Menopause therapies: genneve’s position

At genneve, we view menopause and the menopausal transition as a natural part of a woman's life, not as a disease to be cured. However, it can be accompanied by symptoms that are problematic in daily life.

There are many safe, alternative and complementary therapies that provide options for women who wish to try them. Our approach to evaluating and promoting treatments for menopause symptoms is to look at the evidence both for effectiveness and safety of those therapies. 

In our blogs and information, we will refer to all treatments with our best attempt to estimate the chance that they will be effective. We have more data for pharmaceutical therapies and will present these with the appropriate warnings. While we are western-medicine based, we recognize that there are safe, alternative therapies that are not harmful and may help some women.

We will always strive to give you our best current judgement about what we can safely recommend and let you know where therapies can be harmful and should be avoided.

Menopause symptoms: physical

The exact cause is still unknown, but it’s thought the loss of estrogen confuses the hypothalamus, the part of the brain that regulates body temperature. Solutions aren’t perfect, but some women find relief by reducing sugar, alcohol, and caffeine, practicing meditation, acupuncture, or using herbal remedies such as black cohosh or evening primrose. Hormone replacement therapy (HRT) has also been proven effective against hot flashes.

Like hot flashes, cold flashes can result from menopause and the effect estrogen loss can have on the brain – specifically the hypothalamus, which regulates body temperatures. Cold flashes often strike in the middle of the night and can last much longer than typical hot flashes. Many women find it difficult to get warm, though hot baths, hot drinks, and magnesium glycinate supplements have all been anecdotally reported to help.

Many women find it difficult to fall or stay asleep during perimenopause and menopause. Causes vary, but restless leg syndrome, sleep apnea, and night sweats can be disruptive to sleep, and many women experience anxiety early in the morning. To get a better night’s rest, be sure to practice good sleep hygiene (no screens, consistent bedtimes, dark, cool bedroom), consider adding a magnesium glycinate supplement to your nighttime routine, and talk to your doctor about taking a sleep study if you suspect sleep apnea.

Vaginal dryness is extremely common, affecting up to 80 percent of women in menopause. Other women may experience it with breast feeding, from hormonal birth control, at certain times during their cycle, or as the result of certain medications. The primary cause is the lack of estrogen, which means there’s less lubrication in the vaginal area. Tissues become thinner, drier, less elastic and more susceptible to tearing. For many women, lubricants and moisturizers are enough to replace the missing moisture. Other women may do better with topical hormonal creams, while others may choose a non-hormonal treatment like the Mona Lisa Touch laser.

Menopause symtoms: emotional

Anxiety is very common among women going through the menopause transition. Progesterone is naturally calming, and as levels of progesterone drop, we lose that protection. Additionally, your fight-or-flight response (cortisol) can get ramped up, making anxiety worse. Some women even experience panic attacks returning or for the first time. For those who prefer the natural route, try ashwagandha, magnesium (supplements or from food), or foot massage with sesame oil. Meditation and mindfulness can help those with milder symptoms. If you like tech, an app like Personal Zen might work well for you. Most importantly, know that this is likely caused by hormone changes and will pass as your body adapts.

Midlife is a stressful time, and losing the fight-or-flight-dampening effect of estrogen and progesterone really doesn’t help. Women find themselves have strong emotions and “losing control” more often, resulting in guilt and damaged relationships. We strongly suggest you be as open as you can with your intimates (partner, kids, friends) and at work, if it is a safe place to do so. The rage checklist has ideas for calming yourself in the moment, like remembering all your school teachers in order or shifting your stance to a less hostile posture.

Women are at 2 – 4 times the risk for depression during the perimenopause to menopause transition, though those rates drop dramatically in post-menopause. Women who have experienced depression earlier in life are at even greater risk. If depression that affects your life lasts two weeks or longer, it’s said to be “clinical,” and it’s best to consult with a doctor. For milder symptoms, vitamin D from sunshine, food, or supplements can be a major mood booster.

Menopause symptoms: sexual

A lackluster libido can take a lot of fun out of life and be damaging to some of our most important relationships. In fact, nearly one in four divorces is to couples over 50. Sex is good for our health, physical and emotional, but desire can be a complicated process in women, particularly as hormone levels dip in menopause. To revive a limp libido, visualization can be a powerful driver. Role play and toys or vibrators are also useful for remembering and returning to pleasure. Finally, if pain with penetration is part of the problem, there are remedies that may help you enjoy sex again.

HRT and hormones

HRT is the practice of medically providing the hormones women’s bodies no longer manufacture enough of after menopause. HRT hormone levels are generally lower than from birth control pills, since the dosage needed to control hot flashes and other symptoms is less than that needed to control ovulation. There are different kinds of HRT (varying levels of estrogen and/or progesterone) and different ways to administer (pills, vaginal creams, transdermal patches). The formulation and administration will depend on your needs, goals, risks, and the length of time you’ve been taking hormones.

The Women’s Health Initiative study was a very large, long-term study of the effects of taking estrogen-only HRT or combined (estrogen and progesterone) HRT. The study, which was published in 2002, showed a small but significant increase in incidences of breast cancer, stroke, heart disease, and blood clots in women taking the combined HRT, causing many doctors to stop prescribing it and many women to stop taking it. More recent findings suggest that HRT is probably safe – even beneficial – for healthy women younger than 60, though many doctors suggest women stop taking combined HRT after 5 years. HRT can be highly effective for controlling or eliminating many symptoms of menopause, so it’s worth having a detailed discussion with your doctor. If you have a personal or family history of breast or endometrial cancer, blood clots, or liver disease, or if you smoke, HRT is not recommended.

Ask an OB/GYN

When a woman enters perimenopause – which can be as early as her mid- to late-30s – her levels of estrogen, progesterone, and testosterone begin to fluctuate. Most women already have experience with hormonal changes, as levels dip and rise during monthly cycles as well, but in this phase, the peaks are higher, the troughs deeper, and the trend is generally downwards. This the body beginning to ramp down reproduction: fewer eggs are released, cycles may get longer or shorter, heavier or lighter, mood can seem more volatile, sleep can be interrupted. Women’s brains are regulated to a very significant extent by estrogen, so as that hormone decreases, pretty much everything is affected. This period can last for years, though for most women it’s about four years in duration. Generally, the body adapts and finds its new normal as hormones level out, post-menopause.

Nutrition, exercise, and weight management

Nutrition plays a big part in our general health and well-being, and it may be especially important in perimenopause and menopause to help control symptoms. Phytoestrogens such as soy products, flaxseeds, chickpeas, and lentils can help some women by replacing the estrogen the body no longer produces. Women in this time are often short on magnesium, which can be replaced by foods or supplements. Fiber can relieve the constipation brought on by slower digestion; Omega 3s may help with memory and mental acuity. A diet rich in vegetables and lean protein helps with weight management and supports bone health. Ditching sugar may help with many menopause symptoms; increasing vitamin D can help with mood and energy.

Complementary care / natural remedies

Naturopathic remedies have shown real benefit for some women and are particularly useful for women who are unable or unwilling to take HRT. A naturopathic doctor (ND) can help you understand your hormones better, find remedies that support your body’s natural processes and provide relief from symptoms, and generally maintain a more healthful lifestyle. Soy, especially unprocessed and fermented, maca, black cohosh, alfalfa, oats – all of these may offer help for menopause symptoms, and an ND can help you figure out how to make the most of nature’s remedies. Additionally, an ND can help you identify lifestyle habits that may be making symptoms worse and suggest healthier alternatives.

Fertility and birth control

Until you’ve reached menopause (defined as 12 months without a period), you can still get pregnant, so some form of birth control is called for. Birth control choices for older women are basically the same as their younger counterparts’: hormonal birth control such as the Pill or vaginal ring; the IUD; barrier methods such as condoms, sponge or diaphragm, and the rhythm method. Many women in perimenopause choose hormonal methods, as those can come with the added benefit of reducing menopause symptoms. However, older women may be slightly more at risk of blood clots or other side effects, so it’s worth having a detailed conversation with your ob/gyn. 

Menopause in the workplace

Having open conversations about menopause while avoiding ageism and sexism can be a tricky dance in the modern workplace. One place to start might be finding a sympathetic ear in management. Ask about flexible working hours or permission to use the nursing room (when not needed by a mom) when symptoms interrupt your day. Ask HR about sick day policies and if menopause can be made part of your company’s wellness program and education efforts. On a more day-to-day level, wear layers to accommodate hot flashes, keep ice water handy, get a small fan for your desk, and avoid spicy foods and coffee when you really need to minimize the risk of hot flashes.

Skin and hair care

As we age, decreases in estrogen mean our skin gets thinner, drier, and less elastic. It also produces less oil, making it more vulnerable to environmental damage. To protect your skin, you should hydrate, use lotions with anti-oxidants and a high fatty acid content, apply lotions and sun screen more often, exfoliate gently, avoid products with sulfate, and eat lot of anti-oxidant foods. Also, check your skin carefully for changes that may indicate other health issues.

Midlife issues

Midlife is a tough time, and many long-term relationships give under the strain. Reasons can include changes in culture making divorce more acceptable, women’s increasing financial independence, the freedom of a suddenly empty nest. Many marriages in midlife are not the first marriage of one or both partners, and second marriages are less stable. Lack of libido, hormonal issues such as rage or depression, the pressures of taking care of aging parents, retirement worries, and the very simple fact that people live longer now than they used to – all of these can contribute to the dissolution of a relationship. Successful relationships often rely on communication (why are we angry?), self-reflection (am I really unhappy with my partner, or with myself?), and proactive problem-solving (what are our options for taking care of mom?).

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