteoporosis later in life.

 

Doing it naturally

From changing your diet, to taking supplements or homeopathic remedies, to undergoing alternative therapies, many swear by natural treatments to alleviate menopausal symptoms. For example, acupuncture and hypnosis, especially when it comes to symptoms like hot flushes are often recommended.

While women experience them differently, hot flushes generally engulf you with warmth or heat and often cause excessive sweating and end with chills. They can be accompanied by heart palpitations or feelings of anxiety, agitation or dread.

Everything from herbal teas to vitamin E have been touted as potential hot flush remedies. Even a tablespoon of organic apple cider vinegar diluted with a glass of water or juice is said to reduce flushes or at least lessen their effects. Avoiding foods or drinks that trigger hot flushes or mood swings, such as those that are spicy or contain excess caffeine or alcohol, is also advisable.

Commonly touted supplements for managing hot flushes and other menopause symptoms include:

  • Phytoestrogens: Compounds naturally found in plants, which can have oestrogen-like effects, can be consumed through natural food sources or supplements such as red clover extracts.
  • Black cohosh: Although some studies found that black cohosh may effectively alleviate hot flushes, the evidence is mixed.

 

Yet these supplements all lack sufficient evidence in terms of their long-term impact and effectiveness in treating menopausal symptoms.

When it comes to homeopathic medicine, doctors suggest exercising caution. “As scientists, we like to quote randomised placebo-controlled trials and we don’t have reliable ones in this area,” says Dr Trudy Smith. “The problem with natural and homeopathic remedies is that often a person we know says it works and therefore we think it must. What we do know with complementary alternative medicines (CAMS) is that there’s a large placebo effect – initially it works and then it doesn’t.”

However there’s no discounting the benefits of a healthy lifestyle when it comes to navigating menopause.

A healthy lifestyle

As menopause approaches, commonly recommended adjustments in diet and fitness include:

 

  • Taking supplements as well as eating food rich in calcium, vitamin D and vitamin B-12 is advisable, especially when it comes to maintaining bone health. Think dairy, green leafy vegetables, oily fish and eggs.

 

Bone health is a focus as research shows that women can lose up to 20% of their bone density in the five to seven years following the onset of menopause. The drop in bone density is caused by falling levels of oestrogen, which helps to preserve bone strength. Yet even though bone density is affected, your risk of osteoporosis generally remains relatively low until much later in life.

 

Supplements can also be useful for mood imbalances. Vitamin E supplements can help ease stress and may help reduce your risk of depression. B-6 supplements taken during and after menopause may help modify or prevent symptoms caused by low serotonin levels which include loss of energy and depression.

 

  • A healthy, balanced diet, rich in the abovementioned vitamins as well as in protein, fruit and vegetables is also vital. Avoiding foods with refined carbs and sugar is also beneficial and can stabilise the mood changes or feelings of depression that menopause can sometimes illicit. Drinking eight to 12 glasses of water a day can stimulate weight loss and help manage the dryness associated with decreased oestrogen levels. Eating regular meals is also important.

 

  • Regular exercise – Weight gain is commonly associated with menopause. Yet losing excess kilos and maintaining a healthy weight may alleviate other menopause symptoms and aid in preventing disease. One study of 17 473 postmenopausal women found that those who lost at least 4.5 kg of weight or 10% of their body weight over a year were more likely to eliminate hot flashes and night sweats. That’s why regular exercise – which includes weight bearing and resistance training for bone health – is recommended.

 

Stimulating endorphins, exercise also has a positive impact on lifting one’s spirits. Meditation and yoga are also valuable options when it comes to dealing with the mood fluctuations that can accompany menopause.