In the years since hormone therapy was dethroned as the best way to adjust to menopause—the transition ranges from a few symptom-free months to six or more life-disrupting years—how have women adapted? While some are simply toughing it out, others are trying numerous approaches, many nonmedical, to manage their hot flashes, chills, vaginal dryness, breast tenderness, sleep disruptions, headaches, and mood swings. Here are 10 strategies that can help you make the transition smoothly:
1. Get moving. Many women find that working out for an hour three or more times a week provides relief from hot flashes, though researchers haven't been able to document this in studies. Aerobic exercises such as walking, swimming, dancing, and bicycling are good options. Staying active also reduces stress and staves off the blues, which can both result from hot flashes. What's more, it builds muscle and may reduce bone loss and fractures, which become more common as estrogen production falls.
2 . Keep a hot flash journal. This may help you pinpoint what's triggering those hot flashes. Is it an overheated bedroom? Spicy supper? Stressful day? Knowing the cause may help you ward off hot flashes or at least reduce their frequency by, say, sticking with blander foods or turning down the thermostat at night.
3. Watch what you eat. In addition to spicy foods, caffeine and alcohol can disrupt sleep and trigger a hot flash. Women who are affected can limit caffeine to mornings and avoid alcohol in the evening. Experts note that it also helps to stay hydrated by drinking plenty of water. Some women swear by certain dietary supplements: vitamin E (400 IU a day), soy, and black cohosh, but, again, research is lacking on these.
4. Stick to a regular schedule. Make it a priority to get seven to eight hours of shut-eye a night, and try to go to bed and wake up at roughly the same time each day. If possible, eat your meals and snacks on a regular schedule. All of these help keep your body's systems on an even keel, better able to withstand hormonal changes.
5. Breathe deeply. Practice slow breathing from the abdomen-taking six to eight deep breaths a minute. This technique can be particularly helpful at the onset of a flash. Carving out 15 minutes twice a day for this type of slowdown can work magic in busting stress, too. You may also benefit from adding yoga or meditation to your regimen. "While these practices have not been proven to be effective for treating menopausal symptoms in clinical trials, many women do find relief," says Ellen Freeman, a research professor in the department of obstetrics and gynecology at the University of Pennsylvania.
6. Consider unconventional treatments. Until now, no large study has shown that acupuncture helps relieve menopause symptoms. But a randomized controlled trial of 267 women, published in the May/June 2009 issue of the journal Menopause, shows an overall reduction in hot flash frequency in women who received 10 treatments over 12 weeks. Massage may also help in relieving anxiety, insomnia, and headaches.
7. Alleviate vaginal dryness. This is an uncomfortable, and sometimes painful, condition frequently due to a lack of estrogen. If estrogen-free vaginal lubricants such as K-Y Jelly, vitamin E, or Replens don't provide relief, your doctor might recommend a local vaginal hormone treatment via a ring, tablet, or cream. The estrogen is absorbed into your bloodstream without passing through your liver. (If you still have a uterus, your doctor may prescribe progesterone tablets to counteract an increased risk of endometrial cancer associated with taking estrogen pills alone and possibly with nonpill forms of estrogen.) Topical estrogen is usually effective at restoring vaginal lubrication and elasticity.
8. Ask your doctor about hormone therapy. If hot flashes, mood swings, and other symptoms continue to make your life miserable after you make lifestyle changes, consult your doctor about hormone treatment-estrogen with progesterone, or estrogen alone for women who no longer have a uterus. This is controversial, and the decision is an individual one that requires carefully weighing the risks and benefits. After the 2002 Women's Health Initiative findings suggested that women taking hormones were at a higher risk for breast cancer, blood clots, and heart disease, women and doctors turned away from the treatment. Today, the pendulum seems to be swinging back. Some experts now say the risks have been overblown, especially for younger women on low doses. The WHI findings were based on a study of women with an average age of 63, says Isaac Schiff, head of the obstetrics and gynecology service at Massachusetts General Hospital. "If you start relatively early with small doses, there are some real benefits to hormones, which can bring relief with diminished risks," Schiff says. Some women are opting for bioidentical hormones, which have the same chemical structure as natural estrogen and progesterone, in the belief that these products provide safer relief of menopausal symptoms than do synthetic hormones. But the jury is still out on that.
9. Put things in perspective. In the overall scheme of things, "the transition is a very short time in your life," Schiff says. "Look at this as an opportunity to do an inventory of your diet, nutrition, exercise, and overall health. There's no terrible danger about menopause. In fact, some women actually look forward to it—happy not to have a period or worry about pregnancy."
10. Prevent crippling bone loss. While technically this isn't a menopause symptom, menopausal women typically lose a significant amount of bone mass, setting the stage for osteoporosis later in life. Now is the time to start adding extra dollops of calcium and vitamin D to your daily diet. In general, before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,500 mg per day. Good sources are fruit juices, green leafy vegetables—such as broccoli and spinach greens—almonds, and soy milk.
Vitamin D helps the body absorb calcium and stimulates bone formation. The government's recommended daily amount is 400 international units, though the National Osteoporosis Foundation (NOF) recommends 400 to 800 international units (IU) of vitamin D daily for adults under 50 and 800 to 1,000 IU of vitamin D daily for adults 50 and over. If you get 15 minutes of sunlight a day, that might be enough, at least in the summer months.