Our expert is Cynthia A. Stuenkel, MD, Clinical Professor of Medicine at the University of California San Diego School of Medicine, and attending physician for their Endocrinology and Metabolism Service.

If there is a medical topic you would like to see explored here, please let me know!

Very best,

Mitzi Perdue

MPerdue@LiebertPub.com


COMMON SYMPTOMS OF MENOPAUSE START EARLIER AND END LATER THAN PREVIOUSLY THOUGHT

In the last few years we’ve learned that instead of lasting for one or two years, the most common symptom of menopause, the hot flash, will frequently last for five years and 1/3 of women have hot flashes for ten or more years. The information for this is both new and robust. The Penn Ovarian Aging Study and the SWAN (Study of Women's Health Across the Nation) studies concur in these findings. In the case of women whose symptoms begin early, their symptoms will possibly last the longest. When we thought that distressing menopausal symptoms would be over within a year or two, it might have made sense to think of toughing it out for a couple of years. But 5 to 12 years is a long time for anyone to endure the discomfort of vasomotor symptoms (hot flashes) or vaginal dryness.

MENOPAUSE IS ASSOCIATED WITH FOUR MAJOR VASOMOTOR SYMPTOM PATTERNS 

Eighty percent of women experience the vasomotor symptoms of hot flashes and night sweats of menopause. When deciding on treatment for these women, it helps to categorize the kind of experience they are likely to have.

These patterns are:

1.    Early symptom onset, beginning up to 11 years before the final menstrual period and declining after menopause
2.    Onset of symptoms near the final period with a later decline
3.    Early onset with high frequency of symptoms that persist for as long as 12 years
4.    Persistently low frequency of symptoms with a slight increase at the time of the final menstrual period and a few years after

The third pattern, early onset with high frequency of symptoms, and persistence of these symptoms for more than a decade, is particularly tough for those who experience it.

TREATMENT OPTIONS: SAFETY AND PREFERENCE

One of the first considerations is, how much do your patient’s symptoms bother her? She may be visibly perspiring, yet she may tell you her symptoms aren’t particularly important to her. However, in the more likely case that her symptoms do bother her, the next question is, what kind of treatment does she prefer? She may have ideas from her book club, her car pool, or the Internet, and these may or may not be medically sound. It’s important to find out where she’s coming from. However, we are also concerned with her safety, and we need to evaluate her risks for cardiovascular disease and breast cancer. Because breast cancer is talked about so much, your patient may be unduly worried about this and insufficiently concerned about cardiovascular disease. 

NON-HORMONAL THERAPIES

The following may help: hypnosis, cognitive behavioral therapy, herbs, prescription anti-depressants, and analgesics for neuropathic pain such as gabapentin. These may be helpful and they may be enough for her needs.  However, in some cases, they’re not.

HORMONE REPLACEMENT THERAPY

Hormone Therapy (HT) (or Menopausal Hormone Therapy) has the greatest efficacy. There are contraindications if a woman has risk factors for heart attack, stroke, blood clots, or estrogen-sensitive cancers (uterus or breast). However, absent these risk factors, if a patient is less than 60 years old and less than 10 years since menopause, HT is generally considered safe for at least 3 to 5 years and in some cases, for longer durations.

ADDITIONAL RESOURCES

The Endocrine Society has a 2015 publication which covers the most current research on treating menopausal symptoms. (Full-disclosure, I chaired the effort.) Look for The Treatment of Symptoms of the Menopause: an Endocrine Society Clinical Practice Guideline. It’s available at https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2015-2236.

MenoPro is a free app created by The North American Menopause Society. Look for it in the Apple App Store and Android apps on Google Play. It was updated in 2016 and it’s designed to help clinicians and patients work together to personalize treatment decisions based on the patient’s personal preferences, such as whether they prefer hormonal or non-hormonal treatment, and their individual risk factor profile.

MENOPAUSE IS A GOOD TIME TO ASSESS ALL HEALTH ISSUES

Menopause is the portal to the second half of a woman’s life. It’s an opportunity to address bone health, smoking cessation, alcohol use, cardiovascular risk assessment and management, and cancer screening and prevention. These are important in themselves, but any of them may influence which therapy you use for treating menopausal symptoms.