New attitudes and new treatments help women with menopause

Too many women have suffered in silence as their bodies transitioned to perimenopause and menopause, a time that can trigger an array of symptoms that can range from annoying to temporarily disabling. The need to change that drives the work of David Soper, M.D., a Menopause Society Certified Practitioner at MUSC Women’s Health. 

“I kept seeing a substantial number of women who needed treatment and hadn’t received  it. That's what prompted me to look at the science of menopause in more  depth.”

 

Soper, an OB/GYN and a faculty member in the Medical University of South Carolina’s College of Medicine, decided to specialize in caring for women in perimenopause, the time before menopause when estrogen levels begin to fluctuate, and menopause, the time after a women’s last period when estrogen levels fall. 

Soper is happy to see those conditions becoming part of a national conversation led by some high-profile women. One of them, Oscar-winner Halle Berry, shouted, “I’m in menopause,” at a D.C. event. Another, Naomi Watts, has launched a line of products focusing on menopause and aging. Other famous figures including Michelle Obama, Salma Hayek and Tracee Ellis Ross have spoken publicly about their experiences with menopause as well.

Soper said the timing of the new openness makes sense. “Menopause is enjoying its heyday, as you might expect, because as the population evolves into an older group, women are going to be interested in dealing with the implications of having lower estrogen levels. Significant bone loss can occur following menopause and bothersome symptoms occur.”

Those symptoms can include:

• Hot flashes.
• Night sweats.
• Sleep trouble.
• Vaginal dryness.
• Mood changes.
• Joint and muscle pain.
• Difficulty concentrating.

Soper encouraged women to ask if menopausal hormone therapy is right for them, even if that means bringing it up with a doctor who hasn’t broached the subject. “There's a stigma associated with menopause and aging in general and that needs to change,” he said. “Women can expect to spend a quarter to a half of their lives in this phase.”

And attitudes toward menopause may be changing, thanks to women willing to speak out. 

Menopausal hormone therapy

Things are also changing when it comes to the terminology of treatment. Soper said hormone replacement therapy is now often called menopausal hormone therapy. 

Perceptions about the therapy need to change too, Soper said. “I think the messaging that has occurred before now has been that it's dangerous. It causes breast cancer and blood clots. And frankly, that's misinformation. Modern day menopause therapy is, for the most part, bioidentical.” 

Bioidentical hormones are lab-made but chemically the same as the ones the body makes.  “In addition, we’ve found that the route of administration, oral versus transdermal, favorably impacts the risk for clot formation. Transdermal eliminates the risk.”

Older messaging was tied to a large study published more than 20 years ago, suggesting hormones for menopause might be unsafe. But newer research found for women under 60 and those within 10 years of their final menstrual period, hormones’ benefits outweigh the risks.Soper said women who start hormone therapy can remain on it past 60 after consulting with their health care provider.

“It can make a big difference. Hormone therapy should be considered in symptomatic women with hot flashes, night sweats, disrupted sleep, the vaginal dryness oftentimes associated with pain during sex and other less touted symptoms such as joint pain and brain fog. I don't think there's any doubt about it.”

Soper said he’s seen perimenopausal and menopausal patients with complaints of palpitations, joint pain and brain fog improve on menopausal hormone therapy. “Internal medicine physicians are now considering menopause syndrome in their differential diagnoses when these patients present to their offices.”

But hormone therapy is not for everyone. Women who should not take it, according to the American College of Obstetricians and Gynecologists, include those with breast or endometrial cancer; women who have had a stroke, heart attack or liver disease; and women who have had blood clots. However, Soper said, on a case by case basis, there is an opportunity for symptom relief. “Topical estrogen for lower genital tract symptoms is a safe alternative in all of these patients.”

New options

Soper said there’s an innovative treatment that combines estrogen with a breast estrogen blocker. “This combination of estrogen with a selective estrogen receptor modulator or SERM (like tamoxifen) may be useful in women at higher risk for breast cancer. Like typical hormone therapy this combination can prevent osteoporosis and relieve hot flashes. Additional studies are underway.”

Soper is also enthusiastic about another new treatment option. “We've participated in the research of  a non-hormonal hot flash treatment. These new agents block the NK3 receptor in the brain which then inhibits the release of a chemical causing hot flashes. These agents work really well. They have helped women with breast cancer who can’t take estrogen for their menopause symptoms.”

Another option that may surprise some women: an antidepressant that can offer relief from menopause symptoms. So far, the Food and Drug Administration has approved paroxetine for menopause treatment, but research suggests other antidepressants may help as well.

Other non-hormonal options for easing menopause symptoms, according to the Menopause Society:

• Clinical hypnosis.
• Cognitive-behavioral therapy.
• Weight loss.
• The drugs venlafaxine and gabapentin.

Soper said he always looks for ways to help, even when a woman’s existing health issues make that challenging. “It's easy to practice medicine if your answer's no. But what if your answer is, ‘I really want to help make you feel better. How can we do that safely, engage in a conversation and then see what options are available?’”

Soper said women should expect to receive therapeutic options and not feel embarrassed about asking for them – including the most common option of menopausal hormone therapy. 

“It’s interesting to compare the therapeutic landscape of men to women. It appears that testosterone therapy for men with low testosterone levels is well accepted. Why would we think any differently about estrogen for women? Women should have similar access to menopause hormone therapy. It’s safe and effective.”