menopause approaches, whether it is a natural process of aging,
the result of surgical removal of the ovaries, or the effects of
radiation or chemotherapy, many women will have symptoms of
estrogen loss. While every woman will experience menopause in
her own way, most will have hot flashes—ranging from rarely to
more than ten times a day. Hot flashes are often worse at night
and can disrupt sleep, causing mood changes and difficulty
making decisions. Some women will complain of anxiety and even
periods of depression. These symptoms will improve over time.
Other problems can occur because of estrogen loss. The vagina
becomes shortened and more dry. These changes can cause itching
and burning and can interfere with comfortable sexual
intercourse. A woman may also experience more vaginal and
bladder infections. Other symptoms include headache, dizziness,
skin changes, and thinning of the scalp and pubic hair.
Management The best way to manage the symptoms of
menopause is to restore the body’s level of estrogen. This can
be done by taking a pill (e.g., Premarin), by applying an
estrogen patch to the skin twice a week, or by using a vaginal
cream. However, estrogen therapy is not for every woman. Some
women prefer to try other means of learning to live with the
change of life. Your doctor will help you make the choice that
is best for you. The following suggestions may help you with
your symptoms of menopause.
1. Hormone replacement: Estrogen therapy is given for
menopause symptoms but also to prevent heart disease, stroke,
and frail bones. If estrogen therapy has been prescribed for
you, it is important that you continue therapy as prescribed. If
you have not had a hysterectomy, you may also need to take
progesterone. The purpose of this drug is to shed the lining of
the uterus once a month, which means you will once again start
to menstruate. This is normal and helps to prevent uterine
cancer. If you choose not to take progesterone (as some women do
because it can cause mood changes and depression), you will need
to be examined regularly to ensure a healthy uterus. If you have
had your uterus removed you do not need to take progesterone.
2. Vitamin E: Vitamin E, 400 IU twice a day, has been
found by some women to increase energy and help minimize hot
flashes and vaginal dryness.
3. Venlafaxine: 12.5 mg twice a day may help to minimize
hot flashes and is an antidepressant.
4.Clonidine: Clonidine is a drug taken to manage high
blood pressure. It can also help to relieve hot flashes in some
women. It should be taken at night time, because it can cause
light-headedness. This drug is also available as a patch. It
requires a prescription from your doctor (0.1 mg patch once a
5.Bellergal: Bellergal is sometimes used to minimize hot
flashes but can cause mouth dryness, blurred vision, and
sedation. Do not use with alcohol. It requires a prescription
from your doctor.
6. Diet, vitamins, and herbs: A multivitamin may be added
each day to your diet, but large doses can be harmful. Ask your
doctor before starting higher doses of vitamins. Try to limit
caffeine from all sources (colas, coffee, and chocolate) and
avoid hot, spicy foods and alcohol. All can trigger hot flashes.
Ginseng root is a natural plant estrogen and is available as
a tea, capsule, powder, or syrup. Some women feel it helps to
control their hot flashes. Other possibly helpful but unproven
methods to minimize hot flashes include garlic, hops, catnip,
chamomile, passion flower, black cohash, wild yams, dong quai,
licorice root, and evening primrose oil.
7. Biofeedback and relaxation: Stress has been known to
increase the frequency and intensity of hot flashes and tension
headaches. Learning biofeedback techniques can help to reduce
stress. Relaxation tapes have helped some women to ease the
severity of their hot flashes and to cope with the normal
tensions of life.
8.Exercise: Many women are sedentary and do not exercise
regularly. No matter what a woman’s age, there is an exercise
to enhance well-being and general health. Consult your doctor
before engaging in strenuous sports, but begin a program that
fits your lifestyle and abilities.
9. Vaginal lubricants: It is not uncommon for women to
notice a lack of sexual desire and passion during the menopausal
years. Some women have pain during sex and may even notice
bleeding afterward. Orgasm may occur less often, especially in
women who also are diabetic. The male partner may also abstain
from sexual intercourse for fear of hurting the woman. While
other factors such as stress, fatigue, and each other’s
general health will play a role in sexual relationships, most
women prefer to maintain a healthy sexual relationship with
their partner. Women who continue to have sexual intercourse
throughout menopause experience fewer vaginal changes than women
who abstain or have sex only infrequently.
- Vaginal estrogen creams are useful to reverse vaginal
changes. A start-up dose of estrogen cream, 2–4 grams
nightly for 1 to 2 weeks, followed by 2 grams once or twice
a week will help to restore vaginal health.
- Personal lubricant, Lubrin, K-Y Jelly, or Astroglide will
temporarily relieve vaginal dryness during sexual
intercourse. Apply liberally and as often as necessary to
prevent discomfort and irritation during sexual intercourse.
- Replens is applied 2 to 3 times per week and restores
vaginal moisture and comfort but should not be used as a
lubricant during sexual intercourse.
- Sitz baths followed by Burrow’s solution applications
help to relieve itching and irritation.
- Cotton undergarments should be worn and tight garments
made of synthetic materials (girdles) and pantyhose should
be worn only if necessary.
- Kegel exercises may help to strengthen the muscles that
control bladder relaxation and can help reduce urinary
accidents when you laugh, cough, or strain. Ask your nurse
or doctor for information.
Many women will benefit from counseling with a trained
professional. Women’s health centers are available throughout
the country and help women to both understand and cope with
menopause. Occasionally, women will find that antidepressants
and antianxiety drugs help to improve their mood and level of
anxiety. A woman should speak openly about her concerns
regarding her health during menopause and in general. Seeking
help and guidance from your physician and members of your health
team will help you make informed decisions regarding your
Follow-up Report the following symptoms to your doctor or
- Chronic vaginal discharge
- Vaginal itching, burning, and irritation
- Urinary frequency and burning
Symptoms of gallbladder disease:
- Right upper quadrant pain