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“Your Menopause Handbook” by Lilah Borden

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Dietary changes like a reduction of consumption of alcohol, citrus

juices, caffeine, spicy foods, and artificial sweeteners can provide

some relief if you suffer from bladder related problems during


Get your doctor’s advice as to whether changing some medications

might provide some relief.

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20. Menopause and Cancer

Cancer is a debilitating disease. It requires many prolonged

treatments, therapies, and medications. The impact of these

treatments and therapies is not the same for all women.

Cancer often requires radiation and chemotherapy treatment. These

treatments can damage your ovaries and bring on early menopause.

Sometimes they cause irregular periods, which later develop into


If you are diagnosed with cancer in your youth and seek

chemotherapy treatment, you stand a greater chance of having a

premature menopause. When this is a sudden change, you

experience severe menopausal symptoms like hot flashes, poor sex

drive, depression, and irritability.

Women in their menopause have a higher risk of developing cancer

than women in pre-menopause stages due to poor resistance. In

some cases, the age of reaching menopause may affect their

chances of developing cancer.

A long reproductive period may give a woman higher than average

estrogen levels and that may increase their greater risk of

developing these cancers in their menopause to some degree.

Women undergoing hormone replacement therapy record higher

instances of breast cancer.

Chances of ovarian cancer are higher with women with higher

ovulation. So, women with a longer than average menstrual history

have had many ovulations and may have a higher risk of ovarian


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21. Menopause and Osteoporosis

Menopause may be a factor in the development of osteoporosis.

Osteoporosis is general weakening of bones where bones tend to

lose more density than the amount they form.

Excessive bone mass loss is osteoporosis. This disease has no

warning symptoms. You often only realize its presence only when

you suffer a fracture. More than 20% of expected bone loss in your

lifetime occurs during the first five to seven years of your


Menopause involves falling estrogen levels in your body. Estrogen

plays an important role in building of the bones in your body.

Osteoblasts are small cells within your body. These cells build up

your bones with the help of estrogen. However, low estrogen levels

during menopause reduce the easy and quick buildup of bones.

When the bones start wearing out faster than the rate of rebuilding,

they become weak and osteoporosis sets in.

Osteoporosis is treatable to some extent and doctors advise

relevant therapies and treatments to overcome or prevent


Although you cannot increase estrogen levels in your body, you can

take better care of your bones.

Eat calcium-rich foods like milk and yogurt, take calcium

supplements, and increase vitamin D levels in your body.

Vitamin D is essential for calcium absorption in your body. Drinking

vitamin-D fortified milk is a good option. You can take additional

vitamin supplements in consultation with your doctor.

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Regular exercises, like walking, keep your muscles stronger and

better toned.

Although exercises cannot stop bone loss, a regular program can

help to slow down the pace of osteoporosis.

Exercises increase overall fitness and may reduce the damage

sustained by falls.

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22. Menopause and Smoking

Smoking influences the onset of menopause greatly. Women who

smoke cigarettes regularly have a greater risk of entering

menopause around one to three years earlier than those that don’t

smoke according to some medical research and studies.

Smoking cigarettes causes inhalation of tobacco smoke The nicotine

that is present in cigarettes can affects the central nervous system,

causing numerous changes in hormone secretions. These changes in

hormonal levels may be a factor in the early menopause.

An early menopause may make you more susceptible to heart

diseases and osteoporosis.

As these conditions reduce your resistance to common menopausal

symptoms like hot flashes, night sweats, irregular sleep patterns

and irregular periods they have greater effect. You may, therefore,

experience a more intense menopause.

Women concentrating on their career tend to delay having their first


Smoking may also increase your chances of developing ovarian,

uterine, or cervical cancers. In some cases, these cancers remain

undetected for long and that may lead to ovarian failure.

Giving up smoking is claimed by some to sometimes help delay the

onset of menopause which may help you to combat menopausal

symptoms better when they occur.

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Part-V: Treatment Options

23. Treatment Options for Menopause Symptoms

Menopause is a natural occurrence in women. It is not a disease

that needs treatment. Menopause is often accompanied by

symptoms that require suitable treatments

Common menopausal symptoms include hot flashes, heavy and

irregular bleeding, mood changes, irregular sleep patterns and


Treatment Options for Menopause Symptoms

Irregular and Heavy Periods

This bleeding is due to low progesterone levels in your body.

Doctors may prescribe birth control pills, non-steroidal anti-

inflammatory drugs (NSAIDs) or a levonorgestrel (LNg) IUD to

combat heavy bleeding.

Surgical procedures, like removal of the uterus (hysterectomy) can

offer a permanent solution.

Some claim that surgical application of heat to scar the uterus walls

can prevent or reduce heavy bleeding.

Hot flashes

This is a very common menopausal symptom. Low-dose hormone

therapy, high blood pressure medication clonidine, selective

serotonin reuptake inhibitors (SSRIs), antidepressants like

fluoxetine and paroxetine or anti-seizure medication gabapentin or

Neurontin may offer relief from hot flashes.

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Multiple symptoms

If you suffer from multiple severe menopause symptoms, some say

that hormone therapies may be the best treatment option.

Low-dose hormone replacement therapy with estrogen and

progestin may bring relief from heavy bleeding. You might consult

your doctor whether using low-dose estrogen-progestin birth control

pills would be a suitable option.

Vaginal dryness and irritation

Vaginal muscles lose their elasticity during menopause; dryness and

irritation are common.

Vaginal lubricants like estrogen creams and tablets can combat

dryness of skin and help to relieve the irritation.

Vaginal application may cause lower absorption of these estrogen-

based creams into your system and this might be an option with

reduced risk.

Treatment Options for Menopause Symptoms

Hormone therapy

This is the most popular and effective treatment option for hot

flashes, a menopausal symptom.

Doctors prescribe estrogen in low doses after considering other

factors such as your family medical history.

Many use this therapy as a short-term treatment option.

Initially, it was thought that this therapy provided protection against

heart disease and dementia. Of late, however, research results

show otherwise.

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Some women may suffer stroke, heart attack, or blood clotting after

more than one year of using this therapy.

Regular use of therapy for many years may increase the risks of

breast and ovarian cancers.

But, the incidence of these risks do not relate just to hormone

therapy alone. Your physical condition may also play a major role.

Bioidentical hormone replacement therapy (BHRT):

This is a new hormone therapy treatment.

Scientists produce hormones from plants like soy and yams, or from

animal sources like horses and pigs.

They treat these hormones with chemicals in laboratories and

produce synthetic hormones.

The molecular composition of these synthetic hormones is very

similar to that of natural hormones.

They are available in the form of oral pills, gels, creams and other


These therapies are yet to record an established success rate. They

may have the same risks as those of hormone replacement therapy,

like the increased chance of heart disease, cancer, blood clots and


Herbal remedies

There are some herbal preparations that are claimed to provide

relief from emotional upsets and to help to control excessive


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Some people claim that certain herbal extracts and potions may

bring relief from menopausal symptoms.

Always consult your doctor before buying or using any of the

preparations in this section.

Black cohosh is claimed to alleviate depression and hot flashes.

There are unconfirmed reports that it may increase the risks of

uterine and breast cancer.

The changes in hormone levels during menopause may cause

severe emotional disturbances like mood swings, depression, and

irritability. Some people suggest that yoga, meditation, deep

breathing, and biofeedback may help to control your emotional

symptoms associated with menopause.

Lifestyle Changes

Adopting a healthier lifestyle may reduce the impact of menopause


Eat a regular and balanced diet.

Reduce or eliminate your alcohol and caffeine intake.

Quit smoking.

Make exercise a regular part of your daily life. You can choose from

many forms of physical exercise to help to maintain body fitness

and build up or protect healthy muscles and bones.

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24. Medications

Menopause causes potentially serious symptoms like hot flashes,

night sweats, fatigue, irritability, depression, irregular bleeding and

mood swings.

Some medications offer relief from such symptoms.

Hormone replacement therapy

This is a very popular treatment option. Many women take hormone

therapy treatment for a short-term and at a low dosage. Hormone

replacement therapy is believed to increase the risk of serious

health problems like heart diseases, cancer, dementia, strokes, and

blood clots if used over long periods.

So, many women opt for non-hormonal treatments and medications

to get relief.

Some people claim that most menopause symptoms can be relieved

to some degree by non-hormonal or hormonal medications for

menopause symptoms.

Common Medications for Menopausal Symptoms


Clonidine: This medication is said to be in common use among

high-pressure patients. It is claimed to be effective against hot

flashes as experienced during menopause.

Some women report side effects of this medication like low blood

pressure and dizziness.

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Belladonna (Bellergal): This medication contains Phenobarbital. It

is claimed to lower the effects of hot flashes. It can cause sleepiness

and should be only ever used for a short period. It is addictive.

SSRIs: SSRIs are selective serotonin reuptake inhibitors. They

are antidepressant medications like Paxil or Prozac.

It is claimed that they can bring relief from hot flashes; you

experience fewer flashes and with lesser severity.

However, there is no clear indication of how safe they are for long-

term use.

Gabapentin or Neurontin: This is an anti-seizure medication. It is

claimed to reduce hot flashes. It can cause a few side effects like

dizziness, sleepiness and swelling.

Medications for bone loss: Raloxifene, Calcitonin and

bisphosphonates are claimed to help reduce bone loss due to

menopause, thereby reducing risks of fractures and dislocations.


Progestin pills: These pills like levonorgestrel IUD release

progesterone into the uterus. It is claimed that they help control

irregular and heavy menstrual bleeding during perimenopause.

It is claimed that there are few minor side effects of these pills.

Birth control pills: These pills contain estrogen and progestin.

They can regulate menstrual bleeding. However, you should take

these pills only until menopause.

They are said to have side effects. Low-dose pills are available for

women over the age of 35.

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Stay away from this medication if you suffer from diabetes,

cardiovascular disease, high blood pressure or if you have had

breast cancer. Smokers also should not take these pills.

Vaginal estrogen medications: These are available in the form of

tablets, creams or rings. They alleviate urethral and vaginal dryness

and irritation without changing your body’s estrogen levels.

Progesterone creams: These creams may help to correct low

progesterone levels. They also may give serious side effects like

headaches, blood clots, and breast cancer or increase the risk of

uterine cancer in some cases.

Low-dose estrogen: A small dose of daily estrogen may help to

maintain good health and make your bones strong. However, the

effects of long-term use of estrogen is not very clear.

Estrogen therapy is claimed to provide relief from hot flashes,

improve cholesterol levels and reduce the risk of fractures. It is

claimed to be beneficial in treating urinary infections and vaginal

problems due to menopause.

Side effects including stroke, gallstones, painful intercourse, and

blood clots may occur.

It does not prevent pregnancy.

Hormone Therapy: Hormone therapy involves taking estrogen

with progesterone according to your doctor’s specifications.

Continuous use of this therapy may increase the risk of breast


Testosterone-estrogen: If estrogen therapy is unable to give you

the desired relief from menopausal symptoms, you might be

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advised, subject to your doctor’s advice, to try Testosterone-


This is a new therapy and it does not have FDA approval. Long-term

use may cause serious side effects like facial hair growth, hair loss,

acne and deepening of your voice.

It may also increase your risk of heart ailments, stroke, blood clots

and breast cancer.

Doctors do not advise this for menopausal women except in special


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25. Hormone Replacement Therapy (HRT)

Hormone replacement therapy involves replacing the hormones

that your body no longer produces to alleviate symptoms associated

with menopause. Menopause can involve debilitating symptoms like

hot flashes, fatigue, irritability, night sweats, depression and mood


Menopause causes erratic production of hormones in your body.

These unpredictable levels can trigger severe symptoms.

Doctors sometimes recommend hormone replacement therapy to

overcome severe menopausal symptoms.

Before starting on hormone replacement therapy, doctors advise

various tests. Blood tests help determine cholesterol levels.

Your individual constitution requires thorough analysis to see how

good this therapy may be for you.

Doctors start with low doses and may increase doses according to

the results you get.


Hormone replacement therapy has been claimed to have many


It may manage your menopausal symptoms because it increases

your body’s hormone levels to where you suffer less from hot

flashes, vaginal irritation or fatigue.

Low estrogen levels increase chances of osteoporosis. This therapy

can help to increase estrogen levels and may reduce the

osteoporosis risk.

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Low estrogen levels could increase the chance of heart diseases.

With hormone replacement therapy, estrogen levels increase and

that may lower the risks of heart ailments. But, this is more likely if

you are not a smoker and have good health.


Hormone replacement therapy may carry some inherent risks like

increased risk of uterine and ovarian cancer. But, these risks are

probably, in part, also dependent on other factors, including your

genetic history, your medical history of ailments like cancer or a

family history of serious ailments.

It may be difficult to arrive at a suitable dose of hormones in your

hormone replacement therapy. Hormonal loss is very individualistic,

so your doctor has to be very careful when judging how much

hormones you require and how much hormones your body is

actually producing.

This therapy can have its own side effects such as:

headaches leading to migraines,

excessive weight gain, especially around hips and


HRT may also cause excessive fluid retention, resulting in swollen

ankles, facial swelling, breast tenderness and pain in the legs.

Such excess fluid is normally reduced within the first few months of


Nausea and vomiting are other common side effects. Taking

hormonal injections or having hormonal pills after a small snack at

bedtime can reduce such feelings.

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HRT can induce heavy bleeding in the initial months. After a few

months, the bleeding may tend more to be within a specific pattern

and you could be better able to adjust to it.

HRT and Menopause

HRT has its advantages and risk factors. Recently, there have been

indications that HRT may be a factor in women who take it getting

various serious diseases like cancer and heart ailments.

These ailments could occur during the treatment or even long after

stopping the therapy. In that context, many are wary of going in for

this treatment.

You should discuss whether the advantages for you are greater than

the risks.


Another way of possibly reducing the possible risks of HRT is to take

a few precautions:

• Consider a low estrogen dosage, in the form of vaginal

creams, to provide necessary relief and perhaps reduce the

chance of serious problems.

• Have scheduled pap smears and regular pelvic examinations

to assist early detection of any problems.

• Regular mammograms and breast examinations are also


Other tactics to reduce potential negative effects of HRT include:

• avoiding spicy foods, caffeine, and alcohol,

• use relaxation techniques like meditation, yoga, deep


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• practice Kegel exercises regularly

• have an active sex life

• include soy foods in daily diet, and

• use water-based lubricants during intercourse to prevent

vaginal pain and irritation.

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26. Bioidentical Hormone Replacement

Therapy (BHRT)

Doctors sometimes prescribe bioidentical hormone replacement

therapy for specific women as an alternative therapy treatment for


Bioidentical hormones have similar chemical content to natural

hormones that occur in your body. They are similar to natural

hormones like Estradiol, Estrone and Estriol.

Bioidentical estrogen compounds are normally in specific ratios of

these estrogen compounds like 10% Estradiol, 10% Estrone, and

80% Estriol. This is popular as Tri-estrogen or Tri-est.

Another combination includes two estrogen compounds and is

popular as Bi-estrogen.

Formation of Bioidentical Hormones

Bioidentical hormones are chemically synthesized hormones

produced from plants and animals.

Some refer to bioidentical hormones as natural hormones because

their molecular identity is similar to hormones produced naturally

within your body.

Scientists and researchers take hormones and steroids from plants

and animals like soy and yam plants or pigs and horses. They then

treat them with specific chemicals in laboratories to alter their

molecular structure.

These hormones are made available in the form of gels, creams,

injections, nose spray or oral pills.

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Popularity of Bioidentical Hormone Replacement Therapy

This therapy helps to stabilize hormone levels in women during

perimenopause and menopause.

As the chemical construction of bioidentical hormones is very similar

to natural hormones, many women find them effective. They say

that they are able to overcome most menopausal symptoms

through use of this therapy.

However, this therapy is not without any risks. Bioidentical hormone

replacement therapy, being a new entrant, could have many far-

reaching risks and consequences. This therapy still requires more

time for doctors to study them and understand all possible

implications and effects when many women use them.

This therapy may carry the same risks as hormone replacement

therapy. Women using bioidentical hormone replacement therapy

could expose themselves to various risks like heart disease, stroke,

blood clots, breast cancer, and dementia.

Advantages of Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy may have advantages

over hormone replacement therapy.

Normally, hormone replacement therapy treatment is the same for

all. All women irrespective of their symptoms undergo the same

therapy treatment.

Bioidentical hormone replacement therapy functions differently.

Treatments and dosage is set according to specific individual as per

their individual symptoms.

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Estriol is claimed to offer protection against hormone-induced

cancer. It also binds to an estrogen receptor and is said to function

as a tumor suppressor.

Success Rate of Bioidentical Hormone Replacement Therapy

Bioidentical hormone replacement therapy is a relatively new

concept. It is still in its early stages and the success rate is not very


Also, every therapy can be expected to have side effects.

You can improve your overall health to sustain therapies if the need

arises. Regular exercises help build up your muscles and bones.

These also may help to provide relief in the early stages of

debilitating diseases like cancer, heart ailments, and osteoporosis

which sometimes occur among menopausal women.

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Part-VI: Managing Menopause and Keeping Healthy

27. How to Reduce or Eliminate

Menopause Symptoms

Menopause often causes severe symptoms, although all women do

not suffer from the same symptoms. Most symptoms are temporary

and do not cause any long-term effects.

Simple self-care may reduce the severity of most menopausal


Osteoporosis is common among menopausal women. Some believe

that you need around 1,000 to 1,500 mg of calcium daily. Spread

your consumption of calcium through the day, as your body cannot

absorb more than 500mg at a time. Good calcium sources include

milk, cheese, calcium-fortified orange juice, yogurt and salmon with

bones. If need be, ask your doctor if you should take appropriate

calcium supplements.

Adequate vitamin D is essential for absorption of calcium. Doctors

recommend a suitable dosage according to your individual medical

condition. Vitamin D fortified milk is a good source.

Regular physical exercises strengthen your muscles and bones.

Adhere to a regular schedule, building up from fairly short sessions

to maybe thirty to forty-minutes.

You can adopt the longer exercise schedule if you want to reduce

body weight and your doctor approves.

Exercises reduce stress and alleviate menopausal symptoms of

depression, irritability and mental fatigue.

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Exercises help you combat the onset and effects of diseases like

diabetes and cardiovascular diseases.

Kegel exercises strengthen your pelvic region for better

management of menopause symptoms and controlling urinary


Reduce or eliminate smoking and alcohol consumption, as they

reduce body resistance and are claimed by some to encourage an

early menopause.

They may also aggravate hot flashes experienced during


Consume a balanced diet with lots of green leafy vegetables, whole

grains and fruits.

Restrict consumption of fats, oil, and sugar.

Stay away from spicy or oily foods and caffeine.

Use water-based vaginal lubricants and moisturizers like Astroglide,

Vagisil and Replens. These control vaginal dryness and irritation.

Having an active sexual life may help to reduce vaginal discomfort

during menopause.

Get adequate sleep and rest. This keeps all emotional symptoms

under control. Consider using relaxation techniques like meditation,

yoga, deep breathing, muscle relaxation, and similar others to relax

all nerves of your body.

Go for regular medical checkups. Undergo screening tests like pap-

smear tests, lipid levels and mammograms at prescribed intervals.

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28. Ten Ways to Relieve

Menopausal Hot Flashes

Hot flashes are synonymous with menopause. Almost all women in

their perimenopause or menopause experience hot flashes in

varying degrees.

Here are some ways to relieve menopausal hot flashes:

1] Your diet could be the trigger for your hot flashes. Normally,

spicy and hot foods, oily foods, caffeine products (like tea, coffee,

and carbonated drinks), consuming alcohol and smoking cause hot

flashes. Staying away from these may give you lot of relief.

2] Soy contains phytoestrogens, a plant estrogen similar to

estrogen hormone. Daily consumption of soy foods is claimed by

some to bring marked relief from hot flashes. Soy-rich products

include whole soybeans, soymilk, soy powder, tofu, and miso. One

to two servings of these products daily may alleviate hot flashes.

3] Black cohosh is a herbal remedy that some people use for hot

flashes. They claim that daily consumption of 20mg to 60mg three

times provides relief from hot flashes. Additionally, it may also

reduce other menopausal symptoms like anxiety and headaches.

Discuss these and any other treatments you are currently

considering with your medical practitioner before starting, as they

might cause adverse reactions.

4] Some people claim that 400 IU to 800 IU of Vitamin E tablets

may reduce the frequency and severity of hot flashes. Vitamin E is

also claimed by some to strengthen your body’s immune system

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and even reduce the incidence of heart disease. I don’t know of any

independent endorsement of these claims by qualified researchers.

5] Prometrium is a progesterone cream available by prescription for

relief of hot flashes.

6] Gabapentin is claimed to be an effective drug for migraine

headaches and for hot flashes too.

7] Effexor is an antidepressant which is said by some to provide

considerable relief from hot flashes. It is a prescribed antidepressant

that is also said does not cause weight gain.

8] Physical exercise is a natural way that many claim will help to

reduce the impact of hot flashes. You can adopt any suitable form of

physical exercise like walking, jogging, cycling, or others. Build up

your amount of exercise to maybe thirty minutes daily but only after

consulting your doctor.

9] Hot flashes may increase in hot weather. Wear cotton clothes

and keep yourself cool where possible by staying under a fan. Avoid

going out in extreme hot weather.

10] Hormone replacement therapy is claimed to provide relief from

hot flashes. However, be aware of all advantages and disadvantages

of the therapy before starting.

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29. Diet Tips to Stay Healthy

During Menopause

Menopause induces a biological change in your life. It brings some

of these symptoms with it; hot flashes, mood changes, fatigue and


Different women experience different symptoms and with different

intensity because of their individual health situation. Healthy women

with good nutrition levels report fewer symptoms.

Your diet plays a major role in the frequency and intensity of

menopausal symptoms.

Here are a few simple dietary tips to help you stay healthy and

reduce the effect of most menopausal symptoms:

Eat a balanced diet every day with three small meals and, maybe, a

few healthy snacks in between. Eat a healthy combination of

carbohydrates, proteins, and fats. Eat food low in calories to help

your digestive system assimilate food easily. This restricts weight

gain, as commonly seen during menopause.

Consume more whole grains, dark leafy vegetables and fruits. These

provide necessary vitamins like vitamin C, carotene, essential

minerals and necessary fiber.

Some of the vegetables to include are sweet potatoes (in place of

ordinary potatoes), tomatoes, cauliflower, carrots, spinach and


Fruits like grapefruit and oranges are good sources of vitamins and


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Salads and peppers are healthy foods.

Include soy and soy products, like soymilk and soy flour, as soy

contains phytoestrogens. This is similar to body estrogen.