Managing “The Change”

by Dr. Chantel Roedner // July - August - September 2023

Menopause – the change that every woman knows is coming. With these tips, you can be prepared and know what to expect, so you can go through the change like a pro.

What is Menopause?

Menopause is the cessation of menstruation for 12 or more months in the absence of any other cause. The average age of menopause is 51, but women will experience symptoms years or months prior during the perimenopausal period.

Symptoms of Menopause: Hot flashes (most common); sleep disturbances; depression; vaginal dryness; change in sexual function; joint pains.

Eighty percent of women will experience hot flashes, but only 20 to 30 percent of women will see their physicians about them. If untreated, the hot flashes will stop on average after five years, but nine percent of women will experience them into their 70s. That’s why it’s important to discuss symptoms with your physician so they can determine how to best help.

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is the giving back of estrogen and/or progesterone as these hormones decline. The primary goal is to relieve symptoms using the lowest dose possible. Studies show that women who begin therapies earlier experience fewer side effects than women who begin them later. Most women use HRTs for three to five years, and taper off the meds to help avoid symptoms returning.

Risks of HRT: Most healthy, non-smoking, normal weight peri-menopausal women are appropriate candidates. Women who are older or who have health conditions are at an increased risk of having adverse events on HRT. Examples include history of cancer, DVT/PE, stroke, heart disease, hypertension, and poorly controlled diabetes. Visit a gynecologist to find out if HRT is right for you. If your risk is elevated, HRT may not be a good option.

Benefits of HRT: Prevent osteoporosis; reduce incidences of colorectal cancer; improve severe menopause symptoms.

Non-Hormonal Options

SSRI/SNRIs: Celexa, Effexor, or Brisdelle; modest improvement for hot flashes and mood disturbances; costly, but generics help offset cost.

Gabapentin: Can cause drowsiness, which can help in those experiencing sleep disturbances; best for women experiencing hot flashes at night or having trouble sleeping.

Clonidine: Less commonly used because of side effects such as dry mouth, dizziness, constipation, and sedation; available if other treatments fail; best tolerated as a transdermal patch.

Progestin Therapies: Moderate improvement with 20 to 40 percent of women seeing improvement; not estrogen; can be used alone when estrogen is contraindicated; should be used as co-therapy in women who still have their uterus.

Conjugated Estrogen/Bazedoxifene (DuaVee): Newer agent that may be used in women who can’t tolerate oral progestin therapies; slightly increased risk of clots; costly.

Non-Traditional Therapies: There may be no harm in using non-traditional therapies to treat menopause if they help with symptoms and there are no ill effects from other drugs you are taking. Be sure to check with your doctor before starting them. Examples include hypnosis, cognitive behavioral therapies, acupuncture, evening primrose oil, and flaxseed.

Plant Therapies: Plant and herbal therapies, such as black cohosh.

Weight Loss: Can be useful for women suffering from mood symptoms and fatigue.

Dr. Chantel Roedner

Dr. Chantel Roedner of WakeMed OB-GYN specializes in high-risk obstetrics, infertility, minimally invasive gynecological surgery including robotic surgery, well woman care, and contraception.