As your body goes into menopause, your hormones go in and out of the menopause range. We can test your hormones and if they come back into the menopause range, it can mean that you are starting the process. This process can take months or even years. We do not recommend routine blood test screening for menopause unless there is something else going on. Remember, menopause is a normal part of the aging process. It is not a disease.
No, there are many causes of irregular bleeding, including thyroid disease and certain diseases of the uterus. It is very normal for your cycles to become heavier, closer together (21 to 24 days when previously 28 to 30 days) with more cramping and clotting. Frequently, it can look different than you are use to as you get older (starting late 30s to late 40s). We can look for any abnormal reasons with blood tests and an ultrasound.
The first thing to do is to exercise regularly and eat a healthy diet. Avoiding caffeine can be very helpful in reducing hot flashes. Dress in layers so you can take something off when the hot flashes hit. There some new options for treating hot flashes that do not involve hormones. These are medications so they can have side effects but you may find them helpful in managing your symptoms. Please ask about them.
Many herbal remedies have been studied for menopause. Black cohosh has been well studied and can be very helpful. It comes as the brand name Remifemin, and is often found in other menopausal formulations, such as Estroven. You need to take it for a month in order to notice a difference. It is felt to be safe to take it for 6 months, possibly more. You can also try red clover, which is found in Promensil, as well as other herbal remedies. Many women find this helpful. Soy products have been studied extensively, and have not been found to be very helpful, although some women will benefit.
It depends on your individual history, and there is no simple answer for everyone. You should only take hormones if there is nothing else that will control your hot flashes and night sweats. If you have heart disease or are at risk for heart disease, you should not take hormones. If you have a strong family history of breast cancer, you should be cautious about taking hormones. You should discuss this with your physician.
Every woman should think about osteoporosis, because it easy to prevent but harder to treat. Even before menopause you should take calcium, 1000mg per day. As you enter menopause you should increase this to 1500mg per day. Also, 1,000 to 2,000 IU of Vitamin D is also recommended along with regular weight bearing exercise (walking and aerobics is great, swimming not good enough). This can help prevent bone loss. Your doctor will discuss with you when you should have a bone density scan done, usually at age 65, but earlier if you went into early menopause or are taking certain medications that put you at higher risk. Bone density studies are done at most every two years but frequently can be spaced out if the results have been stable.
There are some prescription drugs that can help with vaginal dryness. Vaginal estrogen is very low dose and very little of it is absorbed into your blood stream, so it does not have the same risks as taking hormone pills. It comes as a cream, pill or ring, depending on your preference. They can improve dryness as long as you continue to use them. If you stop, the problem will return.
Hoffman and Associates is an all-female OB-GYN doctor group with offices in Baltimore, Catonsville and Dundalk, Maryland. Led by Dr. Terry Hoffman, and in affiliation with Mercy Medical Center, our obstetricians and gynecologists offer an individualized approach to obstetrics, gynecology and menopause which allows us to provide women with top quality and compassionate medical care.
Tracie Cox, CNM, is a certified nurse midwife with the all-female Obstetrics and Gynecology group practice, Hoffman and Associates.