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 week).

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 health.

Follow-up Report the following symptoms to your doctor or nurse:

• Chronic vaginal discharge
• Vaginal itching, burning, and irritation
• Urinary frequency and burning
• Depression
• Anxiety
• Insomnia
• Light-headedness
• Headaches

Symptoms of gallbladder disease:

• Right upper quadrant pain
• Indigestion
• Burping
• Nausea