As I walked into the examination room, the 55-year-old patient looked distraught, her eyes sallow and despaired. She started to cry and told me she had been in menopause for four years and since then, she has been in a downward spiral. Her symptoms were unmanageable and were impacting every aspect of her life, including her relationship. She was on the brink of divorce.
Menopause is defined as a period of 12 months without menses. All women go through menopause, or the cessation of menstruation, as a result of a loss of ovarian function. The average age of onset is 52, but the range is typically between 40 and 58 years. In fact, by the year 2025, 1.1 billion women, or 12% of the world’s population, will be in menopause. While menopause can be from the loss of ovarian function, it can also be a result of surgery, chemotherapy, radiation or other causes.
Menopause manifests differently in each woman. The age at which one experiences menopause varies, the length and severity of symptoms is inconsistent, and the constellation of symptoms isn’t uniform. While one woman may have life-altering symptoms, another may have very mild ones.
What is universal though, is all women go through menopause and none need to suffer symptomatically. The diagnosis and management of menopausal symptoms should be individualized to each patient with the goal of alleviating symptoms that affect one’s quality of life.
[READ: Tips for Better Vaginal Health.]
Painful Intercourse
Sara, 45, came to the office reporting increasingly painful intercourse. She used to have a vibrant sex life. Her mother went through menopause at age 42 and so did she. By age 44, sex became painful to the point of avoidance and her marriage was suffering.
Up to 40% of postmenopausal women will experience vaginal atrophy, which can result in vaginal itching, vaginal dryness, recurrent urinary tract infections and painful intercourse. Vaginal atrophy, or vaginal thinning, is a result of a decrease in circulating estrogen levels. Decreased libido, or sex drive/desire, is a result of an age-related decline in testosterone. Both are common among menopausal women. This can lead to decreased sexual motivation and avoidance, which can be a source of distress for some women and their partners.
Fortunately, there are many hormonal and nonhormonal therapies available to manage vaginal atrophy and decreased libido.
Nonhormonal therapies
— Vaginal moisturizer. Common options include Replens, Sliquid and K-Y Liquibeads.
— Vaginal lubricants, such as Astroglide, K-Y Jelly and Sliquid.
— Topical anesthetic, like Lidocaine.
— Mechanical/physical. This may include pelvic floor therapy or the use of vaginal dilators.
Hormonal therapies
— Vaginal estrogen. This may be used as a cream, suppository, tablet or ring.
— Systemic estrogen, which is adminstered in the form of a tablet, patch, pellet, ring or gel/cream.
— Dehydroepiandrosterone (DHEA), like Prasterone.
— Selective estrogen receptor modulator (SERM), like Ospemifene.
In Sara’s case, we were able to dramatically improve her symptoms with a combination of both hormonal and nonhormonal therapies. Vaginal estrogen cream was used to treat her painful intercourse and an herbal medication was used to improve her libido.
After one month, she reported a significant improvement in her symptoms and felt like her sex life was returning to normal.
[READ: Does Keto Cause Menopause?]
Hot Flashes
Claudia, 37, is a breast cancer survivor. As a side effect of systemic chemotherapy, she entered into menopause at age 35. She came to the office reporting debilitating hot flashes that kept her up at night, resulting in excessive daytime sleepiness. She also reported feeling depressed; her quality of life was suffering and she was desperate.
Hot flashes are the hallmark of menopause, with up to 75% of women experiencing them. They can last from six months to 10 years and in varying degrees of severity. Some women may experience hot flashes that are barely noticeable, whereas others will experience hot flashes that are life-altering. Unfortunately, there is no reliable way to predict the duration or severity of hot flashes.
In addition to hot flashes, menopause can also bring on mood changes. In fact, nearly 1 in 4 women experience them.
Like all menopausal symptoms, the management of hot flashes is individualized and dependent on severity and frequency, as well as medical comorbidities and medications a patient is already taking. The standard treatment for hot flashes is estrogen replacement, which can be taken orally, transdermally, in the form of implantable pellets and vaginally.
For patients with a history of hormone receptor positive breast cancer, estrogen replacement is not an option. However, the antidepressant paroxetine, the only FDA-approved selective serotonin reuptake inhibitor, or SSRI, for treating hot flashes in menopause, has been found to be very effective in menopausal patients.
In addition to estrogen and paroxetine, there are additional hormonal and nonhormonal treatments, including herbal supplements that can be used to manage patients’ hot-flash symptoms. Black cohosh is one of the most frequently used herbs to treat hot flashes. It appears to be safe with limited side effect — the scientific evidence is varied in regards to black cohosh, but the benefits generally outweigh the risks.
[SEE: Health Screenings You Need Now.]
Urinary Tract Infections and Urinary Leakage
Angela, 63, complained about recurrent UTIs as well as frequent urinary incontinence during her routine annual exam. She shared the embarrassment of wetting her underwear and wearing underwear liners. From what she understood, the experience she was having was normal and she just had to learn to deal with it.
UTI is the most common bacterial infection in older women. It’s known that estrogen deficiency plays an important role in the development of bacteria in the urinary tract. Menopause and a decrease in estrogen leads to changes in the urogenital epithelium (urinary and genital lining) and subsequently, the way good bacteria function in the vagina. This can lead to recurrent urinary tract infections which can lead to patient frustration, embarrassment and poor quality of life.
But UTIs can be prevented. Standard treatments can include cranberry supplements, probiotics, increased water intake, low-dose antibiotics or vaginal estrogen.
Urinary leakage is a common problem, but it’s also treatable. Urinary incontinence is an important social problem that affects more than 50% of postmenopausal women. It occurs twice as frequently in women compared to men and comes in multiple types. The most common type of incontinence in postmenopausal women is stress incontinence caused by weakened pelvic floor muscles and characterized by leakage of urine with coughing, laughing, sneezing or physical exercise.
Conservative nonsurgical therapy is a first-line treatment and includes pharmacotherapy, physiotherapy and behavioral therapy. In the event that these treatment options don’t work, surgical options, which are a last resort, are available. These can include anything from bulking agents to using native or synthetic mesh to alleviate the problem.
Angela was treated with probiotics and vaginal estrogen cream, and her recurrent UTIs resolved. To manage her urinary incontinence, she was able to modify her lifestyle and use physiotherapy to alleviate her symptoms.
Living a Normal Life
The process of menopause is universal and unavoidable, but living with the symptoms of menopause is avoidable. There are a wide range of nonhormonal and hormonal options available to manage hot flashes, painful intercourse, mood swings, recurrent urinary infections and urinary incontinence associated with menopause.
Women shouldn’t be afraid to take an active role in managing their health. Talk to your gynecologist and don’t assume that living with your symptoms is the only choice: Menopause should not get in the way of a happy, healthy and normal life.
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Why No Woman Should Suffer Through Menopause originally appeared on usnews.com
