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Conditions in Depth

This page contains the basic information about Menopause And Perimenopause .

Return to the Menopause And Perimenopause Main Condition Center

Treatment

Lifestyle Changes

Diet, exercise and lifestyle changes can reduce the symptoms and complications of menopause. The following recommendations are appropriate for all women who are approaching menopause or who are in menopause.

  • Refrain from smoking. Smoking increases the risk of osteoporosis and hip fractures. Smoking also increases the risk of heart attack and stroke.

  • Limit caffeine. High caffeine intake, more than three cups per day, can aggravate hot flashes and may contribute to osteoporosis.

  • Wear layers of clothing. Since you can have hot flashes any time, wearing layers can help you to cool off quickly during a hot flash and warm up if you get chilled after a flush. Keep bed blankets light and use layers at night for the same reason.

  • Exercise. Exercise can:

    • Reduce blood pressure and the risk of heart attack and stroke

    • Relieve hot flashes in some women

    • Reduce osteoporosis and fractures

    Exercise to prevent weak or thin bones must be weight-bearing exercise such as walking, low-impact aerobics, dancing, lifting weights, or playing a racquet sport such as tennis or paddle ball. Exercise does not need to be vigorous to help. Walking a few miles per day helps to maintain bone mass.

  • Get sunlight and vitamin D. Vitamin D helps your body absorb enough calcium from food. You can get enough vitamin D with only a few minutes of sun exposure each day. If natural sunlight is not an option, you should take 400 to 800 international units of vitamin D every day.

  • Treat vaginal dryness. Lubricants such as Astroglide or K-Y Lubricant can help with dryness during sex. Vaginal moisturizers such as Replens or K-Y Vaginal Moisturizer can help to treat irritation due to dryness. Doctors can also prescribe a hormonal cream if over the counter treatments do not work.

  • Consume calcium. Women should get between 800 to 1,500 milligrams of calcium every day. Good sources of calcium include:

    • Dark green vegetables (except spinach, which contains another ingredient that reduces the amount of calcium that can be absorbed from the food) — One cup of turnip greens supplies 197 milligrams of calcium, and 1 cup of broccoli provides 94 milligrams.

    • Dairy products — One cup of milk provides approximately 300 milligrams of calcium, and 1 cup of yogurt supplies 372 milligrams. Cheese is another good source. One ounce of Swiss cheese has 272 milligrams of calcium.

    • Sardines and salmon — Four ounces of sardines provide 429 milligrams of calcium, and 4 ounces of salmon have 239 milligrams of calcium.

    • Legumes — One cup of navy beans supplies 127 milligrams of calcium.

Medication Therapy

A number of medications are used to treat the symptoms of menopause. The type of medication needed is a complicated decision and each woman should discuss the issue with her doctor. The treatment will depend on what symptoms are most bothersome and how bothersome they are.

Estrogen taken as a pill or applied to the skin as a patch can reduce hot flashes, sleep disturbances, mood changes and vaginal dryness. Estrogen can be prescribed alone when a woman no longer has her uterus. A combination of estrogen and progesterone is used when a woman still has her uterus. Progesterone is necessary to balance estrogen's effect on the uterus and prevent changes that can lead to uterine cancer.

However, evidence has shown that there are some risks associated with the use of these medicines. Estrogen therapy can increase the risk of heart disease, stroke, breast cancer and blood clots in a small number of women. On the other hand, it prevents fractures and can decrease the risk of colon cancer. Therefore, the decision to use hormone replacement therapy to treat symptoms of menopause is an individual decision. A woman should talk to her doctor about the risks and benefits of hormone replacement therapy for her.

There are several other medications that can be used to treat the symptoms of menopause:

Hot flashes

  • Antidepressants — Medications such as venlafaxine (Effexor) and paroxetine (Paxil) are often the first choice for women with hot flashes who are not on hormone replacement therapy. They relieve the symptoms of hot flashes in 60% of women.

  • Gabapentin (Neurontin) — This medicine is moderately effective in treating hot flashes. Gabapentin's main side effect is drowsiness. Taking it at bedtime may help improve sleep while decreasing hot flashes.

  • Clonidine — This is a blood pressure medication that can relieve hot flashes in some women.

Osteoporosis

  • Calcium and vitamin D supplements — All postmenopausal women who have osteoporosis or are at risk of osteoporosis should take calcium and vitamin D supplements. The usual recommended supplemental dose is 1,000 milligrams of calcium carbonate (taken with meals) or calcium citrate daily. It is best to take this as 500 milligrams twice a day. Women also need 800 international units of vitamin D daily.

  • Bisphosphonates — Etidronate (Didronel), alendronate (Fosamax) and other similar drugs are the most effective medicines that can be used to both prevent and treat osteoporosis. They increase bone density and decrease the risk of fractures.

  • Raloxifene (Evista) — This drug has some of the beneficial effects of estrogen without the increased risk of breast cancer. It is effective in building bone strength and preventing fractures.

  • Parathyroid hormone — This is a synthetic form of a naturally occurring hormone produced by the parathyroid glands. It increases bone density and decreases the risk of fracture.

  • Calcitonin — This hormone is produced by the thyroid gland and helps the body keep and use calcium. A nasal spray form of this drug is used to help prevent bone loss in women at risk. Doctors may prescribe calcitonin to help relieve pain from fractures due to osteoporosis.

Several alternative treatments have been proposed to treat the symptoms of menopause. Many of these treatments have not been studied in large clinical trials. Although black cohosh has been previously promoted as a treatment for hot flashes, well-done medical studies conclude the root is no more effective than a placebo.

Some women have found St. John's wort to be effective in treating mood disorders related to menopause.

The use of soy products in the diet such as tofu is controversial. While it may improve symptoms for some women, the phytoestrogens (plant estrogens) that may help relieve hot flashes may also increase the risk of breast cancer.

Scientific studies have found no benefit to the use of vitamin E or primrose oil. No evidence has been found to support the use of acupuncture or homeopathy, but few studies of these therapies have been done.

     
Created: 4/27/2004   |   Last Modified: 8/21/2006
From Health A-Z, Harvard Health Publications. Copyright 2006 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.