While your family is gathered in the living room during the heart of winter, your mother comments that she finds the house temperature to be uncomfortably warm. She proceeds to lower the thermostat to a chilly 50 degrees and you remind her that everyone else in the house finds that temperature to be unbearably cold. She quickly snaps back at you and responds, “Well, I’m feeling hot and sweaty and can’t stand this heat.” Though seemingly ripe for a sitcom, this is a typical experience of a woman who is transitioning into menopause, the stage of a woman’s life when there is a permanent cessation of the menstrual cycle. Yet, contrary to popular belief, the classic symptoms of hot flashes and mood changes that most people associate with menopause are most prominent in the period of time just preceding menopause (a.k.a. peri-menopause); an interval during which hormonal fluctuations are considered erratic. Symptoms related to menopause are exceedingly common and studies have shown that up to 80% of females experience the aforementioned manifestations. Luckily, treatment is available for women who are symptomatic, and for men, recognizing and understanding this clinical syndrome can only benefit them, as knowing what to expect will allow them to better manage their relationships with a close or companion female.
The physiologic changes accompanying the menopause transition occur about 4 years prior to the final menstrual period. As a woman gets older, the ovaries start to degenerate, resulting in the subsequent decline of the estrogen and progesterone hormones. These hormonal changes are responsible for the clinical manifestations of menopause. The most commonly reported symptoms include: A) hot flashes, i.e., an intense heating sensation felt over the chest and face, often associated with perspiration and anxiety; B) sleep disturbances; C) depression; D) vaginal dryness, due to a decrease in estrogen levels; E) sexual dysfunction; F) cognitive changes, commonly described as memory loss or difficulty with concentration; G) joint pain; and less commonly noted, H) migraine headaches. The diagnosis of menopause is based on the patient’s clinical history and presentation, but it may involve blood testing for hormone levels. The treatment for this condition is hormonal replacement therapy, and there are a variety of formulations available that can be used. These can be administered orally, topically, or as an intra-vaginal cream (a remedy that has less systemic effects than the oral formulation).
For the majority of women, peri-menopause is an extremely trying stage to cope with, both from a mental and physical standpoint. Different natural therapies have been looked at and some have reported that plant based estrogens, such as those found in soy, could serve as an alternative treatment for menopausal women. However, studies have failed to demonstrate a clear benefit. Moreover, even though there are a variety of effective treatments available, not all women are candidates for hormonal therapy. It is contraindicated in women with a history of breast cancer, coronary artery disease, or blood clots, as hormonal therapy has been known to increase the risk of these conditions. Nevertheless, if someone close to you is approaching menopause, consider that they are undergoing uneasy and uncontrollable physiologic changes; so if you recognize a shift in behavior, remember: being receptive and patient is the first line of treatment.