Updated March 04, 2008

Menopause
What to Expect, How to Cope

by Pat Dougherty, C.N.M., M.S.N., and Joyce Green Pastors, M.S., R.D., C.D.E.

Coping with hot flashes
In addition to the lifestyle changes already described, there are many simple techniques that may help to relieve minor to moderate episodes of hot flashes. These include the following:

• Avoid heat around the face area from devices such as hair dryers and curling irons.
• Avoid using hot tubs, and keep baths and showers tepid or cool.
• Drink cold water or water with ice.
• Wear layers of clothing so you can take off some clothing, if needed.
• Sleep with a light blanket or other covering and with the windows open or a small fan blowing directly on you.
• Use a ceiling fan or air conditioner if you have one.
• Place cold compresses on your face when you experience hot flashes or sweating.
• Practice deep abdominal breathing—count to 10 while inhaling slowly, then exhale slowly while counting to 10. Repeat 10 times.
• Try to identify and avoid your own personal hot-flash triggers.
• Remind yourself that your symptoms will eventually lessen or abate.

Treatment for severe symptoms
Hormone therapy (HT) can be used to alleviate severe menopausal symptoms, especially unrelenting hot flashes, night sweats, and vaginal dryness. Estrogen therapy (ET) is appropriate only for women who have had a hysterectomy (removal of the uterus) because estrogen alone increases the risk of uterine cancer. Women who wish to use hormone therapy who have not had a hysterectomy must use a combination of estrogen and progestin together, called estrogen-progestin therapy (EPT).

Hormone therapy is the only FDA-approved medicine for the treatment of hot flashes and night sweats. Many women report that other menopausal symptoms such as insomnia, mood instability, and lack of concentration are also improved when taking HT, although scientific data has not confirmed these claims.

However, the benefits of HT must be weighed against the risks, such as those recently documented in the Women’s Health Initiative, a large scientific study looking for ways to prevent a variety of conditions in postmenopausal women. According to the results of this study, there is a slightly increased risk of heart attack (7 more cases per 10,000 women per year), stroke (8 more cases per 10,000 women per year), and potentially life-threatening blood clots to the lungs (8 more cases per 10,000 women per year) for women taking EPT. In addition, dementia risk appears to double, increasing from 22 cases to 45 cases per 10,000 women per year.

For women with a hysterectomy taking ET, the risk of heart attack did not increase, but the risk of stroke did increase (13 more cases per 10,000 women per year). In women taking EPT, but not those taking ET, breast cancer increased by 8 cases per 10,000 women per year.

Because women with diabetes already have an increased risk of heart disease, it is especially important for women with diabetes to discuss the benefits and risks of HT with their health-care provider. Heart disease is the leading cause of death of American women.

On the plus side, HT use was associated with 5 fewer hip fractures per 10,000 women per year and with 6 fewer cases of colorectal cancer per 10,000 women per year in the Women’s Health Initiative. HT is approved for the prevention of osteoporosis.

There have been some studies suggesting that taking estrogen promotes insulin sensitivity, which may in turn lead to a lowering of blood glucose levels. (The combination of estrogen and progestin, however, does not seem to have this effect on blood glucose control.) However, this benefit alone is not considered a reason to use estrogen, since there are other, safer options for the prevention and treatment of insulin resistance (namely weight loss and increased physical activity).

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Pat Dougherty is a Certified Nurse Midwife and Nurse Practitioner in the Department of Obstetrics and Gynecology, Division of Midlife Health, in the University of Virginia Health System. She is also certified as a Menopause Practitioner by the North American Menopause Society. Joyce Green Pastors is a Diabetes Nutrition Specialist with the Virginia Center for Diabetes Professional Education and an Assistant Professor of Medical Education in Internal Medicine, Division of Endocrinology at the University of Virginia School of Medicine.

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