Menopause

What can I do to relieve uncomfortable hot flashes?

DEAR DOCTOR K: What can I do to relieve uncomfortable hot flashes?

DEAR READER: Yesterday I discussed new research showing that menopausal hot flashes can last for much longer than the "several years" the textbooks say they are supposed to last. We are beginning to understand why women in menopause (and sometimes for years after) get hot flashes. There is a center in the brain that is constantly measuring the inner temperature of our bodies. For example, body temperature rises on a hot day, or when we exercise. When the brain center thinks the body needs to cool off, it causes little blood vessels near the skin to open wide.

How long can I expect hot flashes to continue?

DEAR DOCTOR K:I just experienced my first, full-blown menopausal hot flash. It was awful. How long can I expect hot flashes to continue?

DEAR READER: Your question reminds me of a patient I saw when I had recently finished my training. (Believe it or not, I was even younger then than I am now.) She said she had come to see me because of hot flashes. Then she said: "I had heard about hot flashes since I was a girl, and I thought I knew what to expect. But you can't really imagine it until you've experienced it."

Can you discuss how menopause might affect my sex life?

DEAR DOCTOR K:

I have recently entered menopause. Can you discuss how menopause might affect my sex life?

DEAR READER: As a woman approaches and enters menopause, her ovaries gradually make less and less of the hormones estrogen and progesterone. The drop in these hormones -- of estrogen in particular -- can affect how a woman experiences sex. Estrogen stimulates the growth of breast tissue. It maintains blood flow to and lubrication of the vagina. The decline and eventual end to estrogen production provokes a host of symptoms. These include hot flashes, fatigue, vaginal dryness and loss of libido. Many of these changes can have unwanted effects on a woman's sex life.

Does menopause cause weight gain?

DEAR DOCTOR K: Does menopause cause weight gain?

DEAR READER: In the United States, women typically go through menopause between 47 and 59 years of age. And the average woman gains about one pound per year around the time of menopause. Not surprisingly, we tend to assume that menopause causes weight gain.

What can I take to ease my hot flashes?

DEAR DOCTOR K: I have terrible hot flashes. My doctor no longer recommends hormone replacement therapy because he says it has heart risks. Is there anything else I can take?

DEAR READER: Hot flashes are a common symptom of menopause. They probably result from changing hormone levels. My patients describe them as a sudden, intensely uncomfortable onslaught of heat. They are often accompanied by a rapid heartbeat, headache, nausea or dizziness.

I had a period after 5 years of menopause– is this normal?

DEAR DOCTOR K: I thought I entered menopause five years ago, but now I seem to be having a period again. Is this normal?

DEAR READER: A woman is considered to be in menopause once it has been one year since her last period. Once menopause begins, vaginal bleeding is not normal. Post-menopausal bleeding (PMB) can happen for many reasons. It may result from infection or injury. Non-cancerous growths such as polyps and fibroids can cause PMB. So can bleeding disorders or use of blood thinners.

Does vaginal estrogen cream carry the same risks as systemic hormone therapy?

DEAR DOCTOR K: I use a vaginal estrogen cream for vaginal dryness. Does it have the same risks as hormones taken orally or by skin patch?

DEAR READER: Hormone therapy (HT) is estrogen taken alone or with other female hormones to treat the symptoms of menopause. "Systemic" HT involves hormones that enter the blood and travel throughout the body. It is the most effective treatment for postmenopausal hot flashes and vaginal symptoms, including vaginal dryness.

Are there natural remedies for hot flashes?

DEAR DOCTOR K: I'm having menopausal hot flashes, but I don't want to take hormone therapy. Can you tell me about natural remedies?

DEAR READER: Natural remedies can help for hot flashes, but hormone therapy is helpful more often. For that reason, I'll come back to the pluses and minuses of hormone therapy after answering your question.