Managing menopause: Strategies to help you cope with 3 common consequences

The Bottom Line

  • Menopause is underpinned by symptoms such as vaginal dryness, urinary tract infections, hot flashes, and night sweats, and complications such as bone loss and an increased risk of osteoporosis.  
  • Vaginal estrogen can reduce symptoms of genitourinary syndrome associated with menopause (e.g., vaginal dryness, painful intercourse, urinary infections, and urinary incontinence). 
  • Hormone replacement patches, isoflavones and black cohosh can reduce how often women undergoing natural menopause and with an intact uterus experience hot flashes and night sweats. 
  • Combined exercise programs can improve bone mineral density in postmenopausal women by a small amount.  
  • Speak with your health care provider about the variety of strategies available to help you manage the symptoms and complications associated with menopause.  

Menopause—a word that’s top of mind for most women approaching middle-age (1;2)—causes a range of impacts from physical to emotional and everything in between (3;4). Some common symptoms of menopause include issues with the genital system (e.g., vaginal dryness, soreness, itching, and burning), issues around sexual activity (e.g., painful intercourse), and issues of the lower urinary tract (e.g., urinary tract infections and urinary incontinence). More simply, these symptoms are referred to as ‘genitourinary syndrome’ (5).

The vast majority of women experiencing menopause also "feel the heat" so to speak. How? Through mild to severe hot flashes and night sweats, also known as vasomotor symptoms (3;6-9). In addition to these unpleasant symptoms, menopause can bring with it a host of complications, such as the increased risk of bone loss and osteoporosis (10;11). What’s more, these challenges are not only confined to menopause, they can also persist into the post-menopausal period as well (9-13).

Although the picture painted looks gloomy, there is indeed a bright side! And it’s that women don’t have to go it alone during this trying time. Here are some of the evidence-based strategies available to help women deal with the most commons symptoms and complications that accompany menopause. Click on the links below to learn more.

1. Genitourinary syndrome

Vaginal estrogen, which can be applied directly to the vaginal area in the form of a tablet, cream, gel, or vaginal ring, is one treatment option for the symptoms of genitourinary syndrome. It’s typically recommended for individuals experiencing more than one symptom or whose symptoms are severe. Research shows that in comparison to no treatment or placebo, vaginal estrogen can reduce symptoms of genitourinary syndrome—including vaginal dryness, painful intercourse, frequency of urinary tract infections, and urinary incontinence—in menopausal women. While currently the use of vaginal estrogen is deemed to be generally safe, more long-term research on safety is needed (14).

2. Hot flashes and night sweats

In women going through natural menopause and with an intact uterus, research on treatment options suggests that hormone replacement patches that contain estrogen and progestogen, isoflavones, and black cohosh can reduce the frequency of hot flashes and night sweats, compared to placebo. These strategies appear to be generally safe, with most women not experiencing serious side effects. With that said, anyone considering these treatment options should consult a health care professional to see if they are safe for them as an individual. It’s also important to consider that alternative therapies such as isoflavones and black cohosh can be prepared in a variety of ways, so the effectiveness and safety of each type of preparation my differ (7).

3. Bone loss

When it comes to osteoporosis, risk factors are aplenty. Having undergone menopause and being in the post-menopausal stage is one such risk. But exercise is here to help yet again. Research suggests that exercise programs that combine multiple forms of exercise—generally resistance training and aerobic exercise—can enhance bone mineral density levels by a small amount in postmenopausal women, compared to usual levels of activity (11). Given that osteoporosis weakens bones, making them more vulnerable to breaks (10), this holds positive implications for bone loss and the potential to reduce fracture risk (11).

Next steps

Whether you’re well into your journey through menopause or are nearing the start of this next chapter of your life, be proactive and initiate or maintain dialogue with your health care provider on this topic. Inquire about the various stages of menopause and what they entail, be transparent regarding the symptoms you are experiencing or are concerned about for the future, seek information on available treatment options and strategies that reduce your risk of complications, and collaborate in the development of a plan that works best for you.

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  1. Marjoribanks J, Farquhar C, Roberts H, et al. Long-term hormone therapy for perimenopausal and postmenopausal women (Review). Cochrane Database Syst Rev. 2017; (1):CD004143. doi: 10.1002/14651858.CD004143.pub5.
  2. Palacios S, Henderson VW, Siseles N, et al. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric. 2010; 13:419‐428.
  3. Gaudard AMIS, Silva de Souza S, Puga MES, et al. Bioidentical hormones for women with vasomotor symptoms (Review). Cochrane Database Syst Rev. 2016; (8):CD010407. doi: 10.1002/14651858.CD010407.pub2. 
  4. North American Menopause Society. Hormone therapy position statement of The North American Menopause Society. Menopause. 2012; 19(3):257‐271. doi: 10.1097/gme.0b013e31824b970a.
  5. Portman DJ, Gass ML. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014; 21(10):1063-1068. doi: 10.1097/GME.0000000000000329. 
  6. Speroff L, Glass RH, Kase NG, editors. Clinical gynecologic endocrinology and infertility. 8th Edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.
  7. Sarri G, Pedder H, Dias S, et al. Vasomotor symptoms resulting from natural menopause: A systematic review and network meta-analysis of treatment effects from the National Institute for Health and Care Excellence guideline on menopause. BJOG. 2017; 124(1):1514-1523. doi: 10.1111/1471-0528.14619. 
  8. van Driel CM, Stuursma A, Schroevers MJ, et al. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: A systematic review and meta-analysis. BJOG. 2018; 26(3):330-339. doi: 10.1111/1471-0528.
  9. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015; 44:497-515.
  10. Mayo Clinic. Osteoporosis. [Internet] 2016. [cited August 2020]. Available from https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968  
  11. Zhao R, Zhang M, Zhang Q. The effectiveness of combined exercise interventions for preventing postmenopausal bone loss: A systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017; 47(4):241-251. doi: 10.2519/jospt.2017.6969.
  12. Management of symptomatic vulvovaginal atrophy: 2013 Position statement of the North American Menopause Society. Menopause. 2013; 20(9):888-902. doi: 10.1097/GME.0b013e3182a122c2.
  13. Kingsberg SA, Wysocki S, Magnus L, et al. Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013; 10(7):1790-1799. doi: 10.1111/jsm.12190.
  14. Rahn DD, Carberry C, Sanses TV, et al. Vaginal estrogen for genitourinary syndrome of menopause: A systematic review. Obstet Gynecol. 2014; 124(6):1147-1156. doi: 10.1097/AOG.0000000000000526.

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