idlife can present a time of many changes in a woman’s life, one of which is menopause. While menopause has some common characteristics in its presentation, not every woman experiences menopause in the same way. Furthermore, women don’t have to sit idly by without any solutions to the changes they are living through.

Transition

Menopause signals a transition from a woman’s reproductive years and includes physiological changes of loss of ovarian function and decline in circulating blood estrogen levels. Menopause is defined as cessation of menstruation for 12 consecutive months.

Menopause typically occurs between the ages of 45 and 55 years. Perimenopause is the transition to menopause and can last for years prior to the onset of menopause. During perimenopause, estrogen levels start to decline.

Symptoms

Symptoms of perimenopause/menopause can include: irregular menstrual cycles, hot flashes, night sweats, vaginal dryness, urinary urgency, sleep disturbances, mood changes, difficulty concentrating (brain fog), decreased libido, and weight gain. Other changes related to decreased estrogen levels include slowed metabolism, loss of bone density, weaking of pelvic support structures, and increased cardiovascular risks, such as hypertension, high cholesterol, and diabetes.

As I write this article, as a woman in her late 40s, I am going through perimenopause. I have experienced night sweats and hot flashes, sleep disturbances, mood changes, and brain fog. Interestingly, I also had a sudden increase in blood pressure, which was likely additionally complicated by stress and inadequate sleep.

I share this because women going through menopause are at increased risk for hypertension, which increases risk for cardiovascular disease, which is the leading cause of death in women in the United States. Most, but not all, studies looking at risk of hypertension in menopause showed a positive relationship, meaning there was increased risk for postmenopausal women to get hypertension.

There are many postulated reasons for this increased risk, related to decreases in estrogen production. However, other lifestyle factors such as stress, diet, sleep, exercise, and weight must also be considered.

“…plant-based diets rich in soy (soybeans) reduced menopause symptoms, especially hot flashes.”

In clinical studies, Black Cohosh and Red Clover have been consistently shown to reduce menopausal symptoms. Some other herbal supplements that have shown positive benefits include Vitex (chasteberry), Ginseng, and Evening Primrose Oil.

Hormone Treatment

Conventional treatment for menopausal symptoms with hormone replacement therapy (HRT) may be appropriate for some women. This should be determined on an individual basis with shared decision making with a trusted health care professional, such as your Primary Care clinician or gynecologist.

Some benefits of HRT include a reduction of menopausal symptoms and improved quality of life. Some risks of HRT include increased risk of endometrial cancer, cardiovascular disease, blood clots, stroke, gallstones, dementia, and breast cancer (with long-term use). Combining lifestyle modifications with HRT can minimize these risks. Women with a uterus should take progesterone with estrogen to reduce risk for endometrial cancer. Limiting the duration of HRT use can reduce risk for breast cancer. Risks can also be reduced by taking the lowest effective dose of HRT or using patches or vaginal products instead of pills.

Best of Both?

Remember, lifestyle modifications with secondary herbal supplementation can be beneficial for managing perimenopause and menopause. But when symptoms persist despite implementation of these components, hormone replacement therapy may be a consideration for women who have no contraindications to this treatment. As always, remember to have ongoing conversations with your healthcare team regarding any symptoms you may be experiencing.

CHRISTINA WELLS, M.D., works as a family physician on the South Side of Chicago. She has a strong interest in the health and education of communities, especially those with underserved and vulnerable populations.