Menopause

Diagnosis

Tests are often not required to confirm menopause. Most women will know that they are in perimenopausal as they start to experience several signs and symptoms as it will be uncomfortable and may affect a person’s daily activities.

In some cases, the doctor might advise testing is done to check specific hormone levels:

• Follicle-stimulating hormone (FSH): consistently elevated levels confirm menopause.
• Estrogen (estradiol): falls below the normal level during menopause.
• Thyroid-stimulating hormone (TSH): to distinguish menopause symptoms from thyroid (hypothyroidism) symptoms.

FSH levels can vary greatly during menopause transition. One test is not enough to confirm menopause. To conveniently check FSH levels, there are available over-the-counter urine kits for this test but they may provide little information and may not be able to confirm menopause.

Treatment

Menopause is part of a woman’s natural life cycle. No medical care is necessary during menopause, but some treatments are available to manage the signs, symptoms and complications that comes with it. Possible treatments are:

• Hormone replacement therapy: Hormone levels are increased which helps improve some symptoms of menopause. The two common types of hormone therapy are Estrogen Therapy (ET) and Estrogen Progesterone/Progestin Hormone Therapy (EPT). ET is considered as the most successful method in treating menopausal symptoms such as hot flashes. It is recommended to start in low doses. The duration of the treatment depends on the lifestyle and medical history of the person. This treatment is commonly used after a hysterectomy. But if the uterus is still present, estrogen alone is not advisable, progestin will have to be added. EPT is a combination therapy which incorporates both estrogen and progestin. Hormone therapy can also help in preventing bone disease such as osteoporosis.
• Vaginal estrogen: Women may experience dry, itchy, or painful vagina during menopause. Estrogen treatments can be put in the vagina to manage dryness which will be absorbed into the vaginal tissues. This treatment does not enter the blood and only affects the area where it is applied. Vaginal dryness, discomfort during sexual activity, and urinary symptoms can all be managed by this treatment. Vaginal estrogen treatments are administered in the form of ring, cream, or tablet.
• Low-dose antidepressants: Mood symptoms can be managed by certain anti-depressants. Hot flashes during menopause may be lessened by a subset of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). It can minimize the frequency and the intensity of hot flashes felt by women during menopause.
• Gabapentin: This is another alternative for women who are unable to take estrogen to ease their symptoms and who have sleeping difficulty due to hot flashes at night. Although Gabapentin is known as seizure treatment, it was also proven to lessen hot flashes. Typical adverse effect of this medication includes unwanted weight gain, edema, disorientation, fatigue, nausea, and dizziness.
• Clonidine: This non-hormonal treatment alternative lowers blood pressure, treats migraine, and reduces menopausal hot flashes. It can be in a form of pill or patch. Fatigue, constipation, drowsiness and dry mouth are the typical side effects of this medication. Non-hormonal treatments must be accompanied by lifestyle changes.
• Osteoporosis prevention and treatment: The risk for osteoporosis increases as women enter menopause. The body produces less estrogen which affects the bone mass. Women may be more susceptible to fractures and bone loss. To prevent osteoporosis estrogen therapy and vitamin D supplements may be used.

Consult a healthcare provider to understand the benefits and risks associated with each of the treatments. Lifestyle, personal and family medical history are important factors in choosing the appropriate treatment. Treatment may change from time to time depending on the changes in symptoms and available treatment options.