Tailor your treatment

Different women face different issues in regards to menopause, and for each woman the solution is different as well.

By NANCY PARADIS
Published April 24, 2007

Becky, 52, has been having hot flashes since she turned 50. Her periods have become irregular. Because of night sweats, she does not get enough sleep and relies on coffee to get her through her day. She's under pressure at work, has no time to exercise and has gained weight. Her husband and children call her the Queen of Mean.

Deirdre, 56, was never bothered much by hot flashes; they ceased when her periods did, at age 51. But she is experiencing increasing vaginal dryness and itchiness. She and her husband had always had a satisfying sex life but now she is a reluctant lover.

At age 42, Christine developed breast cancer that was successfully treated with surgery and radiation. At age 45, she is beginning to have hot flashes and irregular periods. Surrounded by younger colleagues, she is embarrassed when her face turns red during a hot flash, and she is afraid it will affect her job.

At age 47, Emily's periods are irregular, her flow heavy and she is beginning to experience hot flashes - even though she is still ovulating.

Presented in Is It Hot in Here? Or Is It Me? The Complete Guide to Menopause by Pat Wingert and Barbara Kantrowitz, each of these cases is hypothetical, but each represents countless thousands of real women over 40 who are experiencing these menopausal symptoms.

Just as the examples illustrate different issues that women face, for each there is a different solution.

America is aging. Never before have so many women lived so long after reaching menopause - an estimated 6,000 women per day reach menopause.

Understanding the changes going on in her body makes choosing treatment easier as a woman's menstruation ceases, generally considered to be when she has not had a period for 12 months. But even before periods cease, changes have been going on for roughly four years, a transition time often referred to as perimenopause.

In a young woman, the natural hormones made by her body wax and wane in a monthly cycle. Messages between her brain and ovaries trigger ovulation.

An egg is released and her body prepares for pregnancy. If the egg is not fertilized, the body adjusts again, hormone levels drop, and the lining of the uterus is sloughed off during menstruation. The cycle then repeats itself.

But as a woman ages, her ovulatory cycle becomes less reliable, which can produce the highs and lows in estrogen levels associated with many symptoms of menopause. These include changes in timing of menstruation more or less frequently, bleeding (lighter or heavier), hot flashes, vaginal lubrication, mood swings and fatigue.

Eventually ovulation stops, but the ovaries continue to produce low levels of estrogen, testosterone and other hormones.

In the western world, women generally reach menopause between the ages of 40 and 58; the average age is 51.

Women can also experience abrupt menopause through a hysterectomy that includes removal of the ovaries, or as a side effect of medical treatments such as radiation and chemotherapy for cancer. A small percent experience premature menopause, before age 40.

So how do our hypothetical women mentioned above handle their menopause symptoms? The authors present typical treatments for each:

- Before prescribing hormones for her, Becky's doctor suggests some lifestyle changes, including reducing her stress and finding other ways to improve sleep.

She starts going to a yoga class in the mornings, buys a fan for her side of the bed, cuts down on caffeine and takes relaxing baths before bedtime. When she returns to her doctor three months later, she is no longer the Queen of Mean, and she and her doctor agree that she will forgo hormone therapy unless her symptoms worsen.

- Since vaginal dryness is her only menopausal symptom, Deirdre does not need the more potent estrogen contained in pills and patches. He doctor suggests estrogen delivered directly to the vagina in cream, tablet or ring. Deirdre opts for the ring, which releases estrogen over a 90-day period.

Sex becomes much less painful, and she switches to using vaginal lubricants and moisturizers regularly. She also continues to enjoy sex regularly. (The axiom is true, the authors note: Use it or lose it.) If the dryness returns, she can always try ring therapy again.

- Because she has had breast cancer, hormone therapy is not a good option for Christine: The estrogen could cause her estrogen-receptive cancer to recur. But research has shown that some antidepressants can be effective in relieving hot flashes, so she starts taking Effexor (a brand name for the compound venlafaxine).

Six weeks later she reports back to her doctor that this reduces her hot flashes; they agree that she will stay on Effexor for the foreseeable future.

- Emily starts taking a low-dose oral contraceptive to relieve her perimenopausal symptoms, something she can do because she doesn't smoke and is in good health, with no history of blood clots.

Six weeks later, most of her symptoms are gone. With no worry about pregnancy, she is more relaxed with her partner and her sex life is improved. Her doctor suggests she take the pill until she's 51, then go off it for a month to see if she has reached menopause.

Sources: "Is It Hot in Here? Or Is It Me? The Complete Guide to Menopause" by Pat Wingert and Barbara Kantrowitz; "The Hormone Decision" by Tara Parker-Pope; North American Menopause Society (www.menopause.org)

Nancy Paradis can be reached at (727) 893-8342 or nparadis@sptimes.com.

[Last modified April 24, 2007, 00:10:30]