Scottsdale, Arizona — Perimenopause, the end of the menstrual cycle, can trigger symptoms such as hot flashes, night sweats, insomnia , and mood changes. Women are not supposed to suffer in silence: many treatment options are available. Joel Kling, MD , chief of women’s health at Mayo Clinic in Scottsdale, Arizona, describes both hormonal and non-hormonal treatments.
“Sometimes we hear, ‘Do I really need treatment for hot flashes or night sweats?'” says Dr. Kling. For several reasons, the answer is: ‘Yes.’ Because hot flashes and night sweats affect women’s quality of life and their productivity at work and at home.”
Hormone replacement therapy is an estrogen medication; For women with a uterus, hormone therapy usually includes an estrogen plus a progesterone medication to prevent endometrial cancer . For women younger than 60 or within 10 years of their last menstrual period, the benefits of hormone therapy outweigh the risks in healthy women with postmenopausal symptoms, according to the latest North American Menopause Association guidelines .
says dr. Kling: “Many factors influence a woman’s decision: whether to use hormones, and if she does, what particular regimen is best to relieve her symptoms. Common factors considered include: age, underlying health conditions, severity of symptoms, preferences, treatment options available, and, of course, cost considerations. One of the most important considerations is whether the potential benefits outweigh the potential risks.
Benefits:
- says dr. Kling notes that several studies have shown that systemic hormonal therapy, such as pills, patch, gel, or spray, helps relieve hot flashes, night sweats, and vulvovaginal symptoms.
There is also strong evidence that long-term treatment with estrogen therapy or estrogen-progestogen therapy reduces fracture risk after menopause.
“In addition to these benefits, symptoms associated with menopause, including potentially annoying ones, often improve, including: disturbed sleep, mood problems, and decreased sexual satisfaction. Treating these symptoms may lead to a better quality of life,” Dr. Kling adds.
Of the risks:
- Risks of systemic oral estrogen therapy or estrogen-progesterone therapy include: blood clots in the legs and lungs, and stroke .
“Having a stroke depends on the age at which the woman started hormone therapy. The risk is lower for women younger than 60 or within 10 years of the last menstrual period,” says Dr. cling. “It appears that the same risks associated with transdermal estrogen products as the dermal patch do not appear, especially at lower doses.”
- Uterine use of estrogen alone carries a risk of uterine cancer, and this risk can be reduced by including a progestogen or selective estrogen-receptor modulator, also known as a SERM complex .
- Breast cancer risk also needs to be considered , as the chance of developing it seems to be slightly higher, especially in women with a uterus who use estrogen therapy with a progestogen.
says dr. However, in general, significant risks with hormonal therapy are rare. Women with only vaginal symptoms can use low-dose vaginal estrogen. Low-dose vaginal estrogen does not have the same risks as systemic (whole-body) therapy, as it is absorbed Just a little body.
says dr. Dr. Kling said hormone therapy generally isn’t an option for women with breast cancer or other hormone-related cancers or blood clotting problems, and others may simply want to avoid hormone therapy. There are many non-hormonal therapies, from mind-body techniques to medications, that can relieve pain with little to no side effects:
- There is some evidence that losing weight may reduce hot flashes and night sweats.
- Among the medications, low doses of paroxetine have been shown to help some women with symptoms such as hot flashes. At low doses, it does not appear to cause weight gain or have harmful sexual effects.
- Dr. adds. Kling notes that in some cases, antidepressants may be appropriate, and the healthcare practitioner and patient will weigh the benefits and risks.
- says dr. Kling N’s mind-body techniques include cognitive behavioral therapy and clinical hypnosis , both of which rely on expert guidance for success. Some patients find relief from acupuncture , yoga and meditation .
And she says dr. Kling: “There are many ways to help women deal with the discomfort and decreased quality of life associated with menopause.” “Women don’t need to make it difficult for themselves. They can get help.”
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Media contact: Sharon Theimer, Mayo Clinic Contact, newsbureau@mayo.edu
