Managing Menopause

Without Hormones

DANBURY — Depression, anxiety, difficulty concentrating or making decisions, mood swings, decline in sexual desire, bone loss, and vaginal changes are just some of the symptoms women go through during menopause.

Menopause, defined as the loss of ovarian function and the cessation of the hormones they produce, is becoming a growing health issue as the population ages and more baby-boomers enter this phase of life.

Management of these symptoms, including alternative options to the controversial use of hormone replacement therapy, were discussed recently by two obstetricians/gynecologists at Danbury Hospital’s Medical Town Meeting, “Flashing and Flushing: Current Management of the Menopause.”

Bessie Montesano, MD, and Christine Dailey, MD, both members of the Department of Obstetrics and Gynecology, discussed treating and managing menopause symptoms with alternatives to traditional hormone replacement therapy (HRT). HRT has not been widely used for the past two years, since the Women’s Health Initiative (WHI) showed that it increased a woman’s risk of breast cancer, heart attack, stroke, and blood clots.

HRT was prescribed for decades to help protect a woman against osteoporosis and cardiovascular disease that sometimes escalated after menopause. It was thought that natural hormones had a protective benefit. Since the WHI study, however, the current thinking is to give HRT only to relieve menopause symptoms, and in the smallest doses possible, according to Dr Dailey. Transdermal patches, gels, lotions, and vaginal rings are all used today to prescribe estrogen locally. Phytoestrogens, or estrogenlike substances that come from food and plants such as flaxseed, soy and beans, are also useful.

Women need to understand their risks and benefits of HRT, according to Dr Montesano and Dr Dailey.

Menopause can be a very confusing time for women. Described by some as the “change of life” or “midlife crisis,” menopause is medically defined as the last menstrual period, the transition from the reproductive years to the nonreproductive, or the surgical removal of the ovaries, according to Dr Montesano. A woman is in menopause when she has not had her menstrual period for one year.

Dr Montesano and Dr Dailey discussed how the menopause experience is different for all woman, some suffering from hot flashes and night sweats to the point of exhaustion, while others seem to notice no symptoms. Dr Montesano also pointed out that smoking can cause a woman to go into menopause two years earlier than nonsmokers.

Symptoms, they said, occur mostly from the loss of estrogen produced by the ovaries. Such loss can cause hot flashes, vaginal dryness and discomfort, bladder symptoms, escalation of heart disease, osteoporosis, vaginitis, pelvic organ prolapse, depression, anxiety, mood swings, difficulty concentrating or making decisions, decreased sexual desire and response, painful intercourse, lack of sleep, and other symptoms.

Osteoporosis, one of the worst conditions caused by menopause, happens because estrogen is thought to preserve bone. When the body stops producing it, bone loss can occur rapidly, especially in the time right after the final menstrual period.

Risk factors for osteoporosis include women who had an early menopause, being Caucasian or Asian, thin-framed women, a family history, cigarette-smoking, low calcium intake, alcohol and caffeine use, and chronic use of steroids.

To prevent osteoporosis, women are advised to take a calcium supplement, do weight-bearing exercise for 30 minutes at least three times a week and to eat a well balanced diet.

The doctors also discussed nonhormone related therapies to treat menopause today. Antidepressants, antiseizure medications, and certain blood pressure medicines can also help.

For more information about managing menopause symptoms, see your doctor, or visit www.danburyhospital.org.

Those in need of a doctor can call the Danbury Hospital physician referral service at 797-7322.