Today, women are talking about their health issues—online, in person with friends, and with their doctors. But some of the information you may be hearing could be outdated, confusing, or contradictory. In this Q&A, Candice Fraser, MD, MBA, an obstetrician-gynecologist with Mount Sinai’s Carolyn Rowan Center for Women’s Health and Wellness, gives you the latest, science-backed information about what you can do about your symptoms.
What are the symptoms of menopause?
Symptoms vary widely from person to person. Most people associate menopause with hot flashes and night sweats. Because menopause affects multiple systems in the body, symptoms can be far-ranging, and many people might not associate them with menopause. Symptoms can include:
- Difficulty sleeping (very common)
- Brain fog, such as difficulty focusing or finding words
- Mood changes, irritability, and anxiety
- Vaginal dryness and painful intercourse
- Joint pain, weight gain, muscle aches, and itchy skin (less commonly recognized as menopause symptoms)
Brain fog is one symptom that can be very distressing—especially for women who are at the peak of their careers. Struggling to find the words, or losing your train of thought in the middle of a presentation can be very upsetting.
Candice Fraser, MD, MBA
What treatments are available for menopause?
Menopause symptoms are influenced by many changes happening in midlife, including hormonal changes, aging, and changes in the nervous system. The body is complex, and that’s why treatment must be individualized. At the Carolyn Rowan Center for Women’s Health and Wellness, we take our time understanding every patient and their needs. We gather their medical history, their family medical history, and most importantly, we get an understanding of what they are feeling and experiencing. Symptoms might not be entirely hormonal, or they may be due to a combination of factors. Every patient’s care plan might be different.
Also, it’s important to know that these symptoms can occur during the menopause transition or perimenopause—the 5-10-year period before menopause. The following treatments apply to women in these transitional years, as well.
- Currently, hormone therapy is recommended for vasomotor symptoms (such as hot flashes and night sweats), genitourinary symptoms of menopause (including vaginal dryness and bladder changes), and for reducing osteoporosis risk. The formulation of hormone therapies has changed over the years to be safer. Hormone therapy includes estrogen, and progesterone in women who have a uterus to lower the risk of cancer.
- Different delivery methods that make estrogen safer include topical forms of a patch, gel, or spray. Oral formulations may be appropriate, but those have a slightly higher risk of cardiovascular effects including stroke and blood clots in the legs and lungs. There are vaginal formulations for local delivery.
Non-hormonal medications are available, including:
- Fezolinetant and elinzanetant treat hot flashes by regulating signaling paths in the brain that control body temperature.
- A class of medicines known as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIS (Serotonin and Norepinephrine Reuptake Inhibitors). These include paroxetine, fluoxetine, venlafaxine and duloxetone), which can help with mood and anxiety symptoms as well as reduce hot flashes.
- Oxybutynin is a prescription medication typically used for incontinence but has good study data for hot flashes and night sweats, as well.
For the management of vaginal dryness, and discomfort, non-prescription therapies are available, including:
- Vaginal lubricants, which are used during sex, may be an effective option for some women.
- Vaginal moisturizers, used two to three times per week, can also provide lasting hydration and improve comfort.
If lubricants and moisturizers aren’t enough, low‑dose vaginal estrogen is a safe and effective option for most women, with minimal risk of side effects. Other vaginal and oral medications may also be prescribed for management of vaginal and urinary symptoms.
In some cases, laser therapies or pelvic floor physical therapy may also be appropriate after a thorough evaluation.
What lifestyle changes can help manage menopause and perimenopause symptoms?
Lifestyle changes can be powerful in managing, reducing, and even preventing certain symptoms. Regular exercise, a balanced diet (such as the Mediterranean diet), adequate sleep, stress reduction, and cutting back on or eliminating alcohol can make a significant difference in how women feel during menopause.
The good news is that there are a broad range of options to manage the symptoms of menopause, and working with a knowledgeable clinician is essential to developing an individualized plan.