Dr Michelle O'Driscoll: Managing symptoms of the menopause (Part 2)

Today we look at how to manage menopausal symptoms using practical and pharmacological treatments.
Dr Michelle O'Driscoll: Managing symptoms of the menopause (Part 2)

Today, Dr Michelle O'Driscoll looks at how to manage menopausal symptoms using practical and pharmacological treatments.

WELCOME to part two of our WOW! Menopause Mini-Series.

Last week, we got to grips with what actually happens to our bodies during the menopause, and what the most common symptoms are.

Today, we look at how to manage menopausal symptoms using practical and pharmacological treatments.

Practical tips

For many women, the symptoms of menopause, although uncomfortable and inconvenient, can be managed via relatively simple strategies adopted day-to-day, without the need for medication. Some of the most helpful ones are listed below:

For hot flashes, dress in breathable cotton clothes and in layers so that it’s easy to reduce the amount of clothing should you need to. Maintain a cool temperature in your bedroom via an open window or a fan, and avoid caffeine, spicy food and stressful situations where possible.

For vaginal dryness, try using a vaginal lubricant such as Regelle or Sylk, available from all pharmacies. It’s advised to make this part of your routine early on as a preventative measure rather than waiting until the area becomes extremely uncomfortable. Avoid perfumed hygiene products in this area also.

To reduce the risk of urinary tract infections, keep your pelvic floor muscles strengthened with daily kegal exercises, and make sure you’re staying hydrated.

For maintaining overall health during the menopause and beyond, you should avoid smoking and excess alcohol, and eat healthily, taking particular care to maintain adequate calcium intake from dairy and dark leafy vegetables. It is also advised to practice weight-bearing exercise such as walking, tennis and dancing to maintain your bone health and boost your mood.

Prescription medications

If the above strategies are enough to manage your menopause symptoms, great! However for some, menopausal symptoms can be incredibly debilitating.

If they are impacting on your daily life in a significant way and impairing your ability to function then it’s highly recommended that you have a chat with your GP about what can be done to help.

The most well-known type of medication for the menopause is Hormone Replacement Therapy (HRT) and it does exactly that – it replaces the hormones that are lacking in our bodies during the menopause. There are two main types of hormones used; oestrogen and progesterone. Oestrogen is the key ingredient to combat symptoms such as hot flashes and vaginal issues, as well as preventing osteoporosis, but if you still have your uterus (haven’t had a hysterectomy) you’ll also need to take progesterone to prevent cancer of the womb. Many HRT products have oestrogen and progesterone combined into one for convenience.

HRT comes in a variety of forms, and the type chosen by your doctor depends on what stage of menopause you’re at (whether or not you’re still having periods) and what symptoms you’re suffering most from.

HRT can be administered in several ways, including a tablet that you take orally, usually once a day, patches which stick to your skin and allow the hormones to be absorbed across and into the bloodstream, or a gel which you rub into the skin.

Oestrogen can also be administered directly into the vagina in the form of a vaginal tablet, cream or ring to combat vaginal dryness, painful intercourse and some urinary symptoms. In this case, progesterone is not needed because the oestrogen acts directly on the vagina and won’t affect the womb.

There has been a lot of fear around the use of HRT and potential increases in health risks. HRT is usually prescribed at the lowest possible dose for the shortest possible time to minimise the risk of side effects.

Recent evidence has found little-to-no increased risk of heart disease and stroke if HRT is started before the age of 60. It has also been found that the level of breast cancer risk from HRT use is related to the amount of time that you take it for i.e. short-term use shows low levels of risk.

Overall, it’s worth considering the benefit-risk ratio of HRT with your doctor before ruling out its use.

Separate to HRT, it is not uncommon to see menopausal women being prescribed a low dose anti- depressant. Some categories of these are helpful in combatting hot flashes, particularly for women who cannot take HRT for health reasons. They also have the obvious added benefit of improving mood for those who are struggling with anxiety and/or depression during this time.

Other medications that your doctor may prescribe include gabapentin (usually used to treat seizures or nerve pain but also beneficial for hot flashes) and osteoporosis medications such as bisphosphonates or vitamin D supplements.

A note about herbal remedies

While anecdotal evidence points to benefits of the use of herbal remedies such as soy, red clover, black cohosh and ginseng for menopausal symptoms, this has yet to be corroborated with sound scientific research, and care needs to be taken that they do not interfere with other medications you may be taking.

Always check with your healthcare provider before trying any of these products.

Next week in Part 3: We look at the emotional toll that menopause can take, and some practical approaches to help you get through this challenging time.

Dr Michelle O'Driscoll is a pharmacist, researcher and founder of InTuition, a health and wellness education company.

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