Menopause is a natural part of the aging process. It is the point in a woman’s life when the ovaries quit producing reproductive hormones and menstruation has stopped for 12 consecutive months. The reduction of hormones typically starts in the 40’s to 50’s and occurs gradually. Treatment focuses on decreasing the symptoms.


Symptoms vary from person to person but the most common symptoms include:

• Excessive nighttime sweating

• Mood swings

• Fatigue

• Hot flashes

• Vaginal dryness, itching, and/or pain with intercourse

• Frequent urinary tract infections

• Irregular menstrual cycles

• Heavy bleeding (for a day or two)

• Weight gain due to changes in fat distribution


Treatment is not necessary but focuses on symptom reduction. Symptom reduction includes self-care, medications and sometimes therapies. Self-care includes getting plenty of exercise, more calcium and protein rich foods in your diet, and yoga can help regulate your body rhythm. Antidepressants such as paroxetine, fluoxetine, and sertraline can help regulate your mood and hot flashes. If antidepressants do not help with the hot flashes an anticonvulsant and neuropathic pain medication called gabapentin. Gabapentin can be prescribed to regulate hot flashes and help with sleep.

Natural therapies such as the self-care recommendations can be combined with other options. Showering at night and going to bed with wet hair can help with night sweats as well as leaving the window open or using a fan. Damiana tea is useful for night sweats as well. The soy protein in the herbal tea has a similar molecular shape to estrogen and can fool the body into thinking it is estrogen, so much so that if you are being treated for an estrogen positive cancer you cannot have this tea. Kegel exercises help strengthen the pelvic floor muscles. By strengthening the pelvic floor muscles, you can:

•hold off or improve bladder leakage

•improve or eliminate pain with intercourse

•improve your orgasm.

Once you can do Kegels well you can move up to Kegel weights. I recommend Kegel weights from Intimate Rose. The link will get you a $5 discount. Intimate Rose is not associated with Intimate Health.

Your bodies natural estrogen pre-menopause, helped with protection and maintenance of physical health. As estrogen production decreases and stops, that protection is lost. For example, bone health can suffer with bone loss that can lead to osteopenia and eventually osteoporosis. Estrogen also provided protection to the cardiovascular system which is why women tend to experience cardiovascular events at a later age than men. Estrogen helped to maintain a healthy acidic vagina.

Vaginal Acidity

The acidity is what helps the vagina prevent bacteria from growing. As the acidity is lost, bacteria increases and you can have odor, itching, increased bladder infections, vaginal dryness and sometimes pain with intercourse. To help improve vaginal acidity and dryness, the North American Menopause Society recommend vaginal pH creams called vaginal moisturizers. I recommend Replen’s or RepHresh available at Target for a lower price than other retailers.

Vaginal estrogen therapy is effective and safe. It is low-dose estrogen cream applied directly to the vagina. These vaginal pH creams help to restore vaginal health and relieve vaginal dryness and discomfort with sexual activity. Improvement usually occurs within a few weeks but, complete relief can take months. Vaginal estrogen therapy is also safe for women who have had a history of breast or uterine cancer. Vaginal estrogen is only available through prescription and are available as a cream to be applied 2-3 times per week, a tablet inserted twice a week, and as a vaginal ring which is replaced every 3 months.

Oral estrogen used to treat hot flashes in some women, also treats vaginal dryness, women usually still benefit from using the vaginal cream. For pain with intercourse or bladder leakage there are Kegel exercises, water or silicone-based lubricants, pelvic floor therapy, bladder training and medications. Pelvic floor therapy is provided by a specially trained pelvic floor therapist. You cannot get this treatment through just any physical therapy office.

Finally, if pelvic floor therapy is right for you, I can get your referred. The answer to menopause is not a single or simple answer. Each woman is different, and I will help you navigate what is right for you by discussing your options so that you can make an informed decision. I recommend everyone start with the simple natural steps you can do at home and then if you need further assistance, you can schedule a virtual appointment by calling 541-315-8338. Please feel free to ask questions below.

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Sharon Zell NP