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Symptoms and Signs of Menopause

Doctor's Notes on Menopause Symptoms, Signs, Age, Herbal Remedies & Treatments

Menopause refers to the time in life at which a woman no longer menstruates and is no longer able to become pregnant. Menopause by definition occurs when a woman has gone for 12 consecutive months without a menstrual period. In the US, the average age of menopause is 51 but the age at which individual women reach menopause can vary. Menopause is a normal condition that is caused by changes in hormone levels that occur with aging.

Symptoms of the menopausal transition also vary among women, with some women experiencing more severe symptoms than others. Common associated symptoms include hot flashes or flushes, night sweats, mood changes, vaginal dryness, and fatigue. Other possible symptoms can include headache, memory problems, irritability, weight gain, or changes in skin texture.

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Medically Reviewed on 3/11/2019

Menopause Symptoms, Signs, Age, Herbal Remedies & Treatments Symptoms

Menopause is not a disease that has a definitive cure or treatment. Health care practitioners, however, can offer a variety of treatments for hot flashes and other menopausal symptoms that become bothersome. Many prescription medications exist to prevent and control high cholesterol and bone loss, which can occur at menopause. Some women do not need therapy, or they may choose not to take medications at all during their menopausal years.

Black cohosh (Remifemin) is a commonly used herbal supplement that is believed to reduce hot flashes. However, small German studies that tested black cohosh only followed women over a short time period. The German agency that regulates herbs does not recommend using black cohosh for longer than six months. Side effects can include nausea, vomiting, dizziness, visual problems, slow heartbeat, and excessive sweating. Black cohosh is not regulated by the U.S. Food and Drug Administration, so women must be careful about the safety and purity of this supplement.

Plant estrogens (phytoestrogens) such as soy protein are a popular remedy for hot flashes, although data on their effectiveness are limited. Phytoestrogens are natural plant estrogens (isoflavones), which are thought to have effects similar to estrogen therapy. The safety of soy in women who have a history of breast cancer has not been established, although clinical studies indicate soy is no more effective for treating symptoms than a placebo. Soy comes from soybeans and is also called miso or tempeh. The best food sources are raw or roasted soybeans, soy flour, soy milk, and tofu. Soy sauce and soy oil do not contain isoflavones.

Herbals: Inconclusive and conflicting studies indicate that other herbals, such as dong quai, red clover (Promensil), chasteberry (Vitex), yam cream, Chinese medicinal herbs, and evening primrose oil, should be avoided or taken with care under the supervision of a health care professional to avoid unwanted and dangerous side effects and interactions.

CAM: According to the National Center for Complementary and Alternative Medicine, other nonprescription techniques may relieve the symptoms of menopause. These techniques include meditation, acupuncture, hypnosis, biofeedback, deep breathing exercises, and paced respiration (a technique of slow breathing using the stomach muscles).

Estrogens or a combination of estrogens and progesterone (progestin)

Long-term studies of women receiving combined HT with estrogen and progesterone showed an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus).

More recently, studies have suggested that the cardiovascular risks associated with hormone therapy may be more relevant for older postmenopausal women rather than those in the perimenopause or early postmenopausal period. The decision regarding hormone therapy, therefore, should be individualized by each woman and her healthcare professional based on her medical history, the severity of the symptoms, and the potential risks and benefits of hormone administration.

Estrogen is available in a variety of forms, including vaginal creams, tablets, and estrogen vaginal rings (for example, Estring), which are mainly useful for vaginal symptoms; skin patches (Vivelle, Climara, Estraderm, Esclim, Alora); transdermal sprays or gels (for example, Evamist); and oral tablets.

Women should undergo a breast exam and mammogram prior to starting estrogen. Once on estrogen, women must be monitored regularly with breast exams and mammograms. Women who already have heart disease should not use estrogen. Estrogen therapy does not prevent pregnancy. Women who take estrogen also tend to have a higher risk of developing gallstones, increased triglyceride levels, and blood clots.

Estrogens or a combination of estrogens and progesterone (progestin)

Long-term studies of women receiving combined HT with estrogen and progesterone showed an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. Studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus).

More recently, studies have suggested that the cardiovascular risks associated with hormone therapy may be more relevant for older postmenopausal women rather than those in the perimenopause or early postmenopausal period. The decision regarding hormone therapy, therefore, should be individualized by each woman and her healthcare professional based on her medical history, the severity of the symptoms, and the potential risks and benefits of hormone administration.

Estrogen is available in a variety of forms, including vaginal creams, tablets, and estrogen vaginal rings (for example, Estring), which are mainly useful for vaginal symptoms; skin patches (Vivelle, Climara, Estraderm, Esclim, Alora); transdermal sprays or gels (for example, Evamist); and oral tablets.

Women should undergo a breast exam and mammogram prior to starting estrogen. Once on estrogen, women must be monitored regularly with breast exams and mammograms. Women who already have heart disease should not use estrogen. Estrogen therapy does not prevent pregnancy. Women who take estrogen also tend to have a higher risk of developing gallstones, increased triglyceride levels, and blood clots.

Hot flashes: Several nonprescription treatments are available, and lifestyle choices can help. Many women feel that regular aerobic exercise can help reduce hot flashes, but controlled studies have not proved any benefit. Foods that may trigger hot flashes, such as spicy foods, caffeine, and alcohol, should be avoided.

Heart disease: A low-fat, low-cholesterol diet helps to reduce the risk of heart disease.

Weight gain: Regular exercise is helpful in controlling weight.

Osteoporosis: Adequate calcium intake and weight-bearing exercise are important. Strength training (not just lifting weights, but any exercise where you bear your own weight, such as walking, tennis or gardening) can strengthen bones.

Hot flashes: Several nonprescription treatments are available, and lifestyle choices can help. Many women feel that regular aerobic exercise can help reduce hot flashes, but controlled studies have not proved any benefit. Foods that may trigger hot flashes, such as spicy foods, caffeine, and alcohol, should be avoided.

Heart disease: A low-fat, low-cholesterol diet helps to reduce the risk of heart disease.

Weight gain: Regular exercise is helpful in controlling weight.

Osteoporosis: Adequate calcium intake and weight-bearing exercise are important. Strength training (not just lifting weights, but any exercise where you bear your own weight, such as walking, tennis or gardening) can strengthen bones.

The class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) typically used in the treatment of depression and anxiety, has been shown to be effective in reducing menopausal hot flashes. Paroxetine (Brisdelle) is an SSRI that has been approved for the treatment of moderate to severe hot flashed associated with menopause. Another SSRI that has been tested and shown to be effective is venlafaxine (Effexor), although other SSRI drugs may be effective as well.

Clonidine (Catapres) is a drug that decreases blood pressure. Clonidine can effectively relieve hot flashes in some women. Side effects include dry mouth, constipation, drowsiness, and difficulty sleeping.

Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been used successfully to treat hot flashes.

Progestin drugs have also been successfully used to treat hot flashes. Megestrol acetate (Megace) is sometimes prescribed over the short-term to help relieve hot flashes. Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. An unpleasant side effect of Megestrol is that it may lead to weight gain.

Several medications may be used for preventing and treating osteoporosis.

  • The bisphosphonates, which include alendronate (Fosamax) and risedronate (Actonel), have been shown in clinical trials to reduce bone loss in postmenopausal women and to reduce fracture risk in women who have osteoporosis.
  • Raloxifene (Evista), a selective estrogen receptor modulator (SERM), is another therapy for osteoporosis. It reduces bone loss and appears to reduce the risk of back fractures in women with osteoporosis.
  • Calcitonin (Miacalcin or Calcimar) is a nasal spray that has been found to reduce the risk of back fractures in women who have osteoporosis.
  • A prevention drug that may also be effective is PTH (parathyroid hormone), but this is not a usual first-line treatment.

The class of drugs known as selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) typically used in the treatment of depression and anxiety, has been shown to be effective in reducing menopausal hot flashes. Paroxetine (Brisdelle) is an SSRI that has been approved for the treatment of moderate to severe hot flashed associated with menopause. Another SSRI that has been tested and shown to be effective is venlafaxine (Effexor), although other SSRI drugs may be effective as well.

Clonidine (Catapres) is a drug that decreases blood pressure. Clonidine can effectively relieve hot flashes in some women. Side effects include dry mouth, constipation, drowsiness, and difficulty sleeping.

Gabapentin (Neurontin), a drug primarily used for the treatment of seizures, has also been used successfully to treat hot flashes.

Progestin drugs have also been successfully used to treat hot flashes. Megestrol acetate (Megace) is sometimes prescribed over the short-term to help relieve hot flashes. Serious effects can occur if the medication is abruptly discontinued, and megestrol is not usually recommended as a first-line drug to treat hot flashes. An unpleasant side effect of Megestrol is that it may lead to weight gain.

Several medications may be used for preventing and treating osteoporosis.

  • The bisphosphonates, which include alendronate (Fosamax) and risedronate (Actonel), have been shown in clinical trials to reduce bone loss in postmenopausal women and to reduce fracture risk in women who have osteoporosis.
  • Raloxifene (Evista), a selective estrogen receptor modulator (SERM), is another therapy for osteoporosis. It reduces bone loss and appears to reduce the risk of back fractures in women with osteoporosis.
  • Calcitonin (Miacalcin or Calcimar) is a nasal spray that has been found to reduce the risk of back fractures in women who have osteoporosis.
  • A prevention drug that may also be effective is PTH (parathyroid hormone), but this is not a usual first-line treatment.
  1. Hot flashes: Hot flashes are the most common symptom of menopause. According to some studies, hot flashes occur in as many as 75% of perimenopausal women. Hot flash symptoms vary among women. Commonly, a hot flash is a feeling of warmth that spreads over the body, lasting from around 30 seconds to a few minutes. Flushed (reddened) skin, palpitations (feeling a strong heartbeat), and sweating often accompany hot flashes. Hot flashes often increase skin temperature and pulse, and they can cause insomnia, or sleeplessness. Hot flashes usually last 2 to 3 years, but many women can experience them for up to 5 years or longer. An even smaller percentage may have them for more than 15 years.
  2. Urinary incontinence and burning on urination
  3. Vaginal changes: Because estrogen affects the vaginal lining, perimenopausal women may also have pain during intercourse and may note a change in vaginal discharge.
  4. Breast changes: Menopause may cause changes in the shape of the breasts.
  5. Thinning of the skin
  6. Bone loss: Rapid bone loss is common during the perimenopausal years. Most women reach their peak bone density when aged 25 to 30 years. After that, bone loss averages 0.13% per year. During perimenopause, bone loss accelerates to about a 3% loss per year. Later, it drops off to about a 2% loss per year. No pain is usually associated with bone loss. However, bone loss can cause osteoporosis, a condition that increases the risk of bone fractures. These fractures can be intensely painful and can interfere with daily life. They also can increase the risk of death.
  7. Cholesterol: Cholesterol profiles also change significantly at the time of menopause. Total cholesterol and LDL ("bad") cholesterol levels increase. Increased LDL cholesterol is associated with an increased risk of heart disease.
  8. Heart disease risk increases after menopause, although it is unclear exactly how much is due to aging and how much is caused by the hormonal changes that occur at the time of menopause. Women who undergo premature menopause or have their ovaries removed surgically at an early age are at an increased risk of heart disease.
  9. Weight gain: A three year study of healthy women nearing menopause found an average gain of five pounds during the three years. Hormonal changes and aging are both possible factors in this weight gain.
  1. Hot flashes: Hot flashes are the most common symptom of menopause. According to some studies, hot flashes occur in as many as 75% of perimenopausal women. Hot flash symptoms vary among women. Commonly, a hot flash is a feeling of warmth that spreads over the body, lasting from around 30 seconds to a few minutes. Flushed (reddened) skin, palpitations (feeling a strong heartbeat), and sweating often accompany hot flashes. Hot flashes often increase skin temperature and pulse, and they can cause insomnia, or sleeplessness. Hot flashes usually last 2 to 3 years, but many women can experience them for up to 5 years or longer. An even smaller percentage may have them for more than 15 years.
  2. Urinary incontinence and burning on urination
  3. Vaginal changes: Because estrogen affects the vaginal lining, perimenopausal women may also have pain during intercourse and may note a change in vaginal discharge.
  4. Breast changes: Menopause may cause changes in the shape of the breasts.
  5. Thinning of the skin
  6. Bone loss: Rapid bone loss is common during the perimenopausal years. Most women reach their peak bone density when aged 25 to 30 years. After that, bone loss averages 0.13% per year. During perimenopause, bone loss accelerates to about a 3% loss per year. Later, it drops off to about a 2% loss per year. No pain is usually associated with bone loss. However, bone loss can cause osteoporosis, a condition that increases the risk of bone fractures. These fractures can be intensely painful and can interfere with daily life. They also can increase the risk of death.
  7. Cholesterol: Cholesterol profiles also change significantly at the time of menopause. Total cholesterol and LDL ("bad") cholesterol levels increase. Increased LDL cholesterol is associated with an increased risk of heart disease.
  8. Heart disease risk increases after menopause, although it is unclear exactly how much is due to aging and how much is caused by the hormonal changes that occur at the time of menopause. Women who undergo premature menopause or have their ovaries removed surgically at an early age are at an increased risk of heart disease.
  9. Weight gain: A three year study of healthy women nearing menopause found an average gain of five pounds during the three years. Hormonal changes and aging are both possible factors in this weight gain.

10 Ways to Deal With Menopause Symptoms Slideshow

10 Ways to Deal With Menopause Symptoms Slideshow

Keep a diary to track what sets off your hot flashes. Caffeine? Alcohol? A hot room? Stress? All are common causes. When a flash starts, take slow, deep breaths, in your nose and out your mouth. For tough cases, talk to your doctor.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.