Treatment of menopausal symptoms
The treatment of menopause is complex and must be adjusted according to the needs of each patient. Generally, the treatment of each particular symptom is chosen, unless there is a very significant condition that justifies a hormone replacement treatment. The objective is always to improve the quality of life for women.
How is vaginal dryness and pain during sex treated?
To combat vaginal dryness, local treatments are chosen. There are different options based on each need. The two main options, hormonal and non-hormonal, can be combined for better results.
- Hormonal: it is about administering local estrogens in the vagina either by creams, tablets or rings. These medications release local estrogens which will help increase the thickness of the vaginal mucosa with the consequent increase in lubrication. They have very little systemic absorption and, therefore, are safe and do not offer a significant increase in the incidence of breast cancer.
- Non-hormonal: different products are used to help lubrication and relief of symptoms.
- Lubricants: Water-based lubricants tend to dry the mucous membranes because they evaporate and, therefore, do not prevent friction during relationships. The most noble lubricants are oily, such as liquid or solid petrolatum, which do not undergo any evaporation process and tend to have a long duration. The inconvenience they generate is the difficulty in cleaning the genital area.
- Vulvo-vaginal moisturizers: there are aqueous or oily components. Aqueous ones usually contain hyaluronic acid. They are water based and tend to stick to the vaginal walls. There are gels with gotu kola which has a re-epithelizing and healing action. It can help relieve the symptoms of dryness. There are oily moisturizers such as oils based on vitamin E, burdock and almond oil. They tend to last longer.
How are hot flashes treated?
There are hormonal and non-hormonal treatments. Generally, hormonal treatments are the most effective. Still, there are women who cannot use hormones or derivatives for other conditions. The treatment of the symptoms will be based on each case in particular
- Pollen derivatives: are relatively new components. They are natural medications that derive from pollen, but are processed in a particular way so that they can be used by patients allergic to pollen. The maximum efficiency they can offer is 40-50%, being a new alternative that can also improve other symptoms related to the climacteric.
- Antidepressants: there is a subgroup of antidepressants called serotonin reuptakers that have been shown to be 60% effective against hot flashes, since they modulate the vasomotor response with doses much lower than those administered to treat depression.
Hormonal: hormone replacement therapy will be indicated for those women who do not respond to non-hormonal methods or those who present disabling hot flashes.
Phytoestrogens: are isoflavones, or plant estrogens. They are potentially safe, although their effectiveness is at most 30-40%. Should be avoided in women with breast cancer because they are a source of estrogen.
How is insomnia treated?
First of all you have to take measures to carry out a “sleep hygiene”: dine lightly, reduce the intake of carbohydrates and fried food at night, do not drink alcohol at night, dine early so that proper digestion can be carried out before going to bed, avoid caffeine at night, do not watch TV until late at night, take a bath before going to sleep, do not do physical exercise in the evenings / nights. Once these measures are adopted, different medications can be provided. These medications must be administered under medical supervision.
How is weight gain treated?
We must adapt to a new stage in life and this also constitutes a modification of eating habits. Each stage in a woman’s life needs a particular diet. Do not forget the physical exercise. You can get help with a nutrition professional.
How is the decrease in libido treated?
It is a difficult symptom to treat since the decrease of sexual desire is also linked to the corporal changes suffered by each woman. The support of the couple in this new stage is essential. The only treatment that has proven effective is hormone replacement. Still, there are women who fail to improve this aspect of life.
How are emotional disorders treated?
The health professional should identify if the patient will need some kind of psychological support and if she will need medication. This aspect needs to have a multidisciplinary management since it offers better results.
What to do when there is more than one symptom?
In women in whom the climacteric symptoms are more florid and they are associated more than one, they usually benefit from the hormone replacement therapy. The goal is to give a hormonal contribution since the ovaries have stopped producing estrogen and progesterone. There are different schemes of substitute therapies and different medications and routes of supply that will be decided based on the characteristics of each patient. It is about prescribing the lowest possible hormonal dose to have the maximum results. The delivery time should not exceed 5 years.
What are the risks of hormone replacement therapy?
As with any other medication, hormone therapy carries certain risks. There are many studies that argue that the provision of this type of treatment can increase the incidence of breast cancer. In women who still preserve their uterus and who are not given progesterone along with estrogen, they have an increased incidence of endometrial cancer. Some women may experience abnormal uterine bleeding that should not exist with this type of treatment.
North American Menopause Society