What Can I Do About These Symptoms?
Every woman has her own unique constellation of menopausal symptoms. In menstruating women, these symptoms can often be cyclic, often occurring a week or so before the menstrual cycle. Hormones levels are changing on a continuum with age, but at the beginning, a woman may not need hormones to help out with symptoms. The goal during this time is to try to ease symptoms with some lifestyle changes or supplements that work and have minimal side effects or risks.
The first thing to do is really simple, but unfortunately may be one of the most difficult: Get 8 hours of sleep at night. You also have to eat a well-balanced diet. Increased levels of aerobic exercise, which causes a release of beta endorphins, often helps as well.
A variety of over-the-counter supplements are sold claiming that they help with menopausal symptoms. Many of these supplements have not been adequately studied to determine their true effectiveness and they are not FDA regulated. But, there is some evidence that the following supplements may be helpful:
- Black Cohosh
- Vitamin E
- Soy products
- Evening Primrose Oil
The important thing to remember is that there is no evidence that women need to take these supplements. Menopause is not a disease to treat. What we are treating with these supplements is the symptoms of menopause. If those symptoms do not go away after trying these methods for several weeks, then that treatment should be discontinued. If symptoms persist and continue to affect the quality of life, then there are still a few things to consider before taking systemic hormones. Hormones do work, however, and creams and gels may provide new ways for women to treat their menopausal symptoms.
We have traditionally used oral hormones for the treatment of many hormonal issues in women, but there is increasing evidence that the best route for using hormones may be through the skin. If the hormones are appropriately absorbed through the skin, they immediately enter into the bloodstream without the first-pass effect of the GI tract and liver, which occurs when hormones are taken orally. The liver metabolizes oral hormones and produces metabolites, which may be good or bad, but the transdermal route (through the skin) is more direct. There are a variety of FDA approved transdermal estrogens such as estrogen patches, creams and gels. There are fewer transdermal progesterones.