About 6,000 American women reach menopause every day – that’s more than 2 million per year. The hormonal chaos that occurs during this time of life can set off many physical, mental and emotional challenges. In addition to hot flashes and insomnia, women can battle night sweats, weight gain, fatigue, lower sex drive, mental fogginess and irritability.

“The fluctuation in hormone levels during menopause can be severe and occur for several years as the body adjusts to a reduced level of estrogen,” said BCH gynecologist Lisa Jamroz, MD, following a health lecture presented by providers from Boulder Women’s Care on June 6 at the Boulder Jewish Community Center.

“Fortunately, there are several steps women can take to get relief from symptoms that can play havoc with their lives,” Dr. Jamroz said.

Start with Lifestyle Changes
Lifestyles that include a healthy diet and regular exercise can go a long way towards minimizing menopausal symptoms and helping to maintain overall good health.

Dr. Jamroz said, “The risk for several medical conditions — including breast cancer, type 2 diabetes and heart disease — rises during and after menopause. Adopting a healthy lifestyle can be key for not only coping with menopausal changes but also offseting these risks.”

A healthy lifestyle includes a nutritious diet filled with fruits and vegetables, lean protein and whole grains. Regular exercise can help minimize weight gain and stave off loss of muscle mass during menopause. According to the Centers for Disease Control and Prevention, you should aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week.

Individualized Hormone Therapy for Relief
Most healthy menopausal women can also use hormone therapy for relief of their symptoms, according to Dr. Jamroz.

“Medical organizations devoted to the care of menopausal women agree that hormone therapy is an acceptable option for healthy women bothered by moderate to severe menopausal symptoms,” she said.

However, individualization is key in the decision to use hormone therapy.

“Because all medications have potential side effects and risks associated with their use, it’s important to assess the benefits and the risks of this treatment for your individual situation. For women who still have a uterus, estrogen has to be balanced with progesterone to prevent uterine lining overgrowth. For women without a uterus, most symptoms are alleviated with estrogen alone and patients don’t need the added risk of progesterone,” Dr. Jamroz explained.

She recommends women take the lowest dose for the relief of symptoms and then, with physician guidance, determine the best time to taper off slowly.

Depending upon the symptoms, such things as hormonal patches, creams, gels and vaginal rings can be used as alternatives to traditional pills.

“For example, if women have only vaginal dryness or discomfort with intercourse, low doses of vaginal estrogen can often be the preferred treatment,” said Dr. Jamroz.

Talk to your health care provider about what would work best for you based on your symptoms and personal medical risks. If you choose to take hormone therapy, your health care provider should re-evaluate continued use on a yearly basis.

Custom-Blend Bioidenticals Not Any Safer
Bioidentical hormones come from plant sources. Many are formulated at special compounding pharmacies, where women can get "custom-made" preparations. Although some women can benefit from customized doses, there is no scientific evidence these hormones are safer or more effective than standard hormone therapy. Moreover, bioidentical compounds are not U.S. Food and Drug Administration (FDA) approved.

“There is a lack of awareness that custom-blended bioidentical preparations are not FDA approved and that there are risks when using unregulated and untested preparations. In fact, more than 85 percent of women who use compounded preparations are unaware that they are not FDA approved,” according to Dr. Jamroz.

She pointed out that “there are several well-tested and FDA-approved bioidentical hormone options to choose from, so most women interested in bioidentical formulations do not need to use custom-compounded products.”

Alternatives to Hormone Therapy
If you are unable or do not want to take hormones, there are other types of medications that your physician can prescribe. For example, low-dose antidepressants, antiseizure and blood pressure medications are sometimes used to alleviate menopausal symptoms. There are also selective estrogen receptor modulators (SERMs), which are medications for the relief of hot flashes and vaginal dryness.

Many women also try herbal remedies, such as soy or black cohosh, yet only a few of these substances have been studied for safety and effectiveness. Also, because the FDA does not regulate these products, there is no guarantee that the they contain safe ingredients or effective doses of the substance. Talk to your doctor before taking any of these alternatives for symptoms of menopause.

Lisa Jamroz, MD, compassionately advises and attends to patients in the realms of family planning, contraception, fertility evaluations and menopausal care. Appointments are available by calling Boulder Women's Care at (303) 441-0587.

Click here to view PowerPoint slides from the lecture on “Making Menopause and Perimenopause Manageable.”

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