You just turned 50, and you’re juggling a full-time job, shuttling the kids to school and sporting events, and looking in on aging parents. You’ve been noticing some small, nagging physical and emotional changes that you think could signal the start of menopause, but you’re not sure. Plus, you barely have five minutes a day to concentrate on your health needs. How do you know if you’re “in menopause” and how do you determine the best ways to treat your symptoms while living a busy, active life? Get some advice from the experts who practice at Durham Regional Hospital.

What is menopause?

While it may not seem like it, menopause is a normal part of life. It doesn’t happen overnight, but takes many years leading up to the cessation of your period. That’s what menopause is – when you have stopped having your period for 12 months. Menopause happens slowly as your body produces less of hormones estrogen and progesterone, usually between the ages of 45 and 55 years old. As you get closer to stopping your period, your body may undergo some obvious changes. That’s why it’s often called the “change of life.” The time leading up to menopause is called perimenopause, and you may have some of the following symptoms:

• Changes in your period – heavier flow or an irregular cycle. You may have more “spotting” between cycles. If the spotting continues after you are in menopause, you should contact your physician.
• Hot flashes – warmth and/or sweating in the upper body – face, chest and neck. May also include night sweats, which can make you tired or stressed.
• Vaginal changes – the lining the vagina becomes thin during this time, causing sex to be painful and you may also have more vaginal infections. These changes can result in lack of interest in sex and/or sexual response.
• Bone loss – some women develop osteoporosis or bone thinning.
• Mood swings and lack of concentration – you may notice that you’re more irritable or depressed; however, menopause does not cause clinical depression.
• Weight gain or body fat around the abdomen
• Thinning hair or hair loss
• Urinary problems – some women have discomfort when urinating, or experience leakage when sneezing, coughing or laughing.

How can you be sure that you’re in menopause?

The symptoms are a sign that you are entering the perimenopausal stage, which can last for two to four years before your period ends. The beginning of menopause is noted when you have not had your period in 12 months. This can occur naturally over time, or if you have had surgery, such as the removal of your uterus (hysterectomy), which will make your periods stop, or of you have your ovaries removed (oophorectomy), menopause symptoms will start right away.

The time after your period has stopped for a year is called postmenopause. You may continue having some the same symptoms, but the most notable changes after menopause include bone loss, which can lead to osteoporosis and an increase of a fracture, and heart disease. After menopause, women have just as great of risk of having a heart attack as men. Talk to your doctor about reducing your risks if you are overweight, have elevated cholesterol or blood pressure or smoke. Each can increase your chance of developing heart disease.

What are the treatment options for perimenopause and menopause?

Since the hormone levels drop and eventually stop, you can be treated for the individual symptoms or there are therapies that counter the overall impact of menopause. In the past, most women opted for hormone replacement therapy (HRT), which is a combination of estrogen and progesterone, or estrogen only (ERT) for women who have had their uterus removed. These treatments, available in a variety of forms including skin patches, pills, creams or vaginal inserts, may help relieve hot flashes and reduce bone loss; however they may increase the chance of heart disease, stroke, breast cancer, gall bladder disease and blood clots. Medical researchers are still studying the safety of HRT and ERT. You should only use HRT and ERT for the shortest time possible and check back with your doctor every three to six months to see if you still need to take them.

“Hormone replacement therapy is definitely one of the hot topics surrounding menopause,” explained Linda Fetko, M.D., obstetrician/gynecologist with Durham OB/GYN. “Each woman is unique, and each may approach menopause in a different way. Before deciding how best to proceed, each woman will want to discuss her symptoms, medical history, family history and preferences with her physician.”

How can natural treatments help?

Instead of HRT or ERT, many women are using herbal, natural or plant-based products to help their symptoms. While these are natural or plant-based products, there is no evidence that they are any safer than other forms of hormones or proof that they are more effective. They include:

• Soy-based foods and supplements – Soy contains phytoestrogens (a substance similar to estrogen.) While there is no scientific confirmation that soy reduces hot flashes, some women seem to get relief when they include soy in their diet. Sources include pills and powders, tofu, tempeh, soy milk and soy nuts.
• Other types of phytoestrogens – include herbs – black cohash, and can be taken as a supplement.
• Bioidentical hormone therapy – these hormones are identical to those produced by the human ovary and are custom-compounded based on the physician’s prescription. They are made from different plant hormones and dose varies by each patient’s needs.

“The bioidentical hormones react and respond to our estrogen and progesterone receptors exactly like the hormones we make, and that is not true of synthetic hormones,” explained Sheila Allison, M.D., Southpoint Medicine and Women’s Health Associates. “We are able to determine the ratios of the three estrogens that we make in our bodies, and then supplement with bioidentical hormones in the same ratios. The important thing is that we can tailor them to the individual patient. We look at each patient when we are deciding on the best treatment in terms of dosage and delivery system.”

Beyond food and supplements, what can you do?

Some of the best advice for staying healthier during the time leading up to and after menopause, include a balanced lifestyle.

• Stay active and incorporate 30 minutes of exercise each day, especially weightbearing exercises like walking, running or dancing. They will help keep your bones stronger.
• If you smoke, quit. Talk to your doctor or check out the American Lung Association web site: www.lungusa.org.
• Eat healthy
  • Lots of whole grain products, vegetables and fruit (Five-a-Day of fruits and veggies!)
  • Select foods low in fat and cholesterol.
  • Include enough calcium in your diet: 1,000 mg. for women before menopause; 1,500 mg. after menopause.
  • If you drink alcohol, limit yourself to one drink per day.
• If you are overweight (BMI – body mass index – of more than 25), lose weight. If you are under a 25 BMI, maintain your weight.
• See your doctor regularly as recommended.
  • Over age 65, get a bone density test, or if you are at higher-risk, talk to your doctor about scheduling one at an earlier age.
  • Have your blood pressure, cholesterol and blood sugar checked.
  • Get a breast exam and mammogram.

For more information about menopause or if you need a referral for a physician, contact Durham Regional Hospital’s Consultation and Referral Center at (919) 403-4DRH (4374) Monday through Friday 7 a.m. to 7 p.m. or visit our website to access our online Physician Directory.

Websites with helpful information about menopause and women’s health:

American College of Obstetricians and Gynecologists – www.acog.org

National Women’s Health Information Center – www.4woman.gov

National Institutes of Health – www.nih.gov/PHTindex.htm

North American Menopause Society – www.menopause.org