Women Have Treatment Options When Facing Menopause

By Andrew Wilson

Every woman is different, which can be true about many health matters and especially so when it comes to menopause.

“Menopause can occur any time from age 40 and up,” said Elizabeth Pronesti, M.D., St. Clair Medical Group OB/GYN. “The average age of menopause is 51, but some women will begin to show signs of menopause in their 30s, while others may not show any signs until much later.”

Menopause is a natural life occurrence when a woman’s menstrual cycle stops for good. After 12 months without a menstrual period, vaginal bleeding, or spotting, a menopause diagnosis is confirmed.

While monthly menstrual cycles bring discomfort or pain for women, menopause or perimenopause – the term for the months and years leading up to menopause – brings a different set of symptoms.

“Some of the symptoms of menopause and perimenopause are irregular periods, hot flashes, night sweats, trouble sleeping, vaginal dryness, decreased sex drive, weight gain, and hair and skin changes,” said Dr. Pronesti. “It can even cause difficulty in finding the right word or words.”

There are several ways to treat the symptoms of menopause, and how it may be treated depends on the individual and how she is able to manage each symptom. These treatments may involve hormone therapy, non-hormonal therapy, or simple lifestyle changes.

Hormone Replacement Therapy

Hormone replacement therapy, also called HRT, is medication that can come in a variety of delivery forms, such as a pill or skin patch. The dosage can vary depending on the symptoms being treated.

Systemic hormone therapy can be used to treat many of the symptoms of menopause, especially vaso-motor symptoms or “hot flashes,” while low-dose vaginal products are usually only prescribed to treat the vaginal or urinary symptoms. Whichever therapy is prescribed, the medication may contain estrogen, progesterone, or both – two hormones that decline with the onset of menopause.

“The reason a lot of women go on HRT is to improve their quality of life,” said Dr. Pronesti, as it can reduce or eliminate many of the symptoms of menopause. “It’s important to note that there is mixed data about HRT. A lot depends on timing. If you start it when you begin menopause, the benefits likely outweigh the risks.”

Generally, Dr. Pronesti says that women who start HRT at a younger age decrease their risks of heart disease, osteoporosis, dementia, and colon cancer. However, some studies have shown that women who start HRT several years after the onset of menopause may increase their risk of heart disease or stroke, breast cancer, and blood clots in the lungs or legs.

“The risks may be higher the longer you are on it, too,” said Dr. Pronesti. “But the evidence is constantly evolving.”

The benefits of HRT may outweigh the risks though depending on the age and family history of a patient. This is something to discuss in greater detail with your OB/GYN physician.

Non-Hormonal Therapy

For many women, non-estrogen therapies can be prescribed to control hot flashes, though such therapies may not be as effective as estrogen.

“Anti-depressant medications, Gabapentin, or a newer medication called Veozah have proven effective for dealing with hot flashes,” said Dr. Pronesti. “Some blood pressure medications have also shown effectiveness. Herbal medications or supplements are not supported by data, but anecdotally some of my patients have had success with these supplements as well.”

Treating Vaginal Dryness

When women experience vaginal dryness or pain during intercourse due to menopause, low-dose vaginal estrogen can provide relief. This type of treatment, because it is inserted into the vagina, is not thought to increase the risk of cancer significantly because only a minimal amount of estrogen will get into the bloodstream.

Post-Menopausal Health Care

Dr. Pronesti recommends regular exercise, even a daily vigorous walk, as a key for maintaining good post-menopausal health. It is also important to add in at least two sessions of strength training a week. While that’s good advice for any stage of life, it can be particularly important as we age. Diet is important too.

“I recommend that my patients who are post-menopausal take 1200 mg of calcium and 800-1000 units of vitamin D daily for osteoporosis prevention,” she said. “Leafy greens and dairy products, as well as some fish and cereals, are good sources of both of those vitamins and minerals, too.”

Dr. Pronesti recommends mammograms for all women beginning at age 40 – earlier if there is a family history of breast cancer – as well as a colonoscopy starting at age 45 and bone density screenings between the ages of 60 and 65.

“Family history can alter the timing of any of these screenings,” she said. “For example, if there is a family history of breast cancer, we may start the screening several years prior to the age of diagnosis of the affected family member.”

In addition to these screenings, Dr. Pronesti advises women to continue with pap smear screenings and blood work testing for high cholesterol and blood pressure, among other things, that most primary care physicians will make part of an annual physical.

“One of the questions that I get all the time is how often post-menopausal women need to see their gynecologist,” she said. “I tell them that post-menopausal women should see their gynecologist every one to two years.”

A Pittsburgh native and graduate of Chartiers Valley High School, Dr. Elizabeth Pronesti earned her medical degree from the University of Pittsburgh School of Medicine and completed her residency training at UPMC Magee-Womens Hospital. There, she earned awards for excellence in high-risk obstetrics, female pelvic medicine and laparoscopic (minimally invasive) surgery. Board-certified by the American Board of Obstetrics and Gynecology, she’s an advocate for women at every stage in their lives and takes special pride in being a part of a woman’s journey.

Dr. Pronesti sees patients at the following locations:

St. Clair Health Professional Office Building
1050 Bower Hill Road, Suite 205
Mt. Lebanon, PA 15243
(412) 942-1066

St. Clair Health Village Square Outpatient Center
2000 Oxford Drive, Suite 415
Bethel Park, PA 15102
(412) 942-5380

St. Clair Health Multispecialty Suite
1 Robinson Place, Suite 410
Pittsburgh, PA 15205
(412) 788-1330