CSN-CommunityPost-Treatment for severe signs and symptoms

Hormone therapy (HT) can be used to lighten acute menopausal symptoms, particularly unrelenting night sweats, vaginal dryness, and hot flashes. Estrogen therapy (ET) is relevant only for women who have had a hysterectomy (removal of the uterus) because estrogen alone increases uterine cancer risk. Women who want to use hormone treatment who have not had a hysterectomy must use a combination of progestin and estrogen together, known as estrogen-progestin therapy (EPT).

Hormone therapy is the only FDA-approved medication for the treatment of night sweats and hot flashes. Many women report that other menopausal symptoms like insomnia, lack of concentration, and mood instability are also improved when receiving HT, although scientific information has not confirmed these claims.

The benefits of HT must be weighed against the risks, like those documented in the Women's Health Initiative, extensive scientific research looking for ways to prevent a various situation in postmenopausal women. As per the results of this research, there is a slightly enhanced risk of stroke (8 more cases per 10,000 female per year), heart attack (7 more cases per 10,000 female per year), and possibly life-threatening blood clots to the lungs (8 more cases per 10,000 female in a year) for women taking EPT. Also, dementia risk appears to double, increasing from 22 points to 45 patients per 10,000 female per year.

For a female with a hysterectomy taking ET, the heart attack risk did not increase, but the stroke risk did enhance (13 more cases per 10,000 female per year). In females taking EPT, but not those are taking ET, breast cancer enhanced by 8 cases per 10,000 female per year.

Because females with diabetes already have an increased risk of heart disease, it is especially crucial for women with diabetes to discuss HT's benefits and risks with their healthcare provider. Heart disease is the leading cause of death of American women.

On the positive side, HT use was linked with five fewer hip fractures per 10,000 women per year and six fewer cases of colorectal cancer per 10,000 women in a year in the Women's Health Initiative. HT is recommended for the prevention of osteoporosis.

Some studies suggest that taking estrogen promotes insulin sensitivity, which may, in turn, lead to a lowering of blood glucose levels. (The combination of estrogen and progestin does not seem to have this effect on blood sugar control.) This benefit alone is not considered a reason to use estrogen since there are other, safer options for preventing and treating insulin resistance (namely weight loss and enhancing physical activity).

Some females should not take HT or should only take it with caution. Hormone therapy is not supposed an option for women who have a personal history of breast cancer. However, family history alone does not prevent most females from being candidates for HT. Estrogen treatment is usually not appropriate for women with a history of severe blood clotting disorders or other medical conditions exacerbated by supplemental estrogens, such as liver disease and certain cancers.

Some non-hormonal medication has been shown to improve hot flashes for some females and is most frequently used in females with severe signs who cannot or choose not to use hormones. These medications contain certain antidepressants, neurologic medicines, and blood pressure medicines

 Urinary and Vaginal symptoms

The reduction in estrogen levels that follows menopause can make the tissues of the vulva, the urethra thin, dry, and less elastic, the lining of the vagina, and can make shortening of the urethra. These changes can cause reduced lubrication, sometimes bleeding with sexual activity, and vulvar burning, pain. They can also enhance the likelihood of developing vaginal infections, urinary tract infections, and noninfectious vaginitis (inflammation of the vagina not created by disease).

Topical, nonprescription lubricants can give temporary relief from vaginal dryness and help with sexual activity, although they do not change the long-term tissue changes resulting from estrogen loss. Over-the-counter vaginal moisturizers can assist relieve the symptoms of vaginal dryness, like itching and burning. Still, such products do not provide estrogen to the tissues and hence do not treat the underlying condition of vaginal dryness. A prescription vaginal estrogen product like a cream, tablet, or ring applied directly to the vagina, on the other side, can cause urethral and genital tissue to become thicker, moister, and elastic. Vaginal estrogen is not thought to carry the same risks as systemic hormone therapy (therapy that affects the entire body, such as HT administered in pill or patch form) because vaginal estrogen probably does not get into the bloodstream in any significant amounts.

While replacing vaginal estrogen can decrease the risk of urinary tract infections and decrease the need to urinate frequently that often accompanies estrogen loss, an existing urinary tract infection should be treated with antibiotics.

Weight gain

For several reasons, women are prone to accumulating excess body fat, whether or not they have diabetes. Unlike male hormones, which keep muscle mass high, female hormones promote fat formation. The fat is typically deposited first on the thighs and buttocks, then the stomach, followed by the upper body and arms. Women with Type 2 diabetes or metabolic syndrome, however, typically accumulate fat in the abdominal region.

  In addition to biological factors, individual lifestyle choices can also lead to increased body fat. Skipping meals and following "crash" diets can lead to weight gain in the long term by causing the body to slow down its metabolism and use calories more efficiently. Therefore, the key to weight loss is to eat regularly scheduled meals, choose healthy foods containing whole grains, fruits, and vegetables, reduce your fat intake, and consume smaller portions.

Losing even 10 to 20 pounds can help you control your blood glucose levels more efficiently, as well as improve your circulation, blood pressure, and heart health. Increasing your level of physical activity can help with all of these goals, and it's good for your diabetes control and heart health even if you don't lose weight. The following are some strategies for putting an exercise plan into action:

·        Set small goals. If you are currently not physically active, start by walking for 5 to 10 minutes, three days a week. Increase your time and distance gradually.

·        Do an activity you enjoy. Try walking, swimming, water exercises, using an exercise bike, or taking yoga or Pilates classes. Doing more than one type of physical activity works in different parts of your body and can keep your exercise routine from becoming stale.

·        Exercise with other people who keep you motivated.

·        Keep a log of your activities, both for motivation and to see how physical activity affects your blood glucose levels.

·        Become more active in your daily life. Small steps such as taking a walk during your lunch hour and taking the stairs instead of the elevator can add up.

·        Exercise one to two hours after eating. This will help control blood glucose levels.

A unique journey

Perhaps the most crucial thing a perimenopausal woman can do is to listen to and respect her body. Just as each person's diabetes requires an individualized control plan, so is each woman's experience with menopause unique. Because it's common to experience some changes in blood glucose control as you go through menopause, it helps maintain a regular schedule of blood glucose monitoring and good exercise and eating habits. Using relaxation techniques to reduce stress and trying to get adequate sleep can help, too. Consult your medical provider if your symptoms are severe and are dramatically affecting your quality of life.

If you are interested in trying hormone therapy, or taking other medicines to control your symptoms, talk to your healthcare provider about the benefits and risks related to your health. This article and "Resources for Readers" can help you formulate a list of questions or concerns to bring up at your appointment. The goal of balancing diabetes control and menopause symptoms should be to remain healthy and vital so you can maximize the quality of your life.