Menopause, also called the “change of life,” can be difficult to navigate. Fortunately, doctors can help. For answers to some commonly asked questions, we spoke with Elissa M. Gretz–Friedman, MD, Director of the Menopause Center at Mount Sinai and an Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.
Can my doctor help with my hot flashes?
If you are having hot flashes which are disruptive to your life, talk to your doctor about your concerns as they can offer a number of options that may provide relief. Typically, your physician will start with the least invasive approach, which is often a discussion of lifestyle changes that may help, such as dressing in layers, keeping your home on the cooler side, and drinking ice water. Also, hot flashes are more common in women who are clinically obese, so your physician might recommend weight loss.
Some hot flashes are triggered. While it varies from woman to woman, these triggers can include alcohol, hot or spicy drinks, or even stress. Keep an eye on when your hot flashes occur and, if you find that an action or beverage sets them off, do your best to avoid it.
If lifestyle changes don’t help, doctors may suggest certain over-the-counter therapies including black cohosh and S-equol, which contain plant-based compounds that mimic estrogen, or Relizen®.
My menopausal symptoms are severe. Should I consider hormone therapy?
Menopause hormone therapy (MHT) involves taking medication that contains estrogen, the female hormone your body stops producing during menopause. It is the most effective treatment for hot flashes, vaginal discomfort, and other menopausal symptoms, and is typically prescribed to women who have severe symptoms. If you have not had a hysterectomy, it will be recommended that you take a combination of estrogen and progesterone. The progesterone is necessary to prevent developing cancer of the uterus.
Women who are less than 60 years old and less than 10 years from their final menstrual period are good candidates for hormone therapy. Before prescribing this therapy, a physician will take your medical and family history and perform a physical exam. You will also need an up to date mammogram. It isn’t safe to take MHT if you’ve had hormone-related cancers such as breast or endometrial cancer or have a history of undiagnosed bleeding or blood clots in the legs or lungs, coronary artery disease or stroke, or liver disease. Certain women that are very high risk for breast cancer are also not good candidates for estrogen and progesterone.
In addition to helping with menopausal symptoms, hormone replacement can decrease your risk of colon cancer or type 2 diabetes. And, it increases your overall life expectancy.
Are there options besides hormone therapy for my severe symptoms?
If you are not a good candidate for hormone therapy, there are alternative medications that we use for treatment of bothersome hot flashes and other severe symptoms of menopause. These are selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). While these medications are typically used to treat depression and anxiety, they have also been shown in lower doses to help reduce hot flashes. The most common SSRIs used to help with menopausal symptoms is paroxetine, which is approved by the U.S. Food and Drug Administration for this indication. Citalopram and escitalopram have also been prescribed for this use. Helpful SSNIs include venlafaxine and desvenlafaxine. Gabapentin–a medication primarily used for nerve pain in those with shingles and seizures–has also been used for hot flashes, especially those that occur primarily at night, since it may make you tired.
What is a menopause specialist? Do I need to see one?
Menopause specialists are physicians with special training to address the issues of women in midlife. They are certified through examination by the North American Menopause Society and stay up to date on the newest research about midlife women’s health.
You do not necessarily need to see a certified menopause specialist as a matter of routine. But, if you are not getting the help you need to treat your symptoms, a specialist may be able to provide additional advice. We have a number of menopause specialists at Mount Sinai listed on our website and you can find a list of specialists throughout the country on the North American Menopause Society website.