Menopause is dreadful. But there’s hope for how to cope with it better – Foster’s Daily Democrat

Menopause can be unbearable for women, bringing hot flashes, brain fog, insomnia and other life-invading symptoms. Local doctors say there is hope, and better ways to cope, for women today thanwhat was available to their mothers.

"People ask me when they will be done with menopause," said Dr. Sarah Hanson, an OB/GYN at York Hospital. "I answer, 'When you're dead.' Menopause encompasses the last half of a woman's life, the part where they are not reproductive anymore."

Hanson points out that what women think of when they say "menopause"are those symptoms ofhot flashes, night sweats, difficulty sleeping. For most women, thosesymptoms have a shelf life. They usually do not last more than a few years.

"What women think of as menopause is usually pre-menopause, or peri-menopause," Hanson said. "That's where the symptoms are happening. That can last three to seven years. The ovaries are no longer preparing to reproduce and hormones get thrown out of whack. But, it is a normal part of a woman's life cycle."

Some women pass through this phase easily, and menopause is like a lamb, often requiring zero medical intervention. Hanson said for others, it is a lion, fraught with symptoms and women seek any relief available to them.

"I spend a lot of my day talking about menopause," said Dr. Caroline Scoones of Harbor Women's Health, who also practices at Portsmouth Regional Hospital. "Here on the Seacoast, we have a wonderful population of women, teens, moms, menopausal women and much older women. At any time, a good 20% of them are chatting with me about menopause."

Scoones said menopause occurs when a woman has not had a period in 12 months.

"It is a transition and women go through transitions their entire lives," she said. "From the time they begin adolescence, when their reproductive systems are ramping up, to the time we enter menopause and our reproductive systems are ramping down, we are experiencing hormonal changes. It's not the same for men. We get the short end of the stick, but it's the wonderful system we are stuck with."

The average age of a woman entering menopause is 51, but Dr. Kristin Yates of Garrison Women's Heath and Wentworth-Douglass Hospital said it can range several years on either side of that age. It's rare but some women begin entering this phase of life as early as their 40s.

"When you are born, you have a certain amount of eggs in your ovaries," Yates said. "That number goes down every month when you ovulate and have a period. Eventually they run out and you no longer ovulate. You stop having periods and the amount of estrogen your body secretes gets lower."

"My first advice is to do nothing," said Hanson. "If you can handle the symptoms, this is normal and there is nothing you have to do. For other women, of course, that's not the option they choose because the symptoms are interfering with their daily life. Our grandmothers just endured it. You can, but you don't have to."

Scoones said the question of what to do relates to how many of the symptoms a woman gets, how they are interrupting every day living, and herpersonal views.

"Are you a super natural type and you do not want to take anything?" said Scoones. "Are you the oppositeand want to go full hog?Or are you somewhere in between? We can help you, or you can choose to tough it out."

Hanson said women who maintain a more healthy lifestyle, with a lot of physical activity, a healthy diet, and who maintain a good body weight generally handle menopause more easily. And, she said, it's good for our overall health anyway, so why not do it?

"People who are overweight or who smoke may have a more difficult time," Hanson said.

Hanson said women in pre-menopausecan experience hot flashes, difficulty sleeping, mood changes and shifts, and a feeling of cloudiness or fogginess, and still perform equally well every day. But, they are uncomfortable.

"These are neurological symptoms, all of them," said Hanson. "We know moods affect hormones,and hormones affect moods. For some women, low-dose birth control pills will be enough to handle the hormonal change."

Scoones said over-the-counter products, like black cohosh or evening primrose work for some women, but not all. Some natural products like Estrovera canhelp some women mitigate symptoms.

"They can be taken daily, with little side effects," said Scoones. "I think about 50% respond to these non-pharmaceutical methods."

Scoones said those with severe symptoms, like thosewho cannot sleep, who drip sweat and who are miserable in general, might consider prescription relief.

Yates said hormone replacement therapies have gone through several schools of thought.

"Women were worried about the risk of blood clotsor strokes," said Yates. "We now know that relatively small doses have low risk, and can be safe and effective. There are some women who are not good candidates, women who have a history of clots, strokes or who have had breast cancer."

"We all did it, then no one did it," she said. "Now we are better able to use low-dose hormone therapymore successfully."

Scoones agreed, saying hormonal therapies are more nuanced now.

"We can tailor hormonal treatments to deal with your particular symptoms," said Scoones. "There are transdermal estrogen treatments. There is an IUD that can be used to treat the heavy flow that usually precedes peri-menopause. We have choices that can help with sleep, anxiety, hot flashes and weight gain."

Hanson said in cases where blood flow is extreme, a procedure called endometrial ablation, an outpatient surgery, can alleviate the situation.

"Some women opt for hysterectomy," she said. "We can do that usinglaparoscopy in many cases, or with the more traditional vaginal application."

If the choice is hormone therapy, Scoones said the North American Menopause Society recommends the lowest effective dose, for the shortest duration of time, usually two to threeyears.

"You are not broken," said Scoones. "This is a natural course of a woman's life and you will not need hormone replacement therapy forever, just until you feel good again."

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Menopause is dreadful. But there's hope for how to cope with it better - Foster's Daily Democrat