Menopause and treatments

There are treatments for menopause. We interviewed Dr. Vivien Brown, a family physician in Toronto who is certified by the North American Menopause Society as an expert in menopause and women's health. NAMS is a leading North American nonprofit organization that helps to promote the health and quality of life of women through the understanding of menopause. Dr. Brown gave her opinion on some frequently asked questions about treatment options for menopause symptoms.

What are the risks associated with estrogen use? Should women be concerned?

We need to be clear in what form of estrogen we are talking about. There is a significant difference between what we call systemic estrogen (estrogen that gets into the body either by mouth or by the skin, such as via a patch or topical gel) and topical or local estrogen (applied to the tissues directly into the vagina, also referred to as vaginal estrogen).

The two most common concerns for women with respect to systemic estrogen are the increased risk of breast cancer and the increased risk of heart disease. Both of these risks depend on the individual woman, the time since menopause (i.e., how long ago they first reached menopause), and her individual risk profile. She needs to discuss this with her physician. The actual risk increase associated with estrogen use is very small. It's also important to note that using estrogen around the time of menopause is much less risky than using it in older woman who have already gone through menopause.

Vaginal estrogen (such as vaginal tablet, vaginal ring, or vaginal cream) is a product that acts locally. In other words, these products act on symptoms of menopause affecting only the vagina and surrounding area. Vaginal estrogen is a very low-risk product because very small - almost immeasurable - amounts of estrogen are absorbed by the body. For that reason, these products usually are considered very safe. Currently there is no evidence of increased risk of breast cancer or cardiovascular disease with using vaginal estrogen.

What types of products are available to treat hot flashes?

Lifestyle treatments are always helpful. Avoid alcohol, caffeine, and spicy foods, which can trigger hot flashes. Dress in layers so that you can remove clothing when you are getting too warm. Please stop smoking.

There is some evidence that the herbal product black cohosh works well for hot flashes. Talk to your doctor or other health care professional about whether it is suitable for you.

Prescription products used for hot flashes include hormonal treatments (e.g., hormone replacement therapy) and other non-hormonal medications.

What types of products are available to treat vaginal dryness and irritation?

If vaginal dryness is the only symptom, it's best not to use a systemic estrogen. Over-the-counter products (lubricants such as Astroglide® or KY Jelly®, or moisturizers such as Replens®) can be tried. Usually by the time a woman sees her doctor, she would have already tried these products and they are not working, so vaginal estrogen can be tried. There are 3 types in Canada: tablet, ring, and cream.

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