Menopause is BIG! You can’t scroll through a social media feed, stream or read anything without coming across the Great Midlife Awakening. It’s about time, but there is a tsunami of information. How to make sense of it all and find your way to what you need? Sixty percent of women feel ill prepared for menopause. Let’s make sure that’s not you!
So let’s say you already know the difference between being menopausal – defined as no periods for 12 months, and when the ovarian sex steroids, estrogen, progesterone, testosterone drop to near zero – and being in perimenopause, which is the decade or so before menopause when hormonal chaos can cause a confusing and frustrating mix of symptoms, from menstrual irregularities to disrupted sleep to mood and memory issues.
Let’s say you want help. Do you go to the internet? Influencers? A doctor? We can break treatment options into three boxes.
Online and Over-the-Counter
The first is a big grab bag of options we will collectively call “Complementary and Alternative Options.” This includes
- Bedding and sleepwear options which wick moisture to provide more comfortable sleep
- Wearable devices such as EMBRwave which promote good sleep and reduce anxiety by using pulsatile cooling of the wrist to stop hot flashes.
- Supplements which have varying degrees of data to support their safety and effectiveness. Some supplements can be dangerous so it is important to know what has been studied for safety and effectiveness. Equelle, for example, is a twice daily tablet whose active ingredient, S-equol, is plant derived and has been studied and shown to be safe and effective. Melatonin can help with sleep.
- Vitamins and minerals: part of maintaining health is healthy bones and calcium and vitamin D are a part of that; magnesium can help with sleep issues.
Prescription but not Hormonal
The second box of options includes prescription medications which are non-hormonal. One is FDA approved for treatment of vasomotor symptoms, the medical term for hot flashes or night sweats. The others are used off label, meaning they are approved for other indications but control some menopausal symptoms.
Common medications in this category include:
- SSRI/SNRIs – these are anti-depressant/anti-anxiety medications which reduce frequency and severity of hot flashes by affecting the brain’s thermoregulatory center, which controls body temperature. SSRIs increase serotonin and SNRIs increase norepinephrine, two neurochemicals. When estrogen levels decrease in menopause or fluctuate in perimenopause, serotonin and norepinephrine levels fluctuate and this can cause hot flashes and or mood issues. Sleepiness and a lower sex drive can be unwelcome side effects.
- Oxybutynin: this is a medication approved for overactive bladder; dry eyes and mouth can be an issue
- Gabapentin: a medication used for chronic pain which can be effective but drowsiness is an issue.
- Fezolinetant is FDA approved for hot flashes and works in the part of the brain where the hot flashes originate; it is very effective but cost and coverage can be an issue.
Hormonal
Perhaps the most effective, but also the most misunderstood, option to treat symptoms of perimenopause and menopause, is hormonal therapy.
- Oral contraceptives: not just for birth control, oral contraceptives contain estrogen and progesterone and can help perimenopausal women with symptoms while offering still needed contraception.
- Hormone Therapy (HT): whether estrogen alone ( if you have had a hysterectomy) or estrogen and progesterone ( if you have a uterus), tiny doses of hormone therapy can help symptoms quickly and effectively. Also safely. Systemic HT can be used to control symptoms of menopause or for long term health benefits to reduce bone loss; studies suggest many other health benefits from use of menopausal HT including a possible protective effect of estrogen against heart disease, the number one killer of women.
- Estradiol is the main type of estrogen made in the body; it comes as a gel, patch, mist, pill or vaginal cream ( used for treating genital and urinary symptoms).
- Progesterone is a nightly pill used with estradiol to protect the uterus from tissue growth effects of estrogen; it also helps promote good sleep.
- Testosterone is also made in the ovaries and its loss affects libido and likely many other health aspects such as energy, keeping and building muscle mass. There is currently no FDA-approved testosterone available for women in the U.S. but using one tenth of the male dose or compounded testosterone in small doses to restore premenopausal levels is suggested by some medical societies.
- DHEA: this is a hormone your body makes that helps produce other hormones like estrogen and testosterone; it is available as a pill, cream or gel; it has been touted to slow aging, improve physical performance or help with menopausal symptoms but research is mixed on its effectiveness. It can interact with medications and should not be taken with estrogen or testosterone. It can also lower your good “HDL” cholesterol and interact with antidepressants.
The bottom line is that there are lots of options for you, if you know what’s out there. If you need to find a clinician who can guide you, look one up by zip code at menopause.org. Don’t let the symptoms of perimenopause and menopause disrupt your life. A trained clinician can guide you and make sure you have no contraindications to whatever you choose.
