You may experience no symptoms or you may have one or more of the following:
- Hot flashes
- Disturbed sleep
- Mood swings
- Vaginal Dryness
- Loss of interest in sex
- Aches and pains
- Heart palpitations
It's important to understand your treatment options if symptoms are a problem for you.
Hot flashes are uncomfortable and can last for many years. When they happen at night, they're called "night sweats." The earlier in life they start, the longer you may have them.
There are a number of lifestyle changes that may help:
- Carry a portable fan.
- Avoid alcohol, spicy foods, and caffeine.
- If you smoke, quit.
- Maintain a healthy weight.
- Keep your bedroom cooler.
- Drink small amounts of cold water before bed.
- Layer your bedding so it can be adjusted as needed.
- Try mind and body practices like meditation, yoga, and tai chi.
Non-hormone Options for Treating Hot Flashes
If lifestyle changes are not enough to improve your symptoms, you may consider medications. The Food and Drug Administration (FDA) has approved the use of a low-dose antidepressant called paroxetine (Paxil) to treat hot flashes. While this is the only non-hormonal medicine approved for the treatment of hot flashes, researchers are currently studying the effectiveness of other antidepressants for this purpose.
Treating Hot Flashes with Hormone Therapy
During the menopausal transition, hormones like estrogen and progesterone decline over time. Hormone therapy steadies the levels of these hormones in the body. Hormone therapy is an effective treatment for women with severe hot flashes, but only in those who are able to take it. There are risks associated with hormone therapy, including increased risk of heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia.
What About the Risks with Hormone Therapy?
In 2002, a study that was part of the Women's Health Initiative, funded by NIH, was stopped early because some participants taking estrogen with progesterone were found to have a higher risk for stroke, heart attacks, breast cancer, dementia, urinary incontinence, and gallbladder disease. The research suggested an increased risk in women older than 60.
This study raised concerns at the time and left many women afraid of using hormone therapy. The use of estrogen dropped by 71 percent from 2001 to 2009. Research has continued and newer treatment options offered since 2002 may reduce the risks of using hormones. For instance, we now know that hormone therapy should be used at the lowest dose and for the shortest period of time.
Beware of Unproven, Non-scientific "Treatments"
Perhaps you've heard about black cohosh or soy isoflavones to treat hot flashes. These products are not proven to be effective and some carry risks, including liver damage. Studies are ongoing to learn about the benefits and risks. Talk with your doctor before taking any herb or supplement to relieve your hot flashes or other menopausal symptoms.
Getting a Good Night's Sleep
Many women who suffer with hot flashes get them during the night. These night sweats can disturb sleep. Not getting enough sleep can affect many aspects of your life and health. To improve your sleep through the menopausal transition and beyond:
- Follow a regular sleep schedule.
- Avoid napping in the late afternoon or evening.
- Develop a bedtime routine.
- Try not to watch television or use your computer or mobile device in the bedroom.
- Keep your bedroom at a comfortable temperature.
- Exercise at regular times each day but not close to your bedtime.
- Avoid eating large meals close to bedtime.
- Stay away from caffeine late in the day.
- Avoid alcoholic beverages.
Vaginal Pain and Dryness
When your ovaries produce fewer hormones, it can affect the vagina. The result can be a tightening of the vaginal opening, burning, itching, and dryness. Also known as vaginal atrophy, this condition can cause dyspareunia (painful intercourse) and lead to vaginal and urinary tract infections. It can also have an adverse emotional effect on you and your sex partner. Fortunately, there are options to address these issues.
You may find that a non-prescription (over-the-counter) vaginal moisturizer can help, especially if your symptoms are mild. Your health care provider may also recommend you use a water-based vaginal lubricant during sexual activity.
Local vaginal hormone treatments, such as estrogen creams, rings, or tablets, provide lower hormone doses to the rest of the body than a hormone pill or patch. But hormones are not the only option.
The FDA has approved two non-hormone medicines, ospemifene and prasterone, to treat moderate to severe vaginal changes that occur with menopause. Your doctor can talk with you about the risks and benefits of these medicines.
What's Right for Me?
Whether and how to treat your menopausal symptoms is a very personal decision. Discuss your symptoms with your health care provider. No matter what you decide, continue to see your doctor every year to talk about your treatment plan and discuss any changes.