Managing Menopausal Disorders: Navigating Symptoms and Treatments

Menopausal disorders

Hello, doctor: I am 59 years old this year and entered menopause at 49.
I have been postmenopausal for almost 5 years.
Before menopause, I experienced menopausal mood disorders, so I have been taking traditional Chinese medicine for five years to regulate my body.
However, I still experience 10 days of menopausal discomfort each month, including anxiety, depression, irritability, and fatigue, which are severe.
After those 10 days, I return to normal.
The symptoms have worsened after menopause.
I once visited a gynecologist who prescribed me a box of hormone medication (Syntheti) but after taking one pill at night, I experienced palpitations, night sweats, weakness, and difficulty breathing in the morning, which frightened me, so I no longer dare to take hormone medication.
Over the years, I have relied on traditional Chinese medicine (to adjust my autonomic nervous system) and soy isoflavones + DHEA for treatment, but I still experience menopausal symptoms for 7 to 10 days each month.
After those 10 days, my body returns to a relatively normal state.
I wondered if estrogen levels were particularly low during that cycle, so I increased my soy isoflavones from 50mg to 100mg and then to 150mg, along with 90mg of DHEA, but the discomfort during those 10 days has not improved.
Menopause has lasted nearly 10 years, and I thought I could endure it, but it seems endless and has tormented me for 10 years.
Recently, I gathered the courage to see a gynecologist again for hormone therapy.
I am now applying Estrogel (in a bottle) at night and taking progesterone capsules, but both the gel and the progesterone cause me headaches.
I informed my doctor, but they only prescribed me pain relief medication, suggesting I take it only if the pain is severe.
I cannot sleep until the headache subsides.
During the day, I feel anxious, restless, depressed, fatigued, and have no appetite, but I am less anxious at night.
I feel very uncomfortable both physically and mentally, and I have been combining the traditional Chinese medicine I previously took, which seems to reduce my anxiety somewhat.
I am now on day 10 of treatment (still experiencing headaches).
Should I continue this treatment? How long will it take to alleviate my menopausal discomfort? I am really worried that the 10-day cycle of discomfort will continue to haunt me! Should I consider seeing a psychiatrist for my symptoms to completely disappear?

JULIA, 50~59 year old female. Ask Date: 2022/05/27

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, I recommend that you continue with your current treatment method and discuss any improvements with your physician in three months.
If you still experience discomfort, you may consult a psychiatrist or a neurologist to evaluate for autonomic nervous system dysfunction or other underlying causes.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2022/05/27

More Info

Managing menopausal disorders can be a complex and challenging journey, especially when symptoms persist for an extended period. It sounds like you have been dealing with significant discomfort for nearly a decade, and I commend you for your perseverance in seeking solutions.
Menopause typically occurs when a woman’s ovaries cease to produce hormones such as estrogen and progesterone, leading to various physical and emotional symptoms. Common symptoms include hot flashes, night sweats, mood swings, anxiety, depression, and fatigue. The fluctuation of hormone levels can cause these symptoms to vary in intensity and duration, which seems to be the case for you, as you experience a cycle of discomfort lasting about 7 to 10 days each month.

You mentioned that you initially tried hormone replacement therapy (HRT) with a product called "順寧娜" but experienced adverse effects such as palpitations, night sweats, and feelings of weakness. These side effects can occur with HRT, particularly if the dosage is not tailored to your individual needs. It’s crucial to communicate any adverse reactions to your healthcare provider, as they may need to adjust your treatment plan.

Your current regimen includes the use of estradiol gel and progesterone, which are common components of HRT. However, the headaches you are experiencing could be a side effect of these medications. It's not uncommon for women to experience headaches when starting or adjusting hormone therapy. If the headaches persist, it may be worth discussing alternative formulations or dosages with your doctor. Sometimes, a lower dose or a different delivery method (such as patches instead of gels) can alleviate side effects while still providing symptom relief.

In addition to HRT, you have been using herbal remedies and supplements like soy isoflavones and DHEA. While some women find relief with these alternatives, their effectiveness can vary widely. It’s essential to monitor how these supplements interact with any prescribed medications, as they can sometimes exacerbate side effects or lead to unexpected interactions.

Given the complexity of your symptoms and the duration of your discomfort, it may be beneficial to consider a multidisciplinary approach. Consulting with a mental health professional, such as a psychologist or psychiatrist, could provide additional support for the anxiety and mood disturbances you are experiencing. Cognitive-behavioral therapy (CBT) has been shown to be effective in managing menopausal symptoms, particularly mood-related issues.

As for the duration of treatment, it varies significantly from person to person. Some women find relief within a few weeks of starting HRT, while others may take several months to notice significant improvements. Regular follow-ups with your healthcare provider are essential to assess the effectiveness of your treatment and make necessary adjustments.

In summary, it is crucial to maintain open communication with your healthcare provider about your symptoms and any side effects you experience. If you continue to have significant discomfort despite treatment, consider seeking a second opinion or consulting a specialist in menopause management. Additionally, exploring mental health support could be beneficial in addressing the emotional aspects of your experience. Remember, you are not alone in this journey, and there are various options available to help you manage your menopausal symptoms effectively.

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