Tuesday, June 29, 2010

How to STOP Menopause Misery

Menopause may be a natural sign of aging, but there’s no reason you have to suffer through hot flashes, little leaks and dryness down there. Here’s how to tame 4 common symptoms. Your best friend swears by black cohosh herb for hot flashes; the doctor recommends hormone replacement therapy. Your mother? She just would sweat it out.

But you don’t have to.

“Not every woman approaching menopause has problems, but many do,” says Anita L. Nelson, M.D., a professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles. “These problems may not be considered serious because they’re not life-threatening, but they do cause considerable misery and deserve treatment.”

Here are the top expert-recommended ways women can escape menopause misery and get relief for hot flashes, vaginal dryness, low libido, bone loss and incontinence:

1. Hot Flashes
Most menopausal women are all too familiar with the sudden rush of heat to the face and upper body, the sweating and the facial flush: About 75% of them feel hot flashes, according to the American Congress of Obstetricians and Gynecologists.

Hot flashes are caused by a drop in estrogen levels, which affects the hypothalamus, the gland that regulates body temperature.

Although common, hot flashes are different for every woman. You can get them during the day, at night or both. They can be mild or severe. Some last only seconds; others stick around for a half hour or longer.

Some women have them for only a few months; for others, “hot flashes can continue for decades,” says Fredi Kronenberg, Ph.D., co-founder of the North American Menopause Society (NAMS) and director of the Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine at Columbia University.

No matter how hot flashes affect you, relief is at hand.

Menopause solutions: The most effective way to get rid of hot flashes and other menopausal miseries is also the most controversial: hormone replacement therapy (HRT).

Is it a good idea to restore estrogen, progesterone and/or other hormones as a woman ages? The answer depends on whom you ask.

Some physicians, like breast health expert Dr. Susan Love, believe HRT (including bio-identicals) may not be safe, a conclusion backed by the National Institutes of Health (NIH) in 2002.

At the time, the federal agency abruptly ended a major clinical trial within its Women’s Health Initiative because it found a higher risk of breast cancer, clots, stroke and heart attacks in postmenopausal women using a combination of estrogen and progestin (synthetic progesterone, which women produce in their bodies too).

Millions of women dropped HRT, but later the NIH’s conclusions were questioned, mainly because the average age of the participants was 63 — 12 years after the average onset of menopause, when most women are suffering its symptoms.

The U.S. Food & Drug Administration (FDA) stands behind HRT, although it advises women to take the lowest dose and for the shortest time possible.

Nelson agrees with the FDA: “I tell women to relax and enjoy the relief [HRT] provides,” she says.

The way you take hormones may reduce the risk. The best option is a transdermal estrogen patch that’s applied to the skin, because “there appears to be no increased risk of blood clots," says Andrew M. Kaunitz, M.D., professor and associate chair in the Department of Obstetrics & Gynecology at the University of Florida College of Medicine in Jacksonville.

But if HRT isn’t for you, there’s still no need to suffer through hot flashes.

Researchers are investigating other remedies, including low doses of antidepressants and gabapentin, an anticonvulsant used to treat epilepsy, says JoAnn V. Pinkerton, M.D., medical director of the Midlife Health Center, professor of obstetrics and gynecology and vice chair of academic affairs at the University of Virginia, Charlottesville.

Even in low doses, selective serotonin reuptake inhibitor (SSRI) antidepressants reduce hot flashes by about 50%; with gabapentin, there’s a 70% decrease, Nelson says.

For a non-drug approach, natural methods − meditation, yoga, hypnosis, acupuncture and paced breathing − also help, Pinkerton says.

So does the herb black cohosh and soy products, according to Mary Jane Minkin, M.D., professor of obstetrics and gynecology at Yale University School of Medicine and author of A Woman’s Guide to Menopause and Perimenopause (Yale University Press).

For black cohosh, she recommends Remifemin. The standardized extract of the herb has been shown to work better than a placebo and other similar supplements in European and American studies.

Vitamin E also works, but it cuts down on hot flashes by only one a day, according to a Mayo Clinic and Mayo Foundation study.

Dietary changes also can combat hot flashes, including avoiding caffeine and alcohol, says Isaac Schiff, M.D., chief of obstetrics and gynecology at Massachusetts General Hospital in Boston.

But steer clear of magnet therapy, reflexology, homeopathy and the herbs dong quai, ginseng, licorice and red clover, Pinkerton adds. Studies show that they don’t relieve hot flashes any more than a placebo does.

2. Vaginal Dryness and Low Libido

Not only are you struggling with hot flashes, but menopause can put the kibosh on your sex life too. According to a 2007 Harris Interactive Sex and Menopause survey of more than 1,000 women 35 years and older, 44% reported a decrease in sex drive; more than half the women surveyed cited vaginal dryness as a problem.

Again, the culprit is lower estrogen levels, which cause thinner, drier and less-elastic vaginal tissue and decrease blood flow down there.

Menopause solutions: To tame these symptoms, HRT is the most effective approved medicine to relieve vaginal dryness, the FDA says.

It will also help reverse a low libido, Pinkerton points out.

But you don’t have to resort to oral hormones, Schiff says. He recommends these tips:

* Have more sex. “If women continue to have an active sex life, vaginal dryness is not so much of a problem” because it increases blood flow to the area.

* Lube up. Try a water-soluble lubricant, such as K-Y or Astroglide, he says. But don’t use an oil-based product, which can dissolve latex condoms and compromise the prevention of sexually transmitted diseases.

* Try local treatment. Estrogen delivered in a ring, cream or gel that's inserted into the vagina, works where it’s applied and not much of the hormone is absorbed systemically.

Solving the dryness problem might take care of your low libido too. “If sex life improves, then libido usually follows,” Schiff says.

Various over-the-counter products also help women increase their sex drive, including Avlimil, ArginMax and Xzite. Pinkerton also recommends ginkgo biloba and the nutritional supplement Kyo-Green, a powdered drink made from barley leaves, wheat grass and other ingredients.

3. Incontinence

Those little leaks when you cough, sneeze or giggle are no laughing matter. You may also feel a sudden urge to go - fast. Menopause isn’t the cause, but it can make it worse.

As we age, our pelvic muscles weaken and lower levels of estrogen exacerbate the problem by thinning the urethra’s lining.

“About 40% of post-menopausal women might note some urine leakage,” says NAMS President Cynthia Stuenkel, M.D., clinical professor of medicine at the University of California, San Diego.

Menopause solutions: Although diminishing hormone levels are one cause of incontinence, the relief is not in HRT but in shedding excess weight and exercise. Both significantly reduce abdominal pressure on the bladder, Stuenkel says.

Obese and overweight women who participated in a 6-month weight-loss program lost an average of 8% of their weight and cut incontinence episodes by nearly half, according to a study by the National Institute of Diabetes and Digestive and Kidney Diseases.

NAMS also advises women to stop smoking cigarettes; avoid bladder irritants, such as spicy foods and citrus fruits; limit fluid intake; and do Kegel exercises, which strengthen the muscles you use to start and stop urination.

Other solutions include:

* Medications such as oxybutynin, tolterodine, trospium, solifenacin and darifenacin, which reduce the frequency and urge to go and relax the bladder's muscles.
* Therapies (electrical stimulation to strengthen pelvic muscles)
* Surgery for severe cases

4. Bone Loss

This is one symptom that you can’t feel and it can be dangerous: Lower estrogen levels diminish bone density, leading to osteoporosis and fractures.

If you’re slender, a smoker or using cortisone-like medications, you’re at risk for osteoporosis, Kaunitz says.

And look into your family tree: Did Mom or Grandma have a hunchback? If so, you face a higher risk and should start bone density checks in your 50s or earlier.

Without risk factors, “women can hold off on until age 65,” Kaunitz says.

But don’t confuse osteoporosis with osteopenia (low bone density). “I see a lot of women being treated for osteopenia, when their risk for bone fractures is too low to warrant prescription medication.”

Menopause solutions: Hormone therapy may slow and prevent bone loss, the FDA says. So will exercise and taking calcium and vitamin D.

“The traditional recommendation of 400 IU [international units] of vitamin D daily is inadequate” for menopausal women, Kaunitz says. Until age 65, women should get 1,000 IU daily; if you’re older, 2,000 IU is appropriate, he says.

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