Doctor's Review: Medicine on the Move

September 22, 2017

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A brief review of menopause

Common symptoms and recommendations

Six most reported symptoms


Hot flashes or flushes can range from mild to severe. Results from a decreased supply of estrogen, which is gradual in some and abrupt in others. More than half of women report this symptom.


Night sweats caused by hot flashes at night, they range from mild to severe. Cool rooms promote better sleep. Could have other medical implications.


Irregular periods, the most common are hormonal imbalances during perimenopause. Most occurs in women in their mid-40s. Pregnancy or other medical conditions could also be responsible.


Loss of libido caused by hormonal imbalance, commonly an androgen deficiency. Other causes include vaginal dryness, depression or side effects of medication.


Vaginal dryness in which vaginal tissue becomes dryer and less soft, which can lead to itchiness and irritation. Caused by a fall in estrogen levels, it can be emotionally difficult and should be treated promptly.


Mood swings, again caused by hormonal imbalances, the swings can, in some cases be severe, fatigue is often an underlying cause. The most effective way to reducing mood swings is to target the hormonal imbalance.


Other symptoms include: weight gain, bloating, inconvenience, irritability, anxiety, osteoporosis and others.

Recommendations for patients and physicians

SOGC guidelines, sogc.org/wp-content/uploads/2014/09/gui311CPG1409Eabstract.pdf.

Patients


Diet. Eating well is important. An ideal daily diet would include seven servings of fruit and vegetables, six of grain, three of milk and alternatives, and two of meat and fish or equivalents.


Salt. Reduced sodium intake.


Vitamins. D and calcium supplements.


Weight. Maintain a healthy weight.


Exercise. Moderate to vigorous aerobic exercise of 150 minutes a week.

Physicians


A waist circumference of 88 cm or more is associated with diabetes, heart disease and hypertension, and should be part of the initial assessment.


Tobacco use is a strong negative. Patients should be advised to quit with treatment offered to those willing to do so.


Blood pressure should be controlled. If the systolic blood pressure is ≥ 140 mmHg and/or the diastolic blood pressure is ≥ 90 mmHg, a specific visit should be scheduled for the assessment of hypertension.


Lipid-profile screening for those age 50 or over and for those with additional risk factors.


A cardiovascular risk assessment using the Framingham Risk Score should be completed every three to five years for women aged 50 to 75.


A history of past pregnancies should be taken as it can predict and increase risk for cardiovascular disease and may suggest the need for further screening.


Hormone therapy. Physicians should offer hormone therapy, estrogen alone or combined with a progestin, as the most effective therapy for the medical management of menopausal symptoms only after the risks for cardiovascular disease and breast cancer have been thoroughly assessed -- see the SOGC guidelines.

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