By Juliana M. Kling, MD, MPH as told to Alexandra Benisek
In the WebMD webinar “Moving Beyond Hot Flashes: Treatment Options for Symptoms of Perimenopause and Menopause,” Juliana M. Kling, MD, MPH, answered viewer questions about hormone therapy, menopause symptoms, sex during menopause, and more.
It depends. Also called vasomotor symptoms, these tend to last 7-10 years. But some people have symptoms for longer. For example, Black people often have longer vasomotor symptoms during menopause.
When you stop hormone therapy, you may notice that your hot flashes come back. If they’re severe, you may consider restarting hormone therapy (if your doctor finds that it’s a healthy option for you) or you might try a non-hormone treatment.
Or you may not have returning hot flashes after stopping hormone therapy. The important thing to know here is that treating your hot flashes during the menopause transition doesn’t delay you going through menopause.
No. If you stop your birth control pills and notice perimenopause or menopause symptoms, it may be that you’re in perimenopause or menopause (not because of oral contraceptives, but because of your age and when you stopped using them).
Since you’re still at risk of pregnancy up until 12 months past your last menstrual cycle (the definition of menopause), you may decide to continue oral contraceptives to prevent pregnancy, as well as treat your perimenopausal symptoms.
Maybe. Some people may need this treatment for more than 5 years.
But guidelines say you should use the best dose for the best amount of time to treat your menopausal symptoms. There shouldn’t be a random age cutoff for hormone therapy during menopause.
The right time to stop this treatment is different for each person. Talk to your doctor to figure out the right time for you.
Once you start treatment, you and your doctor can look at the risks and benefits of continuing hormone therapy each year. This should go hand-in-hand with age-appropriate cancer screening and healthy lifestyle habits including regular exercise, a heart-healthy diet such as the Mediterranean diet, minimal or no alcohol, and no tobacco use.
Talk with your doctor about your symptoms. They may check for other causes of your symptoms. If your age, menstrual cycle history, and symptoms match up with perimenopause or menopause, then that’s probably your diagnosis. You and your doctor can talk about your options for treatment.
It may be an option for you after your doctor looks over the risks and benefits. If you’re perimenopausal, you may notice changes in your migraines during your menstrual cycles (menstrual-related migraines).
Your migraines may get worse during perimenopause. Starting hormone therapy may improve your perimenopausal or menopausal symptoms. You may notice that your migraines get better after menopause.
The symptoms that commonly happen during menopause (like hot flashes, night sweats, sleep disturbance, vaginal dryness, cognitive fog, and irritability) can either directly or indirectly impact sex.
For example, our group has studied the relationship between sleep and sexual functioning. We found that poor sleep quality puts you at higher risk of sexual dysfunction.
The genitourinary syndrome of menopause – which affects your genitals and urinary organs – typically starts about 2-3 years after your last menstrual cycle. This can cause vaginal dryness, which can cause you to have pain during sex.
It’s important to know that sex should never be painful. You can use lubricants, as well as vaginal moisturizers regularly, to help with these symptoms. You may need to start a low dose of vaginal estrogen to help with your symptoms. These are safe and can be used long term. They don’t increase your risk of breast cancer, blood clots, heart attacks, or strokes.
Sexual health is an important part of overall health. So if you’re experiencing sexual problems, talk with your doctor so you can get checked and treated.
Perimenopause is a time when you may develop depressive symptoms, especially if you have a history of anxiety or mood disorders. We see an increased risk of symptoms and diagnosis during this time.
Talk to your doctors about your options for treatment. They may include cognitive behavioral therapy (CBT) and medications such as antidepressants. During perimenopause, you may benefit from hormone therapy to help your mood.
The best treatment for you will be based on the specifics of your situation.
Yes. The FDA approves hormone therapy, including other similar FDA-approved treatments. It’s covered by most insurance companies.
Go to the North American Menopause Society website and search for a certified menopause practitioner.
Here, you’ll enter information about the state or country you live in. Then, you’ll get a list of menopause specialists near you.
Watch the webinar here.