Treatments for menopause can be divided based on those symptoms that are present in a given woman at a specific time.

Treatment of Early Onset Symptoms

Abnormal Vaginal Bleeding

Prior to treatment, a doctor excludes other causes of erratic vaginal bleeding. Women in menopausal transition tend to have considerable breakthrough bleeding when given estrogen therapy. Therefore oral contraceptives are often given to women in menopause transition to regulate their periods, relieve hot flashes, as well as to provide contraception. Oral contraceptives are considered safe in healthy, non-smoking women.

Hot Flashes

The choice of medication for treating hot flashes depends on whether a woman is still having periods or not. For women experiencing unpredictable bleeding and hot flashes during menopause transition, oral contraceptives are commonly used (even up to 50 years of age) to control both erratic perimenopausal bleeding vaginal bleeding and hot flashes. For women without periods, hot flashes can be treated with either oral (by mouth) or transdermal (patch) forms of estrogen. Both oral and transdermal estrogen therapies are available either as estrogen alone, or estrogen combined with progesterone. For more, please read the Hormone Therapy article. All available prescription estrogen therapies, whether oral or transdermal, are effective in reducing hot flash frequency and severity. Generally, available treatments decrease hot flash frequency by about 80 to 90%.

Mood Symptoms

Even though moodiness, irritability, and tearfulness are commonly attributed to menopause, studies are underway to determine which of these symptoms are actually due to menopause versus other conditions such as medical depression. Even though many women experience improvement in irritability with oral hormone therapy, hormone therapy alone will not be adequate treatment for a woman suffering from true medical depression (a true depression may require antidepressant medications that are different from medications for menopause). Accordingly, women who are experiencing significant mood symptoms should be evaluated by their doctors to exclude depression and other medical illnesses.

Treatment of Late Onset Symptoms

Vaginal Symptoms

Prior to being treated for vaginal irritation, burning, and itching, women should first undergo an evaluation by a doctor, including a pelvic exam, to verify that the symptoms are due to estrogen deficiency.

There are local (meaning vaginal) and oral treatments for the symptoms of vaginal estrogen deficiency. Local treatments include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Oral treatments include multiple types of estrogen either alone, or estrogen given with progesterone (read the Hormone Therapy article). Local and oral estrogen treatments are both effective in relieving vaginal symptoms and are sometimes combined for this purpose. In women for whom oral or vaginal estrogens are deemed inappropriate, such as breast cancer survivors, or women who do not wish to take oral or vaginal estrogen, there are a variety of over-the-counter vaginal lubricants. However, they are probably not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.

Osteoporosis

The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and increasing bone density and strength. Although early detection and timely treatment of osteoporosis can substantially decrease the risk of future fracture, none of the available treatments for osteoporosis are complete cures. In other words, it is difficult to completely rebuild bone that has been weakened by osteoporosis. Therefore, the prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention measures are:

 
• Lifestyle changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D.  
• Estrogen therapy for postmenopausal women and those with other low estrogen conditions. Women using HT for the short-term (less than 5 years) control of hot flashes will probably derive protection against osteoporosis during the time they are using HT. Other safe and effective non-hormonal prescription medications can be used to address osteoporosis in women who stop taking HT when hot flashes cease, and in women not taking HT.  
• Medications that stop bone loss and increase bone strength, such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), and calcitonin (Calcimar).

For an extensive review of osteoporosis, its treatment and prevention, please read the Osteoporosis article, and for more on supplements, read the Vitamins and Calcium Supplements article.

Heart Disease

Although it was previously felt that oral estrogen decreases the risk of heart disease in postmenopausal women, research with a large enough number of women in well-designed research (specifically, the Women’s Health Initiative) has only just become available. The research suggests that estrogen does not protect against heart disease in women who do not yet have heart disease, nor is it protective in women who are already known to have heart disease. In fact, women with heart disease who begin HT may be at increased risk of a heart attack in the first year of starting oral HT. In the near future, we will have more research studies regarding this issue so we can know if the Women’s Health Initiative results can be extended to other HT brands and preparations, and whether the results apply to patches as well as oral HT. In summary, oral HT is not appropriate for heart disease protection, but is clearly appropriate for women with hot flashes who intend short-term (less than 5 years) use and have no other contraindications.

Menopause At A Glance

 
• Menopause is the time in a woman’s life when the function of the ovaries ceases. The ovary, or female gonad, is one of a pair of reproductive glands in women.  
• The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.  
• The average age of menopause onset is 51 years old. There is no reliable lab test to predict when a woman will experience menopause.  
• The age at which a woman starts having menstrual periods is not related to the age of menopause onset.  
• A women is in menopause when she has had no menstrual periods (menses) for 12 months and has no other medical reason for her menses to stop.  
• Symptoms of menopause can be divided into early and late onset symptoms. Early symptoms include abnormal vaginal bleeding, hot flashes, and mood changes. Late symptoms include vaginal dryness and irritation, osteoporosis, and heart disease.  
• Treatments for menopause are directed toward alleviating the symptoms present in the particular woman affected.