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.

Some women should not take HT or should only take it with extreme caution. Hormone therapy is not considered an option for women who have a personal history of breast cancer, although a family history alone does not prevent most women from being candidates for HT. Estrogen therapy is usually not appropriate for women with a history of severe blood clotting disorders or other medical conditions that are exacerbated or complicated by supplemental estrogen, such as liver disease and certain cancers.

Some nonhormonal medicines have been shown to improve hot flashes for some women and are most often used in women with severe symptoms who cannot or choose not to use hormones. These medicines include certain antidepressants, blood pressure medicines, and neurologic medicines.

Vaginal and urinary symptoms
The decrease in estrogen levels that accompanies menopause can make the tissues of the vulva, the lining of the vagina, and the urethra thin, dry, and less elastic and can cause shortening of the urethra. These changes can lead to decreased lubrication, vulvar burning, pain, and sometimes bleeding with sexual activity. They can also increase the likelihood of developing vaginal infections, noninfectious vaginitis (inflammation of the vagina not caused by infection), and urinary tract infections.

Topical, nonprescription lubricants can provide temporary relief from vaginal dryness and assist with sexual activity, although they do not reverse the long-term tissue changes that result from estrogen loss. Over-the-counter vaginal moisturizers can help relieve the symptoms of vaginal dryness such as itching and burning, but such products do not supply estrogen to the tissues and therefore do not treat the underlying cause of the vaginal dryness. A prescription vaginal estrogen product such as a cream, tablet, or ring administered directly to the vagina, on the other hand, can cause genital and urethral tissue to become thicker, more elastic, and moist. Vaginal estrogen is not thought to carry the same risks as systemic hormone therapy (therapy that affects the entire body, such as HT administered in pill or patch form) because vaginal estrogen probably does not get into the bloodstream in any significant amounts.

While replacing vaginal estrogen can decrease the risk of urinary tract infections and also tends to decrease the need to urinate frequently that often accompanies estrogen loss, an existing urinary tract infection should be treated with antibiotics.

Weight gain
For a number of reasons, women are prone to accumulating excess body fat, whether or not they have diabetes. Unlike male hormones, which keep muscle mass high, female hormones promote fat formation. The fat is typically deposited first on the thighs and buttocks, then the stomach, followed by the upper body and arms. Women with Type 2 diabetes or the metabolic syndrome, however, typically accumulate fat in the abdominal region.

In addition to biological factors, certain lifestyle choices can also lead to increased body fat. Skipping meals and following “crash” diets can actually lead to weight gain in the long term by causing the body to slow down its metabolism and use calories more efficiently. The key to weight loss, therefore, is to eat regularly scheduled meals, choose healthful foods containing whole grains, fruits and vegetables, reduce your fat intake, and consume smaller portions.

Losing even 10 to 20 pounds can help you control your blood glucose levels more easily, as well as improve your circulation, blood pressure, and heart health. Increasing your level of physical activity can help with all of these goals, and it’s good for your diabetes control and heart health even if you don’t lose weight. The following are some strategies for putting an exercise plan into action:

• Set small goals. If you are currently not physically active, start out by walking for 5 to 10 minutes, three days a week. Increase your time and distance gradually.
• Do an activity you enjoy. Try walking, swimming, water exercises, using an exercise bike, or taking yoga or Pilates classes. Doing more than one type of physical activity works different parts of your body and can keep your exercise routine from becoming stale.
• Exercise with other people who keep you motivated.
• Keep a log of your activities, both for motivation and to see how physical activity affects your blood glucose levels.
• Become more active in your daily life. Small steps such as taking a walk during your lunch hour and taking the stairs instead of the elevator can add up.
• Exercise one to two hours after eating. This will help control blood glucose levels.

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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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