Understanding menopause’s broad reach and responding to its many symptoms

Menopause is tough because we don’t know how ‘bad’ it will be or how long the symptoms will last for the individual patient.

Menopause affects bone health and sexual health. It can affect mood and emotional well-being, sleep and weight. It also can increase the risks for different cancers or for falls.

The average person reaches menopause at age 51 or 52, meaning more than 40 million people in the United States are experiencing menopause.

Menopause is tough because we don’t know how “bad” it will be or how long the symptoms will last for the individual patient. I have patients who are in their 70s and even 80s who tell me they never want to go off hormone therapy, despite the risks. Others sail through menopause and hardly take anything.

The broad reach and many symptoms of menopause

As physicians, we need to be aware of the broad reach of menopause and respond, as best we can, to address its many symptoms.

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To treat hot flashes, for example, the U.S. Food and Drug Administration has approved low-dose paroxetine (Brisdelle). This product is used as an alternative to hormone replacement therapy and can help some patients with sleep interrupted by hot flashes and night sweats, though it is not indicated directly for insomnia.

Many patients don’t know menopause affects bone health. We advise them to stay active with weight-bearing exercise. For patients at risk of falls, we make sure they survey their home for fall risks and take extra time on stairs, showers and baths, and on ice and snow. A DEXA scan can be used to screen for bone health and osteoporosis.

Patients I see typically are not shy about talking about hot flashes and sleep issues. Sexual health can be a sensitive topic for a lot of patients, so physicians need to ask. Also, ovarian function can start to decline before true menopause, defined as the absence of menses for one year, which can be confusing for some patients.

Eager for help with their symptoms, some menopausal patients will try bioidentical regimens, unopposed estrogen and testosterone shots, and they can come in bleeding and with other side effects as a result. Others will try alternative or over-the-counter remedies. We need to be aware of these.

Even when we’re focused on menopause and its many symptoms, we don’t always have the answers. Patients ask me, “How long is it going to be like this?” I can’t answer that question.

Menopause affects lives — and frequently not in positive ways. We want to help the best we can with the few tools we currently have in place. We can’t get people to feel as exactly as they did before menopause, but we can help.

Gigi L. Girard, M.D., is an OB/GYN and is executive medical director, Norton Women’s Care.

Clinical Update — Menopause

Norton Healthcare specialists write about the latest treatments for menopause, look at menopause and breast health, menopause and heart disease, menopause and bone health, and urogynecological changes that come with menopause.

Ryan Stewart, D.O.: Symptoms of genitourinary syndrome of menopause

Mostafa O. El-Refai, M.D.: Discussing heart disease risk with patients as they enter menopause

Shannon O’Brien, D.O.: Does menopausal hormone therapy increase the risk of breast cancer?

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