Treating Menopausal Symptoms
Here, relief from hot flashes, night sweats, interrupted sleep and other symptoms of menopause
When I found myself lying on the floor of a colleague’s office one day in 2012 unable to get to the washroom because I was so faint from [monthly] bleeding, I figured something must be seriously wrong. But the amiable emergency room doctor I saw diagnosed my problem as simply “a wonky period,” explained with a quick fluttering of his fingers raised in mid-air.
What he also explained was that I had, at the [ripe] age of 47, entered the “run-up” to menopause, otherwise known as perimenopause. In other words, I had joined the “parade of baleful, bloated middle-aged women” that Sandra Tsing Loh eloquently described in her article in The Atlantic last year entitled “The Bitch is Back.”
The good news is that even though there is a long list of symptoms (as many as 34), they are usually relatively short-lived, not that severe and not experienced by everyone. A 2012 survey of 810 women between the ages of 45 and 60 found that half of the women had menopausal symptoms, from hot flashes to night sweats, interrupted sleep, mood swings, low or no libido and irregular periods – 69 per cent of which negatively affected their lives.
Less than a third of those surveyed who had symptoms were treated, likely because, as Dr. Donna Stewart, senior scientist and director of women’s health at the University Health Network in Toronto says, “Most people sail through menopause without a lot of problems or they have a lot of minor symptoms that don’t require treatment.”
Erratic and unpredictable fluctuations in estrogen are responsible for the symptoms of perimenopause, with estrogen (and progesterone) plateauing at very low levels once we reach menopause (a year after the last menstrual period).
Symptoms usually occur from several years before the last menstrual period to several years after it, normally from our late 40s to early 50s, before our periods subside by menopause (except for vaginal dryness, which tends to gets worse). So by your 60s, 70s or older, you should be free of most of these unpleasant effects.
So what to do?
Make time for yourself: do yoga, pamper yourself with a massage, exercise, eat well, but not too much – dietary needs go way down as we age and we gain weight way more easily, an annoyance apparently unrelated to our hormones or hormone therapy. While naturopaths and homeopaths will offer many other complementary therapies for the symptoms, double-blind studies don’t yield the results we would hope for. Unfortunately, there are “no magical products in terms of alternatives, foods or supplements,” Gass says.
Is the building on fire?
One Toronto business executive describes stripping off her jacket in meetings, asking her colleagues if they’re hot, and then using a tissue to mop the rivers of sweat streaming down her cleavage. Hot flashes are the most common and notorious symptom women report – and the butt of many a joke in men’s locker rooms. Stewart says they can be partly blamed on the brain’s hypothalamus having difficulty in regulating body temperature.
And then there are night sweats.
What 54-year-old Montreal store manager and jeweller Cynthia Hawkes describes is classic: she wakes up in the night to throw off her covers because she’s having night sweats or is just hot. Once awake, she finds it hard to get back to sleep and is then tired at work the next day. Experts differ as to whether disrupted sleep is the result of hormones, the effect of night sweats, or of changes related to getting older and being stressed or depressed.
Dr. Petra Selke, a clinical associate professor at the University of British Columbia’s Department of Obstetrics and Gynecology,sometimes prescribes progesterone tablets or skin cream (applied where the skin is thinner, such as the inside of the arms and thighs, and lower abdomen) to promote healthier sleep.
And my scary trip to the ER? Intense fluctuations in the length and frequency of periods before menopause commonly occur, but my mum never told me that heavy bleeding, or “flooding” is far more likely and can be very debilitating. (Clearly the reference to “menopause” has no immediate relationship to blood flow.)
Some women decide to use Cyclokapron (tranexamic acid), a non-hormonal medication they take during their period only (rather than throughout the cycle) to reduce blood flow, says Selke. A non-hormonal treatment involves heating or freezing the lining of the uterus; or, if there are no contraindications, a low-dose oral contraceptive or a progestin-containing IUD, which may eliminate periods altogether. (If the pattern of bleeding becomes heavier and more frequent, doctors recommend ruling out fibroids, polyps, uterine pre-cancer or endometrial cancer before getting treatment.)
Whether memory problems are symptomatic of menopause is controversial, but “word finding” (as opposed to not remembering what happened yesterday) is not quite as efficient during this transitional period,” says Dr. Donna Stewart.
As retired B.C. principal Barbra Paterson, 61, describes it, “memory lapses certainly invaded my being. I’d be speaking with someone when I would completely lose my train of thought, or a word that had absolutely no relevance at all, like “lampshade” would fly out of my mouth. I’d just shake my head and admit to a menopausal moment!”
A large National Institute of Health-funded study that has been following 3,000 women over more than 15 years at the University of California, Los Angeles, found a “subtle decline in cognitive performance.” Thankfully, cognition returned to baseline when women hit menopause.