Defined simply as the final menstrual period, when it is no longer possible for a woman to get pregnant, the current approach to menopause has become increasingly nuanced, recognizing that each individual’s experience varies widely. Many women transition into this stage smoothly with minimal discomfort, but others experience severe vasomotor symptoms such as hot flashes, night sweats, sleep disruption, vaginal dryness, and possibly, “brain fog” and poorer mental health.
The Popularity of Hormone Therapy for Menopause
While hormone therapy (HT) was once routinely prescribed to relieve the symptoms of menopause, this stopped as a result of a large Women’s Health Initiative (WHI) study in 2002 which showed an increased risk of heart attacks, breast cancer, blood clots, and strokes for older postmenopausal females using the estrogen-progestin combination.
However, the pendulum may now be swinging back as subsequent trials that addressed the limitations of the WHI study found hormone therapy – consisting of estrogen for symptom relief and progesterone to protect the uterine lining – may be safer than previously thought. For women under 60 who are less than 10 years out from the start of menopause, an estradiol oral pill or transdermal patch can eliminate symptoms that impact sleep and mood and may decrease the risk for heart disease, diabetes and fractures due to osteoporosis. Progesterone can be taken as a pill, patch or IUD.
Further studies have shown that HT needn’t be routinely discontinued after 10 years for women at low risk for breast cancer and cardiac disease who continue to be challenged by persistent menopause symptoms.
Depression and Menopause
Additionally, new research suggests that despite a long-held association of depression with menopause, women are not universally at risk of depressive symptoms over the transition. For those more vulnerable to depression because of severe sleep disruptions, a long transition through menopause, stressful life events, or a previous history of clinical depression, a combination of psychological interventions and medication is advised. Other studies found estrogen treatment, sometimes with an antidepressant, effective in managing mood-related symptoms.
A Healthy Lifestyle to Mitigate Menopause Symptoms
The renewed acceptance of HT has spurred a reconsideration of our entire approach to menopause with practitioners asking: Can a healthy lifestyle play a key role in mitigating menopause symptoms? Can this passage be navigated successfully with informed, individualized decision-making and social and medical support? In 2024, all signs point to yes.
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