Menopause Symptoms and Treatment

Women have long experienced uncomfortable menopause symptoms, such as hot flashes and vaginal dryness, often without openly discussing them. In recent years, perimenopause and menopause have become more widely discussed, with broader recognition of the need for symptom management, research and medical training.

For most women, menopause occurs between ages 45 and 55 and includes three phases: perimenopause, the transition leading up to menopause; menopause, defined as 12 consecutive months without a menstrual period; and post menopause, the years after that final period.

During this life change, estrogen and progesterone levels fluctuate and decline, leading to a variety of menopause symptoms, including:

• Hot flashes and night sweats
• Mood swings, irritability, anxiety or depression
• Vaginal dryness, burning or discomfort during intercourse
• Increased frequency of urination or recurrent UTIs
• Decreased bone density (osteopenia/osteoporosis)
• Difficulty concentrating, or brain fog
• Weight gain and slowed metabolism
• Dry skin and hair thinning
• Joint and muscle aches
• Difficulty sleeping

“While every patient can benefit from discussing these transitions, you should definitely seek a medical evaluation if symptoms significantly interfere with your daily life or well-being,” says Victoria Schooler, PA-C, a board-certified Physician Assistant at Henry Mayo Newhall OB-GYN.

She says other reasons to seek an evaluation are if there are questions regarding the safety or appropriateness of hormone therapy, the onset of menopause begins at an unusually early age, menstrual bleeding patterns become irregular or abnormal or urinary symptoms or persistent pain develop during intercourse.

Available options to treat symptoms include:

Hormone Therapy

Estrogen pills, patches, gels or sprays are highly effective for severe hot flashes and night sweats. They can also help with vaginal symptoms and prevent bone loss. When vaginal symptoms are the main concern, such as vaginal dryness, burning, urinary symptoms or painful sex, low-dose vaginal estrogen in a cream, tablet, insert or ring may be preferable.

Non-hormone Treatments

Certain antidepressants like paroxetine or venlafaxine can help reduce hot flashes and improve mood disruptions. Fezolinetant can also treat moderate-to-severe hot flashes without using hormones. Gabapentin, primarily a nerve pain medication, can also reduce symptoms.

Lifestyle Modifications

Diet and nutrition, including calcium- and vitamin D-rich foods; maintaining a healthy weight; strength and resistance training to keep bones strong; and good sleep habits can all help manage symptoms.

“It’s also important to keep up with mammograms, Pap smears, bone density scans and routine bloodwork,” adds Schooler.

Because menopause affects each person differently, talking with a healthcare provider can help patients choose treatment options that fit their symptoms, health history and goals.