Managing Menopause, Some Symptoms and Treatments
Other than fibroids and irregular vaginal bleeding, managing menopause symptoms is perhaps the third most common problem I have encountered in my GYN practice. Managing menopause is a tough issue to deal with in women’s health. It is often a cluster of vague symptoms for many women and is a transition that can occur over many years. It refers to the transitional state as perimenopause and this transition is full of conflicting opinions on how it should best treat. The reason for this is that the symptoms can mimic symptoms of other gynecologic problems that must teste.
Irregular bleeding during the transition to menopause is by far the most common problem where management can be difficult for a patient and health care provider. For women in their 50′ the occurrence of irregular bleeding can (though rare) be a manifestation of endometrial cancer (cancer of the uterus). The importance of evaluating abnormal bleeding, especially with an uterine biopsy, is thus crucial with menopause being a diagnosis of exclusion. Over my 20 years of practice in gynecology I can think of many times I have diagnosed endometrial cancer because of a biopsy for irregular bleeding, and in every case a hysterectomy has cured the condition.
Uterine cancer is often cured completely by hysterectomy, since bleeding can occur early in the disease's stage. With this being said, they must test abnormal bleeding (as noted above) by performing an endometrial biopsy (sampling of the uterine lining) as it would be tragic to overlook this early symptom of uterine cancer.
Another difficult symptom to treat when managing menopause is hot flashes, as this symptom runs the full spectrum. I have seen women who never experienced a hot flash during their transition to menopause and women who do plague by the symptom, sweating through their sheets and truly miserable. What is the answer? There really is no one answer to managing menopause with this symptom. Many women try herbal remedies such as Black Cohosh, though the literature does not support the efficacy of this treatment. That being said, if one deals with medical conditions using evidence-based medicine then you will note a difference in opinion as there are women who claim they have found relief from this herbal supplement whether it be coincidental or real.
Truly the most effective treatment of hot flashes is estrogen replacement, bioidentical estrogens or phytoestrogen. However, this is an issue that must be thoroughly discussed with one’s personal healthcare provider, as the risk/benefit has to be determined, which considers many variables relating to a patient’s medical history and personal desire. The symptom can be so bad that I have had patients tell me they don’t care about the potential risks as they need to manage the symptom.
Vaginal dryness is another symptom often seen when managing menopause, and it can range from non-existent to severe. When severe dryness occurs, this can impact a woman's life. Though it might only cause itching for some, vaginal dryness can lead to painful intercourse and bleeding because of the poor condition of the vaginal mucosa because of decreased estrogen. Strictures can develop as the vaginal mucosa loses its elasticity. This problem can lead to relationship problems, particularly when combined with the impact on mental health (as noted below).
Finally, and not least is the impact menopause can have on a woman's mental health, often leading to an unnecessary psychiatric evaluation as the treating clinician sees no other explanation. This is unfortunate sometimes, as this problem can result from a clinician not taking a full medical history and knowing that treatment options exist short of seeing a psychiatrist.
When managing menopause, the mental health issues can mimic depression, and can be treated with a trial of medication that has been determined to be very effective. Only a patient’s primary doctor can make such a management decision as they base it on a patient’s particular history and physical findings.
In closing, what is perhaps most problematic for women in managing menopause is not the condition itself but the lack of understanding by the public who are not in the medical field. Many individuals (mostly men) lack the education that is required to understand menopause in terms of how it can impact a woman's functional status at home and in the workplace.
Menopause awareness by the public requires more education, particularly when a woman is in a male-dominant career. For a woman to experience job-performance issues because of menopause is extremely frustrating and tragic. As I often mention, the management of this problem.
Tags: managing menopause symptoms, Vaginal dryness, women health,
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