More Menopause Questions

It’s been a busy week for us, we received a lot of questions regarding menopause. While we have answered a dozen of them already in other posts, this one will cover the ones which we have not been able to answer so far.

I’m worried that my vagina will change after menopause. What changes should I expect?

When you hit menopause, your ovaries will stop producing oestrogen. This is the hormone responsible for keeping the vaginal lining healthy. Decreased oestrogen stimulation causes your vagina to become flaky, dry and less elastic. This may lead to problems like painful sexual intercourse. Vaginal discomfort after menopause can be relieved by the help of low dose vaginal oestrogen therapy. Even long acting vaginal moisturizers can be used to help with the vaginal dryness. Regular sexual activity even after menopause is important for vaginal health as it stimulates blood supply to the region. It also helps maintain the tone of the muscles and preserves the vaginal length and stretchiness.

What are hot flashes? How long will I have hot flashes?

Hot flashes are the most common symptom of menopause. Although their exact cause is still unknown, they are considered to a result of changes in the hypothalamus. This is the part of the brain responsible for temperature regulation of the body. The hypothalamus mistakenly senses your body to be too hot and sends signals to counter the sensations felt. The blood vessels near the skin dilate in order to lose heat and cool off the body. This results in a red flushed face (hot flashes) and increased perspiration at night (night sweats). It also causes symptoms of a rapid pulse and palpitations (sensation of the heart beating). Some women also experience a cold chill that follow hot flashes. Hot flashes will stop at their own time and do not need any treatment. Hot flashes can be reduced or eliminated completely with the help of lifestyle changes, non prescription drugs and oestrogen replacement therapy if needed.

Does menopause cause mood changes and depression?

Yes it does cause mood changes and depression. It is unclear whether mood symptoms are linked with menopause directly but the sleep deprivation associated with night sweats can result in fatigue, irritability and mood swings. In the perimenopausal period, abrupt hormonal fluctuations can also have an effect on these symptoms. Moreover most pre menopausal women tend to get accustomed to their body’s hormonal rhythm. This rhythm changes once menopause starts and these ups and downs can cause a loss of control which can be distressing. Coping skills and lifestyle changes can help counter the mood changes and depression experienced during menopause. However you must consult a health care provider to assess the precise cause of mental stress and get an appropriate prescription.

Do I need to worry about birth control now that I have started menopause? What type of birth control should I use?

No you don’t have to continue birth control once menopause starts. You should not stop using birth control unless you have missed your period for an entire year. If you stop early, you can get pregnant. Even after you hit menopause, keep using safe sex techniques like latex condoms to prevent the risk of sexually transmitted diseases.

If you are peri-menopausal low dose oestrogen pills containing 20 micrograms of oestrogen may be helpful. They are safer as compared to regular birth control pills for those who are a few years away from menopause (peri-menopause stage). Please consult with your doctor before taking any medication.

I am thinking of taking HRT. Does it increase the risk of cancer?

Taking HRT can slightly increase the risk of ovarian, uterine and breast cancer but the risk depends on the type of HRT that you use. There are two types of HRT that are available: oestrogen containing HRTs and combined HRT. Those HRT which contain only oestrogen can increase the risk of uterine cancer. They are only prescribed to individuals who have had a hysterectomy. But taking a combined HRT which also contains progesterone can reverse this risk for those who have not had a hysterectomy. However, the risk of breast cancer is significantly higher for those taking any either of HRT over a long period of time. Combined HRT is considered to have a higher risk for breast cancer as compared to oestrogen only HRT. This risk decreases back to what it would have been without HRT five years after stopping HRT. It is therefore recommended that you take HRT at the lowest dose for the shortest time duration possible. You must discuss your concerns with your GP to be well informed about your risk for cancer.

I am 35 years old and I am experiencing symptoms similar to menopause. Does that mean I am having menopause?

It is not necessary that symptoms of hot flashes are necessarily associated with menopause. Similar signs and symptoms can also occur in various other conditions as well. It is important that if you are experiencing hot flashes or night sweats, you must consult your GP. He will be able to examine and diagnose a cause for these symptoms. Other conditions like an overactive thyroid, tuberculosis, anxiety, stress or drinking too much alcohol can also cause similar symptoms. Your GP will perform some blood tests like FSH and oestrogen levels to confirm menopause. Once diagnosed, your gynaecologist may prescribe you HRT that will help ease the symptoms. Your ovaries will release eggs from time to time even if you are about to hit menopause. If you are worried about getting pregnant, you should use birth control.

How can I treat hot flashes besides HRT?

If you are worried about the risks associated with hormone replacement therapy, there are other treatment options available that can help treat hot flashes. These may include both over the counter medication and prescription drugs.

The over the counter medication include many common medications that you use regularly like ibuprofen, various vitamins and even soy proteins that are present in food products.

The prescription drugs that are commonly used for menopausal symptoms include HRT. But if want other alternatives then various low dose anti-depressants like fluoxetine (Prozac), Paroxetine or venlafaxine can also be used. Other drugs that are helpful are clonidine (anti-hypertensive drug) and ganpentine (anti-epileptic). There are also some specialized drugs that can be used to treat hot flashes only. These include Brisdelle (paroxetine formulation) and Duavee (conjugated estrogens/bazedoxifene formulation).

References:
http://www.menopause.org/docs/for-women/mnflashes.pdf
http://www.healthline.com/health/menopause/hot-flash-causes
http://jn.nutrition.org/content/140/7/1380S.abstract
http://onlinelibrary.wiley.com/doi/10.3322/caac.21171/full
http://www.nlm.nih.gov/medlineplus/menopause.html
http://www.udel.edu/udaily/2012/apr/melby-soy-menopause-040412.html

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