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How to manage menopause symptoms

Dr. Muthoni Mwangi
Menopause is a life-changing event in a woman’s life, often shrouded by mystery and misconceptions. In this article, we debunk the mystery around it and enlighten women on different treatment modalities that can ease them into the menopausal state.

What is menopause?

Menopause is defined as the permanent stopping of menses, usually when a woman goes for 12 months with no menstruation. It happens at a median age of 51.4 years. During the perimenopause transition, most women have irregular menses and hot flushes for 4-10 years due to declining estrogen levels.

Other symptoms include sleep disturbances, brain fog/forgetfulness, mood changes, and genito-urinary symptoms such as frequent urinary tract infections, lower sex drive, and vaginal dryness.

Premature menopause is defined as menopause before 40 years of age and it is associated with a higher risk of cardiovascular and bone loss.

Long-term health concerns

Long-term health concerns include osteoporosis, which increases the risk of bone fractures and cardiovascular disease.

Managing menopause

1) Lifestyle changes

Care of the woman undergoing menopause includes lifestyle changes such as exercise, weight loss, smoking cessation, and reduction of alcohol consumption. These changes make menopausal symptoms more manageable and improve the overall well-being of the woman.

2) Non-hormonal therapies

Medical treatment for these patients includes both hormonal and non-hormonal therapies. Non-hormonal treatments include use of vaginal lubricants, use of certain anti-depressants for the management of vasomotor symptoms (hot flushes and night sweats).

These antidepressants may improve sleep patterns and mood. Clinicians discuss potential adverse effects with women before initiating treatment. Many women who experience urinary symptoms should visit a urogynecologist for investigations and discussion on management.

Bone density scans are done to assess and diagnose osteoporosis (brittle bones) and to stratify the risk of fractures. The approach to treatment is tailored based on patient presentation and may include but is not limited to calcium, vitamin D, and bisphosphonates which will be prescribed by your physician.

3) Hormonal therapies

Hormonal therapies are available for the management of post-menopausal symptoms. In most cases, they are started within 10 years of menopause. Often, their benefits outweigh their risks; however, patients should be risk-stratified before starting hormonal therapies, which are either estrogen-alone or estrogen-combined therapies.

Hormonal therapies have an added benefit in the reduction of cardiovascular events and osteoporosis. Genitourinary symptoms can be managed using topical formulations of estrogen.

4) Screening for cancer

Women who have irregular bleeding as they approach menopause or experience vaginal bleeding after menopause should see a gynecologist to evaluate the causes of perimenopausal bleeding and to rule out malignancy. Investigations may include a pap smear, pelvic ultrasound (transvaginal ultrasound), and sometimes a biopsy of the inner lining of the uterus. A mammogram should be done every two years to screen for breast cancer.

In summary, the transition to the menopause stage has its challenges, however, there are different treatment modalities to ease a woman into this phase. It is a transition, not an end to a woman’s vitality and sexuality.

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