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Hot flashes, trouble sleeping through the night, mood swings and memory challenges are all part of the transition into menopause and its aftermath.

Exercise, adequate sleep, medications and other steps can help ease those symptoms. This week, we conclude our three-part menopause series with questions about hormone therapies and natural treatments.

Q. Can menopausal hormone therapy (MHT) help treat my symptoms?

MHT, which used to be called hormone replacement therapy (HRT), involves taking the hormones estrogen and progesterone. (Women who no longer have a uterus take just estrogen). MHT can be very good at relieving moderate to severe menopausal symptoms and preventing bone loss. But MHT also has some risks, especially if used for a long time.

MHT can help with menopause by:

1. Reducing hot flashes and night sweats, and related problems such as poor sleep and irritability.

2. Treating vaginal symptoms, such as dryness and discomfort, and related problems, such as pain during sex.

3. Slowing bone loss.

4. Possibly easing mood swings and mild depressive mood.

For some women, MHT may increase their chance of blood clots, heart attack, stroke, breast cancer and gall bladder disease. Research into the risks and benefits of MHT continues.

Q. Are there natural treatments for my symptoms?

Some women try herbs or other products that come from plants to help relieve hot flashes. These include:

1. Soy Soy contains phytoestrogens. These are substances from a plant that may act like the estrogen your body makes. There is no clear proof that soy or other sources of phytoestrogens make hot flashes better. And the risks of taking soy products like pills and powders are not known. If you are going to try soy, the best sources are foods such as tofu, tempeh, soymilk, and soy nuts.

2. Other sources of phytoestrogens These include herbs such as black cohosh, wild yam, dong quai, and valerian root. There is not enough evidence that these herbs – or pills or creams containing these herbs – help with hot flashes. Also, not enough is known about the risks of using these products.

Make sure to discuss any natural or herbal products with your doctor before taking them. It’s also important to tell your doctor about all medicines you are taking. Some plant products or foods can be harmful when combined with certain medications.

Q. What is “bioidentical” hormone therapy?

Bioidentical hormone therapy (BHT) means manmade hormones that are the same as the hormones the body makes. There are several prescription BHT products that are well-tested and approved by the U.S. Food and Drug Administration (FDA).

Often, people use the term “BHT” to mean medications that are custom-made by a pharmacist for a specific patient based on a doctor’s order. These custom-made products are also sometimes called bioidentical hormone replacement therapy (BHRT). Despite claims, there is no proof that these products are better or safer than drugs approved by the FDA. Also, many insurance and prescription programs do not pay for these drugs because they are viewed as experimental.

Q. How much physical activity do I need as I approach menopause?

Physical activity helps many areas of your life, including mood, sleep, and heart health. Aim for:

• At least 2 hours and 30 minutes a week of moderate aerobic physical activity or 1 hour and 15 minutes of vigorous aerobic activity or some combination of the two.

• Exercises that build muscle strength on two days each week.

If you are not able to follow these guidelines, be as physically active as you can. Your doctor can help you decide what’s right for you.

Q. Do I need a special diet as I approach menopause?

A balanced diet will give you most of what your body needs to stay healthy. Here are a few special points to consider:

• Older people need just as many nutrients but tend to need fewer calories for energy.

• Women over 50 need 2.4 micrograms (mcg) of vitamin B12 and 1.5 milligrams of vitamin B6 each day. Ask your doctor if you need a vitamin supplement.

• After menopause, a woman’s calcium needs go up to maintain bone health. Women 51 and older should get 1,200 mg of calcium each day. Vitamin D also is important to bone health. Women 51 to 70 should get 600 international units (IU) of vitamin D each day. Women ages 71 and older need 800.

• Women past menopause who are still having vaginal bleeding because they are using menopausal hormone therapy might need extra iron.

Q. What if I have symptoms of menopause before age 40?

Some women have symptoms of menopause and stop having their periods much earlier than expected. This can happen for no clear reason, or it can be caused by:

• Medical treatments, such as surgery to remove the ovaries.

• Cancer treatments that damage the ovaries such as chemotherapy or radiation to the pelvic area, although menopause does not always occur.

• An immune system problem in which a woman’s own body cells attack her ovaries.

When menopause comes early on its own, it sometimes has been called “premature menopause” or “premature ovarian failure.” A better term is “primary ovarian insufficiency,” which describes the decreased activity in the ovaries. In some cases, women have ovaries that still make hormones from time to time, and their menstrual periods return. Some women can even become pregnant after the diagnosis.

For women who want to have children and can’t, early menopause can be a source of great distress. Women who want to become mothers can talk with their doctors about other options, such as donor egg programs or adoption.

Early menopause raises your risk of certain health problems, such as heart disease and osteoporosis. Talk to your doctor about ways to protect your health. You might ask about menopausal hormone therapy (MHT). Some researchers think the risks of MHT for younger women might be smaller and the benefits greater than for women who begin MHT at or after the typical age of menopause.

Let your doctor know if you are younger than 40 and have symptoms of menopause.

Source: U.S. Department of Health and Human Services, Office on Women’s Health