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What You Have to Know About Menopause

Medically rated by Barbara Dehn

At 47, Louisa, an associate professor at Community College, is struggling with symptoms of perimenopause, including an irregular menstrual cycle, non-bleeding cramps, leg pain, and extremely tender breasts.

“I had to protect her, even in the shower,” Louisa said, referring to her chest pain. Although she had already taken a low-dose birth control pill, her doctor increased the hormone dose on her pill as a first attempt to manage her perimenopausal symptoms. When she spoke to HealthyWomen, Louisa had been on her new regimen for a couple of weeks and said that her chest and leg pain has not come back since she increased her dose.

Healthcare providers are increasingly turning to birth control pills to treat symptoms of perimenopause. Women who don’t smoke or have migraines with aura can safely take the pill well into their early 50s, explained Barbara Dehn, a North American Menopause Society (NAMS) certified nurse and member of HealthyWomen’s Women’s Health Advisory Council.

“”[The pill] smooths out this perimenopause transition with its wild roller coaster fluctuations in hormone levels, “explained Dehn, author of the Hot Guide to a Cool, Sexy Menopause.

Low risk

The pill’s new role in combating perimenopause symptoms is one of the most recent developments in menopause knowledge and treatment that Dehn looks forward to. For too long, says Dehn, women have been forced to make decisions out of fear rather than facts when it comes to menopause and hormone therapy (HT).

Much of the fear came from a study published in 2002 that suggested that HT increased the risk of breast cancer and heart attacks in women. However, over the years since the study was published, it has become increasingly clear that this led to numerous misconceptions about hormones, and it is now believed that using HT to relieve perimenopause / menopause symptoms poses a low risk for women who have are within the first 10 years of graduation and are younger than 60.

“A lot of research has been done to allay that fear and usher in a new era of more holistic thinking about hormones,” said Dehn. “Using hormone therapy is far more beneficial than risky for some women. If they start using hormones early and their bodies are showing symptoms of fatigue, they will have tremendous health benefits in the short and long term.”

Dehn said HT was the most effective way to reduce hot flashes and night sweats, improve sleep, and reduce brain fog. It also helps with vaginal dryness, urogenital symptoms, and maintaining bone mass.

In addition, women who start HT within the first 10 years of their last period appear to have a lower risk of cardiovascular disease. These short-term benefits improve the overall quality of life over the long term. (However, women over 60 who have passed 10 years since their last period are at increased risk of breast cancer and stroke with HT.)

A study published in the August Journal of the North American Menopause Society also found that younger women who used only estrogen therapy after removal of their ovaries (oophorectomy) had a 32% reduction in all-cause mortality on long-term follow-up.

“Especially for women who have had surgical menopause or induced menopause, it is very important to think about using hormones as it can help them live longer,” said Dehn.

While induced menopause can be triggered by drug or radiation therapies that damage the ovaries, the most common cause of surgical and induced menopause is ovarian removal, often combined with a hysterectomy. (A hysterectomy, which involves removing only the uterus, does not cause menopause.) Unlike natural menopause, those who have ovarian removal begin menopause abruptly on the day of surgery.

Symptom relief

There are several ways you can help relieve perimenopause and menopause symptoms. Dehn is a proponent of bioidentical hormones, which are chemically identical to your body’s. These include estrogen and progesterone (FDA-approved, well-studied drugs that require a prescription).

She has patients who are concerned about taking hormones for menopausal symptoms because they are afraid of being unnatural. “As a supplier, we hear a myth that hormones are not natural. We need to make this clear: Hormones are natural, they are currently circulating in your body.”

Estrogen therapy can also improve vaginal health by reducing the risk of bacterial infections and relieving vaginal dryness, which can make even wiping painful. Today, according to Dehn, there are a multitude of treatment options.

“There is a general lack of information about what women need to thrive both during and after the transition into menopause,” said Dehn.

Brain fog

Aside from better understanding HT, according to Dehn, there is now research that is helping providers understand why brain fog occurs.

“It comes from the fragmentation of sleep,” said Dehn. This happens when the body goes from deep, restful sleep to lighter sleep several times at night without being fully awake. “Women may be in bed thinking they sleep for eight hours but wake up exhausted and unable to function.”

Dehn spoke of a patient who, at the age of 48, was considering retirement because she just couldn’t remember things. Dehn discovered that her patient was in the premature menopause and put her on the birth control pill. “A few months later, she told me you gave me my life back,” said Dehn. “Sleep fragmentation is real. It affects memory and creates brain fog.”

As treatments for menopause continue to evolve, it’s important that women speak to their doctor about their symptoms and concerns. Dehn recommends finding a NAMS-certified doctor – be it a doctor or a nurse.

“Remember, women may still live 30 to 50 years after menopause, so choices we make early in menopause have lasting effects,” Dehn said. For anyone with perimenopause or menopausal symptoms, Dehn advised: “If you have a lot of symptoms, don’t hesitate.”

* Louisa asked us not to use her last name to protect her privacy.

The North American Menopause Society

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