Physicians, Patients Must Partner for Menopause

October 8, 2014

Menopause will be unique for each woman, and a physician-patient partnership is a must if women want effective menopause management.

Menopause occurs naturally in most women who live to late adulthood, occurring on average at age 52 years. By 2025, it is estimated that there will be 1.1 billion postmenopausal women worldwide.1

Although every woman will eventually experience menopause, either naturally or surgically, each woman may have a unique experience with this stage of life. In the time leading up to menopause, women can experience a variety of symptoms, including irregular periods, mood changes, thinning hair, sleep problems, weight gain, vaginal dryness, and more.

However, research has shown that vasomotor symptoms, or hot flashes, are the symptoms for which most women seek help from a health care professional.2 It is estimated that hot flashes occur in up to 75% of women, and that some women may experience them for 10 years or longer.1

“About 50% of patients are having moderate to severe hot flashes when they are asked to grade them, which can be disruptive to their personal lives and professional lives,” said Patricia Sulak, MD, an OB/GYN at Scott & White Hospital/Clinic and Texas A&M College of Medicine. “They are also left wondering what else is going on within their bodies. … What are the invisible consequences?”

According to Sulak, because women are experiencing a new phase of life with a new set of symptoms, it is important that they tune in to their own bodies and experiences and that they have an open partnership with their physician to effectively manage this transition.

Treatments

Because the symptoms of menopause can be so varied, it is important that any treatment program be individualized to the patient. Treatments options for women experiencing menopause include both nonprescription and prescription options.

Women going through menopause may be advised to increase their calcium intake, either through dietary changes or through calcium supplementation, to help prevent skeletal-related events. Currently, the Institute of Medicine recommends 1,000 mg/d of calcium for women aged 50 years or older. Increased intake of vitamin D or magnesium may also be recommended. However, the best way to ensure high intake of these important nutrients is with a healthy diet that includes vegetables, fruits, low-fat dairy products, whole grains, chicken, fish, and nuts.1

Women in the perimenopause stage may be able to take low-dose oral contraceptives, which can help to reduce hot flashes, vaginal dryness, or moodiness. In addition, if an older woman does not wish to conceive, low-dose contraceptives may be advised until 1 year after the last menstrual period.

One of the most effective treatment options for vasomotor symptoms available to women is hormonal therapy. Current recommendations suggest the use of the lowest dose possible for the shortest time possible to control the symptoms of menopause. In many cases, progestin will be prescribed in combination with estrogen. In women who may have contraindications to hormonal therapy with estrogen, selective serotonin reuptake inhibitors have been shown to decrease hot flashes.

Women whose main symptom or concern is vaginal dryness have a few treatments available to them, including lubricants and vaginal moisturizers, and some of these products may include estrogen.

Finally, in women at risk for osteoporosis, physicians may prescribe medications that help to reduce bone loss or the risk for fractures.

“There are a lot of treatment options out there, from lifestyle changes to medications,” Sulak said. “Whenever you try a treatment, you should give it at least 6 to 8 weeks to have an effect.”

Active Partnership

Sulak said that one of the first things she discusses with woman going through menopause is that the healthier they are, the more treatment options there are. In contrast, if a woman has a lot of medical problems, certain treatment may be off the table.

“Women can get frustrated about these changes and are not sure if the changes are due to hormones or the aging process,” Sulak said. “I advise my patients to take the time to focus on their health and make sure they are getting good information.”

Health care providers should be providing woman entering menopause with information about the variety of symptoms they may begin to experience and should present the patient with an individualized treatment plan. However, patients may also seek to gain information about menopause from outside sources as well.

Sulak recently partnered with Pfizer on its Tune In To Menopause campaign and the website TuneInToMenopause.com, where women can go to find out more about menopause and take a quiz to find out more about their “menopause style.”

“Remember that when it comes to menopause, it is not one size fits all,” Sulak said.

References:

1. Shifren JL, Gass ML, NAMES Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014;21:1038-1062.

2. Williams RE, Kalilani L, DiBenedetti DB, et al. Healthcare seeking and treatment for menopausal symptoms in the United States. Maturitas. 2007;58:348-358.