Menopause: Symptoms & Treatment Options

Hormonal Treatment:

The most common treatment for menopausal symptoms is HRT (hormonal replacement therapy). HRT medications include estrogen and progesterone. Women who have had a hysterectomy (had their uterus removed) can use estrogen alone, but women who still have a uterus need to take progesterone in addition to estrogen. Progesterone protects the lining of the uterus from estrogen induced overgrowth which can increase the risk for uterine cancer.

HRT, or systemic estrogen, can come in a variety of forms and dosages: skin patches, gels, creams, vaginal rings and tablets. Our medical practitioners can help you decide which modality is best for you but all the products we use are bioidentical.

In some cases, menopausal symptoms will suggest the use of testosterone treatment as well. In cases where there seems to be significant problems in sexual functioning, lack of desire, problems with arousal or orgasm, our practitioners might suggest the use of testosterone in addition to estrogen. In these cases testosterone can be administered through creams, gels, or pellets.

Non-Hormonal Treatment:

There are some women who can’t use estrogen because of a history of breast cancer or simply don’t like using hormonal creams. Luckily, there’s another option that patients love, a laser treatment called the MonaLisa Touch.

• Non-Surgical Procedure
• Clinically Proven to Bring Long Lasting Relief
• No Anesthesia Required
• No Hormones
• 3 Treatments of Less than 5 Minutes Each
• Virtually No Pain or Side Effects
• No Downtime

The MonaLisa Touch generates new collagen, elastin and vascularization of the vaginal mucosa. The procedure is safe, virtually painless and uses proven methods similar to those used to treat aging facial skin. It does this using a gentle fractional CO₂ laser with a vaginal probe. The laser energy is virtually painless. Similar to your annual exam, the physician will insert the probe into your vagina and deliver laser energy pulses. The entire procedure is less than 5 minutes. A unique pulse targets surface epithelial tissue and deep lamina propria tissue to stimulate the synthesis of new collagen and the components of the ground substance of the matrix. Fractionated beams of light penetrate small areas of tissue. This creates small injuries in the epithelial layer of the vaginal mucosa which triggers fibroblast activity to stimulate new collagen production.

Learn more about the MonaLisa Touch laser here!

Menopausal symptoms vary from woman to woman. Some women find that they have severe symptoms, others that their symptoms are barely noticeable. Generally symptoms include some of the following:

• Hot flashes or flushes
• Night Sweats
• Difficulty sleeping or staying asleep
• Memory loss or mental fogginess
• Low Desire
• Difficulty getting aroused
• Dryness
• Weight gain

Hormone replacement therapy should be started within 5-7 years of a woman’s last period.  In 2002 the Women’s Health Initiative (WHI) released findings of a long term study on estrogen and progestin. The investigators found that the associated health risks of the combination hormone therapy outweighed the benefits and it was thought that women were being put at risk for cardiovascular incidents or strokes only if women started HRT 10 years after.

There are no clear rules about when to start using testosterone or how long it can be used, as long-term use has not been studied. Many women are afraid of hormones and cancer. To date there is no direct link between testosterone supplementation and cancer and several studies show testosterone to be breast-protective.

No. Women should not use HRT if they:

• Have problems with vaginal bleeding
• Have had certain kinds of cancers, such as breast and uterine cancer
• Have had a stroke or heart attack
• Have had blood clots or a bleeding disorder
• Have liver disease

Testosterone treatment is less limited in its use and you should discuss with your practitioner whether testosterone is appropriate and safe for you.

There are non-hormonal FDA approved medications that can help with vaginal dryness and hot flashes; these include Osphena (ospemiphene) for vaginal dryness and Brisdelle (paroxetine) for hot flashes. Vaginal moisturizers and lubricants are available over the counter that can help with vaginal dryness as well. See our full list of lubricant options and find one that’s right for you. The newest treatment method which is loved and recommended by patients and physicians alike, is a laser treatment called MonaLisa Touch. It’s fast, painless and does not involve the use of hormones.

There are also supplements that may help. Supplements containing soy or herbs, such as black cohash, can help as they act like estrogens. However research is limited and has yielded conflicting results on efficacy.

Lifestyle changes can offer some relief from hot flashes and other menopausal symptoms, especially those that are mild to moderately bothersome. For example, wearing light layers of clothing to avoid becoming too warm, engaging in physical activity to help reduce stress, and dietary changes including limiting spicy foods, alcohol and caffeine.

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, and breast cancer. Our medical providers will perform a complete physical examination, including a breast and pelvic exam as well as blood work. Blood work will be monitored throughout treatment. Before initiating hormone therapy, an up to date mammogram is required.

Some studies suggest that hormones should be used at the lowest dose that helps relieve symptoms for the shortest time. However, every woman’s needs are different and some women do choose to remain on HRT for an extended period of time.