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5 Ways to Manage Your Menopause

A gynecologist’s guide to easing hot flashes, dryness, and other annoying symptoms.

Photo credit: Getty Images

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Menopause is not a disease that requires treatment, though it may feel that way sometimes. It’s actually a normal life stage that all women go through when they come to the end of their childbearing years. Since sometimes women may think they’re in menopause when actually they may be pregnant (because symptoms of both can include hot flashes and weight gain), it’s important to let your doctor know if this is a possibility. That said, declining estrogen levels can cause a range of bothersome symptoms, including hot flashes, vaginal dryness, sleep problems, and urinary issues.

In the past, menopausal women were routinely prescribed hormone replacement therapy (HRT), which we long believed was the best way to not only manage the symptoms of menopause but also prevent heart disease and stroke. All that changed about 20 years ago, when a major study revealed that HRT actually increased the risk of heart attack, stroke, and breast cancer. Today, we still sometimes prescribe HRT for women who have extremely severe hot flashes—but only if they’re not at high risk for breast cancer, stroke, or heart disease, and only if their breast and gynecological exams are normal and up to date—and only in the lowest possible dose, for as short of a time as possible.

More often, we advise women to use a variety of strategies to combat the most common menopause symptoms, as well as the conditions that are more likely to occur at this stage of life. Here’s what I recommend:

1. Make healthy lifestyle habits a priority

One of the best ways to manage both the symptoms and conditions of menopause is to eat a healthy diet with plenty of vegetables, whole grains and lean sources of protein. It’s especially important to avoid eating too much sugar. A diet high in sugar will make your blood sugar levels uneven, which can exacerbate the feelings of anxiety that many women complain of during menopause.

Staying physically active also carries a whole host of benefits during menopause. Weight-bearing exercise such as walking will help keep your bones strong and your heart healthy, as well as give your metabolism a boost to help keep off excess pounds. And doing yoga regularly is as good for your mind as it is for your body.

2. Try topical estrogen for vaginal dryness

If your main complaint is vaginal dryness, I generally support prescribing topical forms of estrogen, which are safer than oral forms because less of the hormone is absorbed into the bloodstream. There are three types of vaginal estrogens: a pill that you insert into your vagina before bedtime twice a week; a vaginal estrogen ring, which you insert into your vagina and keep there for up to three months (after which time you remove the old ring and insert a new one); and vaginal cream that you apply to your vagina twice a week. Before using any of these products, you need to make sure you have a normal physical exam and Pap test, a normal mammogram, and no history of breast cancer. And, since all forms of estrogen (even the topical kinds) can increase your risk of uterine cancer, your gynecologist may also recommend  a hormone called progesterone to keep the uterine lining in check.

Another option that will help make sex more comfortable is using an over-the-counter vaginal moisturizer. These are products that you use every night (or at least three times a week) to keep your vaginal tissues from getting dry and irritated. This is in addition to using a water-based vaginal lubricant during sexual activity.

3. Combat nighttime hot flashes

If hot flashes at night are interfering with your sleep, keeping the temperature in your bedroom cool and wearing lightweight, natural fiber clothing to sleep can help. There are also cooling products that I often recommend to patients and that I even use myself. One is a cooling towel that you wet with cold water before going to bed. You wring it out, and if your room is cool, the towel stays very cold. You can keep it next to your bed and apply it to your neck and face if a hot flash wakes you up. You can even sleep with the towel draped around your neck. There are also cooling lotions/oils available over the counter which may prove helpful.  Before I go to bed, I put a little on my neck and on my wrists, and I have found it usually works really well.

“Menopause is not a disease that requires treatment, though it may feel that way sometimes. It’s actually a normal life stage that all women go through when they come to the end of their childbearing years.”
Dr. Jill Maura Rabin, urogynecologist

4. Empty your bladder completely

As women approach menopause, they sometimes complain of needing to urinate more often. There are several reasons for this. One is that declining estrogen levels may cause the bladder to contract more often, hold less urine, and become less elastic, which means it’s harder to empty it completely. When you sit down to urinate, take the time to completely relax your pelvic muscles, which will allow your bladder to squeeze out all of the urine. But if urinary symptoms persist or you’re having pain with urination, see your doctor to rule out a urinary tract infection or other urinary issues.

5. Talk to your doctor before using a phytoestrogen

Many women are interested in trying plant-based estrogens, also called phytoestrogens, such as soy and black cohosh. The data on soy is contradictory. Some studies have shown that soy is only slightly better than placebo for treating vaginal dryness, but a large study that was published in the journal Menopause found that soy does help relieve hot flashes. Regarding black cohosh, research shows some promise in treating vaginal dryness, hot flashes, and insomnia.

The main thing to remember is that phytoestrogens are still estrogens, and we don't know exactly how they work. Until we know for sure, it’s best to use phytoestrogens under the supervision of your doctor.

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Published January 2nd, 2019

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