Some women may not want to take HRT, and some women, such as those who have had oestrogen-receptor positive breast cancer, may not be able to take it.
These women do still have options to manage their symptoms.
The treatments available target different symptoms so will be individualised depending on what symptoms are most bothersome.
I would always start with looking at a woman's lifestyle as this can affect symptoms as well as overall health. Midlife is often when chronic illness can start to develop such as high blood pressure, heart disease and osteoporosis.
LIFESTYLE
Diet:
A vitamin D supplement is necessary for most people in Ireland as we don't get enough sunlight to make enough of our own.
Calcium is important for bones - most women will get enough through diet - unless not taking dairy.
Oily fish for omega 3 for brain health.
Minimise refined carbs / sugar. Chose wholegrain to keep steady levels of glucose throughout the day.
Reduce salt to prevent high blood pressure.
Plenty of fruit and veg, legumes and soya.
Exercise:
150 minutes per week of moderate intensity exercise is recommended.
Weight-bearing exercise is important to prevent osteoporosis and loss of muscle mass.
Exercise reduces risk of diabetes, cardiovascular disease and high blood pressure. It also has a positive impact on mental well-being.
Smoking cessation:
Smoking increases risk of heart disease, stroke, lung cancer to name a few.
Alcohol intake:
Excess alcohol is associated with increased risk of heart disease, cancers, osteoporosis and can have a negative impact on mood.
Taking 2 units of alcohol a day increases breast cancer risk more than taking HRT does. So if you are not using HRT due to a concern about breast cancer, keeping alcohol intake low, or stopping completely, should be a priority.
Sleep:
Sleep is key to everything! It is hard to function, never mind exercise if you are tired. Night sweats can affect sleep during perimenopause, as well as anxiety. Good sleep hygiene and keeping a good bedtime routine is key.
MEDICATIONS AND SUPPLEMENTS
Some anti-depressants (such as paroxetine and venlafaxine) can help with hot flushes. Note they DON’T help with mood changes caused by hormonal fluctuations in perimenopause.
Clonidine is a drug that can help some women with hot flushes.
Gabapentin is a drug traditionally used for nerve pain, that can also help with hot flushes
Beta blockers can help with symptoms of anxiety. They slow the heart rate so stop that feeling of heart racing that women can suffer with when anxious.
Note - as with all medications, these have a risk of side-effects.
Cognitive behavioural therapy (CBT) can help women with hot flushes and can also help with anxiety / mood symptoms.
Phyto-oestrogens These are substances in some foods which have oestrogen-like activity in the body. There is some evidence that they can help with symptoms such as hot flushes. You can take them through food and some are available in supplement form.
There are a number of different types:
Isoflavones – found in soybeans, soy nuts, tempeh and red clover
Coumestans – found in peas, beans (including soya), brussel sprouts, alfalfa and clover sprouts
Lignans – mainly found in seeds such as flaxseed and pumpkin.
There are various herbal preparations available marketed to help menopausal symptoms, but unfortunately there isn’t enough evidence for benefit for us to be able to recommend them. There is also the risk that some of them may interact with prescribed medications. Examples: black cohosh, dong quai, St. John’s wort.
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