Food for Health
Food for Health
Women's health
medical conditions

Women's health

Explore the available health information, treatment context, and integrative evidence for Women's health.

Background
  • Healthcare for women includes the entire spectrum of a woman'slife, not just pregnancy and childbirth. Besides developing conditions such as diabetes, heart disease, and cancer, women have special health issues that revolve around hormonal changes in their bodies and their reproductive organs. Also, medical problems canaffect women and men differently.
  • Women's health issues include breast conditions, menstruation, infections, menopause, heart conditions, mental health, osteoporosis, and sexual health.
  • This monograph focuses on hormonal changes in the female body and the relationship these hormonal changes have on the overall health of a woman. Other women's health issues, such as osteoporosis, heart disease, breast cancer, and ovarian cancer, are covered in separate condition monographs.
  • Hormonal changes in women can cause health imbalances to arise, including menopause, pre-menstrual syndrome (PMS) and related conditions (such as dysmenorrhea, menorrhagia, amenorrhea, and polycystic ovary syndrome), and infections of the vagina.
  • For women, hormone imbalance is the term that describes the incorrect relationship between the two primary hormones, progesterone and estrogen, in the body.
  • For a woman to have regular menstrual cycles, the reproductive organs, including the ovaries and uterus, should all be functioning normally. The hypothalamus stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The hypothalamus is a part of the brain that links the nervous system with hormone release. FSH and LH cause the ovaries to produce the hormones estrogen and progesterone. Estrogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. In addition, a woman's genital tract should be free of any abnormalities to allow the passage of menstrual blood.
  • Normally, in the first 10-12 days of the menstrual cycle, only estrogen is produced in the female body. If ovulation occurs, then progesterone is produced by the ovaries. On or about day 28, levels of both hormones drop, resulting in menstruation. However, if ovulation does not occur, women can still have the menstrual period, but the estrogen is never "balanced" by progesterone, which needed ovulation to trigger its production. This results in symptoms of hormone imbalance;- estrogen is present but progesterone production drops to very low levels.
  • Variations in the estrogen/progesterone balance can have a dramatic effect on health. Hormonal imbalances are also thought to play a major role in PMS, or premenstrual syndrome.
  • Hormonal imbalances in women may be a result of aging, stress levels, a lack of exercise, poor nutrition, alcohol intake, poor sleep, synthetic hormone replacement therapy (HRT), and environmental toxins, called xenoestrogens, such as the pesticides DDT and dioxin.
  • Symptoms of hormone imbalance in women tend to increase as a woman ages and continue until menopause. Hormone imbalance symptoms can include: allergy symptoms, such as sneezing and runny nose; depression, fatigue and anxiety; endometriosis, a condition in which the tissue that lines the uterus is found to be growing outside the uterus, on or in other areas of the body; fibrocystic breasts or lumps in the breasts; hirsutism or hair loss and facial hair growth; headaches, dizziness and foggy thinking; low sex drive; osteoporosis or the gradual loss of bone; PMS or premenstrual syndrome; urinary tract infections and incontinence; uterine fibroids; weight gain, water retention and bloating; and wrinkly skin.
Signs and Symptoms
  • Menopause :
  • Menstrual changes: Many women experience irregular periods due to the changing hormone levels and the decreased frequency of ovulation (egg release). The changes may be subtle at first and then gradually become more noticeable. Common changes include short cycles (less than 28 days), bleeding for fewer days than usual, heavier than usual bleeding, lighter than usual bleeding, and missed periods.
  • Although menstrual irregularities are expected during menopause, menstrual changes can also be caused by conditions such as fibroids or pregnancy. Women who experience heavy bleeding (usually with clots), periods that come more often than every three weeks, spotting between periods, or bleeding after intercourse, should see their doctor or other healthcare provider.
  • After menopause, women no longer menstruate. Any woman who experiences vaginal bleeding after menopause should see her doctor or other healthcare provider. Hormone treatments can sometimes cause vaginal bleeding to resume as a side effect.
  • Hot flashes: As many as 85% of women experience hot flashes during menopause. Hot flashes cause a warm or hot flushed sensation that usually begins in the head and face and then radiates down the neck to other parts of the body. There may be red blotches on the skin. Each hot flash averages 2.7 minutes and is characterized by a sudden increase in heart rate and an increase in blood flow to the extremities (such as feet and hands). This process leads to a rise in skin temperature and a sudden onset of sweating, particularly in the upper body. Hot flashes can occur before, during, or after menopause. Hot flashes can begin when a woman's cycles are still regular or, more commonly, as menopause approaches and her cycles become more irregular. They usually last for less than a year following the last menstrual period, although some women continue to experience hot flashes five to 10 years after menopause. Hot flashes can occur once a month, once a week, or several times an hour. They can happen any time of day or night. If they happen at night (such as night sweats), they can interrupt sleep and drench clothing and sheets. Loss of sleep can eventually lead to irritability and fatigue.
  • Skin and hair changes: Estrogen helps keep the skin smooth and moist. The loss of estrogen during menopause makes the skin dry, thin, lax, and transparent. The blood vessels are easier to see, and the skin bruises easily. The woman may experience growth of facial hair, but thinning of hair in the temple region.
  • Vaginal changes: Women may experience vaginal changes. In particular, the tissues of the vagina and vulva may become thin and dry (called vaginal atrophy), which can lead to itching and discomfort during sexual intercourse. In some women, vaginal dryness is the first sign of menopause.
  • Other changes: Other changes that may occur during menopause include: loss of bladder tone, which can result in stress incontinence (leaking urine when coughing, sneezing, laughing, or exercise); headaches; dizziness; loss of some muscle strength and tone; increasing loss of bones, increased risk for osteoporosis; increased risk for a heart attack when estrogen levels drop; emotional changes associated with menopause such as irritability, mood changes, lack of concentration, difficulty with memory, tension, anxiety, and depression; and insomnia that may result from hot flashes that interrupt sleep. Sex drive in women may also be affected by menopause. Decreases in sex drive are seen in approximately 25-40% of women experiencing menopause.
  • PMS :
  • For many women, the signs and symptoms of premenstrual syndrome are an uncomfortable and unwelcome part of their monthly menstrual cycle. The most common physical and emotional signs and symptoms associated with premenstrual syndrome include: weight gain from fluid retention; abdominal bloating; breast tenderness; tension or anxiety; depressed mood; crying spells; mood swings and irritability or anger; oily skin, acne, or greasy hair; appetite changes and food cravings; vertigo or dizziness; heart arrhythmias (irregular heart beat); insomnia or trouble falling asleep; joint or muscle pain; headache; and fatigue.
  • Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems. For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, symptoms disappear as the menstrual period begins. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability, and tension.
  • Other conditions due to hormonal imbalances :
  • Premenstrual dysphoric disorder (PMDD): Premenstrual dysphoric disorder (PMDD) symptoms are similar to those of PMS, but they are generally more severe and debilitating. Symptoms occur during the last week of most menstrual cycles and usually improve within a few days after the period starts. Five or more of the following symptoms must be present: a feeling of sadness or hopelessness, possible suicidal thoughts; feelings of tension or anxiety; panic attacks; mood swings marked by periods of teariness; persistent irritability or anger that affects other people; disinterest in daily activities and relationships; trouble concentrating; fatigue or low energy; food cravings or binge eating; sleep disturbances; feeling "out of control;" and physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain.
  • Dysmenorrhea: Symptoms of dysmenorrheal include: cramping in the lower abdomen; pain in the lower abdomen; low back pain; pain radiating down the legs; nausea and vomiting; diarrhea; fatigue; weakness; fainting; and headaches.
  • Amenorrhea: The main symptom of amenorrhea is an absence of menstruation. Additional symptoms may be present depending on the associated condition, including: galactorrhea (breasts produce milk in a woman who is not pregnant or breastfeeding); headache or reduced peripheral vision could be a sign of an intracranial tumor; increased hair growth in a male pattern (hirsutism) may be caused by excess androgen (a hormone that encourages development of male sex characteristics); vaginal dryness, hot flashes, night sweats, or disordered sleep may be a sign of ovarian insufficiency or premature ovarian failure; a noticeable weight gain or weight loss may be present; and excessive anxiety may be present in women with associated psychiatric abnormalities.
  • Menorrhagia: The signs and symptoms of menorrhagia may include: menstrual flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours; the need to use double sanitary protection to control menstrual flow; the need to change sanitary protection during the night; menstrual periods lasting longer than seven days; menstrual flow that includes large blood clots; heavy menstrual flow that interferes with a regular lifestyle; constant pain in the lower abdomen during menstrual periods; or tiredness, fatigue, or shortness of breath.
  • Osteoporosis: In the early stages of osteoporosis, individuals probably will not have symptoms. As the disease progresses, the individual may develop symptoms related to weakened bones, including: back pain; loss of height and stooped posture; a curved upper back, known as dowager's hump; broken bones (fractures) that might occur with a minor injury, especially in the hip, spine, and wrist; and compression fractures in the spine that may cause severe back pain.
  • Polycystic ovary syndrome: Women with polycystic ovary syndrome (PCOS) usually have several of the many signs and symptoms associated with PCOS. These signs and symptoms include: irregular or no menstruation, which is the most common characteristic; signs of excess androgen (male hormone), such as long, coarse hair on the face, chest, lower abdomen, back, upper arms, or upper legs (hirsutism); acne; and male-pattern baldness (alopecia). However, not all women who have polycystic ovary syndrome have physical signs of androgen excess. Polycystic ovary syndrome is the most common cause of female infertility in the United States. The ability to use insulin effectively is impaired in PCOS and can result in high blood sugar levels and diabetes. Other symptoms that may occur with PCOS include: high blood pressure; high blood cholesterol; elevated levels of C-reactive protein, which may be associated with cardiovascular problems such as heart attack; nonalcoholic steatohepatitis (or fatty liver); and sleep apnea (pauses in breathing during sleep).
  • Vaginitis (yeast infection): Vaginal yeast infections can produce a variety of symptoms, such as abnormal or increased discharge, itching, fishy odor, irritation, painful urination, or vaginal bleeding.
Diagnosis
  • A doctor will review the woman's medical history and perform a physical examination, including a pelvic exam. During the pelvic exam, a doctor will check for any abnormalities in the reproductive organs and look for indications of infection. The doctor will insert an instrument (called a speculum) and/or fingers into the vagina to aid in examination. There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome (PMS) or menopause.
  • The signs and symptoms of menopause, such as hot flashes and mood swings, are enough to tell most women they have begun going through the transition. Under certain circumstances, a doctor may check the level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase and estradiol levels decrease. A doctor may also recommend a blood test to determine the level of thyroid-stimulating hormone, as hypothyroidism (low thyroid hormone levels) can cause symptoms similar to those of menopause.
  • PMS is difficult to diagnose because there is not a clear cause. The symptoms of PMS are varied and are found in other disorders. The cyclical pattern is crucial for a diagnosis - symptoms appear prior to menstruation and resolve when bleeding begins. Hormone levels in women with PMS are normal. Consequently, there are no laboratory tests that determine if a woman has PMS. However, a doctor may do blood tests to determine if the individual has another condition, such as a thyroid condition or early menopause (when menstruation stops, usually associated with aging).
  • The medical history and physical examination involve an evaluation of the symptoms and when they occur in relation to menstruation. Many healthcare providers advise women to keep a diary of menstrual cycles and the physical and psychological changes they experience over the course of several months. The menstrual diary provides clues to the physician and helps women understand and cope with the changes.
  • A doctor may attribute a particular symptom to PMS if it is part of a predictable premenstrual pattern. To establish a pattern, the physician may ask the individual to keep a record of signs and symptoms on a calendar or in a diary for at least two menstrual cycles. It is important to note the day that the first symptoms appear and disappear. Also it is important to be sure to mark the day the period started and ended.
  • Imaging tests: To rule out other causes of symptoms of menopause or PMS or to identify the cause of secondary dysmenorrhea, a doctor may request diagnostic tests, including imaging tests. These noninvasive tests enable a doctor to look for abnormalities inside the pelvis. The imaging tests most often used to diagnose the cause of secondary dysmenorrhea include ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI).
  • Laparoscopy: Laparoscopy is usually performed through a small (1 centimeter) incision into the belly button with the patient under general anesthesia in the operating room. A camera is mounted to a long tube about as big around as one's first finger, which is placed into the incision in the belly button and into the abdominal cavity. Once inside, carbon dioxide gas is used to expand the abdominal cavity so the internal organs can be visualized. A gynecologist (doctor specializing in female issues) either looks through the tube, or, more commonly, looks at a video monitor via the attached camera. A careful survey is made of the liver, appendix, the top layer of intestines, bladder, kidney tubes (ureters), and the gynecologic organs. Specifically, the gynecologist is able to fully visualize the uterus (womb), ovaries, fallopian tubes, rectum, and the bottom part of the cervix (the opening to the uterus) called the cul-de-sac.
  • Hysteroscopy: Hysteroscopy provides a way for a doctor to look inside the uterus. A hysteroscope is a thin, telescope-like instrument that is inserted into the uterus through the vagina and cervix. This tool often helps a doctor diagnose or treat a uterine problem. Hysteroscopy is minor surgery that is performed either in a doctor's office or in a hospital setting. It can be performed with local, regional, or general anesthesia--sometimes no anesthesia is needed. There is little risk involved with this procedure for most women.
  • Recording symptoms: Keeping a record to identify the triggers and timing of symptoms of PMS and menopause is recommended. This will allow the individual and doctor to intervene with strategies that may help to lessen them. PMS is often incorrectly diagnosed as another physical or emotional problem. The main characteristic that distinguishes PMS is the timing of the symptoms.
  • To diagnose PMS a record of symptoms needs to be kept on a calendar for two to three months. This calendar can help individuals see patterns in symptoms. A doctor will use the calendar along with a health history and physical exam to determine if the individual has PMS.
  • Use a calendar to record symptoms, such as hot flashes, mood swings, bloating, and heart palpitations. Rate each symptom on a scale of zero to three: zero (0) means the symptom is not present; one (1) means the symptom is mild; two (2) means the symptom is moderate; and three (3) means the symptom is severe and interferes with normal daily activities.
  • Start the calendar on the first day of the period (day 1) and use it every evening for one cycle. At the start of the next cycle (period), a doctor will help the individual calculate their scores and determine if PMS is present or if the symptoms of PMS are being caused by other health conditions, such as thyroid disorders, depression, or anxiety.
Complications
  • Menopause :
  • Several chronic medical conditions tend to appear after menopause. By becoming aware of the following conditions, women can take steps to help reduce their risk.
  • Cardiovascular disease: When estrogen levels decline, the risk of cardiovascular disease increases. Heart disease is the leading cause of death in women and men. Heart disease risk-reduction steps include stopping smoking, reducing high blood pressure, getting regular aerobic exercise, and eating a diet low in saturated fats and plentiful in whole grains, fruits, and vegetables.
  • Osteoporosis: During the first few years after menopause, women may lose bone density at a rapid rate, increasing their risk of osteoporosis. Osteoporosis is a condition that causes bones to become brittle and weak, leading to an increased risk of fractures. Postmenopausal women are especially susceptible to fractures of the hip, wrist, and spine. It is important during this time for women to get adequate calcium and vitamin D. It is recommended by healthcare professionals for postmenopausal women to have about 1,200-1,500 milligrams of calcium and 800 I.U. (international units) of vitamin D daily. It's also important to exercise regularly. Strength training and weight-bearing activities such as walking and jogging are especially beneficial in keeping the bones strong and healthy.
  • Urinary incontinence: Urinary incontinence is the loss of bladder control. As the tissues of the vagina and urethra lose their elasticity, postmenopausal women may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing, or lifting (stress incontinence).
  • Weight gain: Many women gain weight during the menopausal transition. Individuals may need to eat less, perhaps as many as 200-400 fewer calories a day, and exercise more just to maintain their current weight.
  • PMS :
  • PMS symptoms may become severe enough to hinder women from maintaining normal function. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.
  • Premenstrual dysphoric disorder (PMDD): PMDD is a condition where women suffer from many of the physical symptoms of PMS, often more severely than other women. In addition, they experience debilitating emotional symptoms such as feelings of hopelessness, isolation, and extreme mood swings. Researchers estimate that PMDD affects between 3-8% of women in their reproductive years. Major depression is common in women with PMDD, although PMDD can occur in women who do not have a history of major depression.
  • The complications of secondary dysmenorrhea depend on the underlying cause. For instance, pelvic inflammatory disease can scar fallopian tubes and compromise reproductive health. The scarring can lead to an ectopic pregnancy, in which the fertilized egg stays in the fallopian tube rather than traveling through the tube to implant in the uterus, or it implants somewhere else outside the uterus. Endometriosis, another possible cause of secondary dysmenorrhea, can lead to impaired fertility.
Treatment
  • Menopause, perimenopause, and postmenopause :
  • Calcium management: Adequate calcium intake is important to prevent osteoporosis and bone fractures. Daily calcium intake for postmenopausal women should be around 1,200 milligrams. Women should eat foods rich in calcium (such as dairy products, leafy green vegetables, tofu, calcium-fortified foods), as well as foods that promote calcium absorption. A glass of milk provides about 300 milligrams of calcium. Intake of foods that rob the bones of calcium, such as animal protein and salt, should be limited. Vitamin D helps the body absorb calcium. Fifteen minutes of sun exposure every day provides sufficient vitamin D. Foods such as fortified milk, liver, and tuna contain vitamin D. Women should ask their healthcare provider or nutritionist if they should take a vitamin D supplement.
  • Calcium supplements are available in several forms: amino acid chelate, calcium carbonate, calcium chloride, calcium lactate, calcium gluconate, bone meal, dolomite, hydroxyappetite, and calcium citrate. To maximize absorption, supplements containing amino acid chelate, calcium citrate, gluconate, or hydroxyappetite should be taken. Calcium supplements should be taken with food.
  • Exercise: Exercise is an important part of preventative healthcare for postmenopausal women. By increasing cardiovascular fitness and strengthening the bones, exercise helps prevent heart disease and osteoporosis. Low impact, weight-bearing exercises, such as walking, jogging, tennis, racquetball, and dancing are helpful. Women diagnosed with osteoporosis or cardiovascular disease should consult with their healthcare provider before initiating an exercise program.
  • Hormone replacement therapy: Hormone replacement therapy (HRT) uses man-made estrogens and progestin (synthetic progesterone) to ease the symptoms of menopause. The hormones are available in a variety of forms: pills, vaginal creams, vaginal ring inserts, implants, injections, and patches worn on the skin.
  • HRT has many short-term and long-term side effects. It is important to weigh all of the potential benefits and risks, preferences, and needs before beginning HRT. The benefits and side effects vary considerably from woman to woman. Women who take HRT should be closely monitored by a healthcare professional to ensure that they benefit as much as possible from the hormone therapy. Sometimes, changing the dosage or the way it is administered can help to control side effects.
  • Minor side effects include bloating, breast tenderness, cramping, irritability, depression, and menstrual bleeding for months or years following menopause. More serious risks include: breast cancer - women who have not had a hysterectomy and use estrogen supplements are at increased risk for invasive breast cancer and cardiovascular disease - HRT causes an increased risk for stroke (neurological damage caused by a lack of oxygen to the brain), heart attack, and cardiovascular disease.
  • Endometrial cancer has been linked to high-dose estrogen supplements. Women who have not had their uterus removed are prescribed low doses of estrogen with progestin (progestin protects against endometrial cancer).
  • Women who take HRT are at increased risk for deep vein thrombosis (DVT or blood clots).
  • HRT may help to prevent or delay the development of many diseases, including; osteoporosis; Alzheimer's disease; colon cancer; macular degeneration - the leading cause of visual impairment in persons over age 50; urinary incontinence; and skin aging.
  • Various types and dosages of estrogen and progestin are available and the type of HRT recommended often depends on particular symptoms. For example, women who experience vaginal dryness may opt for a vaginal cream or vaginal ring insert, both of which alleviate dryness. The vaginal ring insert can also help urinary tract problems. For women who suffer from hot flashes, pills or patches may be helpful.
  • Hormonal medications :
  • Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on the individual's personal and family medical history, a doctor may recommend estrogen in the lowest dose needed to provide symptom relief for the individual.
  • Conjugated estrogens: Conjugated estrogens are a mixture of estrogens prescribed to treat menopausal symptoms. The conjugated estrogens in Premarin® and Premarin Vaginal Cream® are obtained from pregnant mare (female horse) urine. The conjugated estrogens in Cenestin® are synthetic.
  • Dienestrol: Dienestrol (Ortho-Dienestrol®) is a synthetic, nonsteroidal, estrogen vaginal cream used to treat atrophic vaginitis. Side effects include vaginal discharge, increased vaginal discomfort, uterine bleeding, vaginal burning sensation, breast tenderness, and swelling in the hands or feet.
  • Esterified estrogens: Esterified estrogens (Estratab®, Menest®) are estrogenic substances consisting of 75-85% natural estrogens and 15-25% equine (mare or female horse urine) estrogens. They are supplied in tablet form and are used to treat hot flashes and atrophic vaginitis and urethritis (infections due to thinning and drying of vaginal tissues).
  • Estradiol: Estradiol is one of the three major estrogens made by the human body and is the major estrogen secreted during the menstrual years. It is available as an oral pill (Estrace®), transdermal skin patch (Climara®, Estraderm®, Vivelle®), vaginal tablet (Vagifem®), and vaginal cream (Estrace Vaginal Cream®).
  • Estropipate (estrone): Estropipate is an estrogenic substance derived from estrone, one of the three major estrogens produced by the body. Estrone is produced from estradiol and is a less potent estrogen. It is available in pill form (Ogen®, Ortho-Est®) and prescribed to treat hot flashes and vaginal atrophy and to help prevent osteoporosis.
  • Ethinyl estradiol: Ethinyl estradiol (Estinyl®) is a synthetic nonsteroidal estrogen available as a tablet that is prescribed to treat hot flashes (vasomotor symptom). It is administered on a cyclical basis (such as three weeks on and one week off) with attempts to discontinue or taper at three to six month intervals.
  • Testosterone: Testosterone is one of the androgens or male hormones and is also produced by women. Testosterone contributes to muscle strength, appetite, well-being, and sex drive (libido). The level of testosterone falls rapidly after menopause, and some women take testosterone supplements in addition to estrogen and progestin as part of HRT. However, supplemental testosterone can produce side effects and has potentially serious risks. Common side effects include weight gain, acne, facial hair, and liver disease. Testosterone can exacerbate estrogen's carcinogenic effect on breast and uterine tissue.
  • Other medications :
  • Low-dose antidepressants: Venlafaxine (Effexor®), an antidepressant related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), has been reported to decrease menopausal hot flashes. Other SSRIs can be helpful, including fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®), citalopram (Celexa®), and sertraline (Zoloft®). Side effects include drowsiness and fatigue
  • Gabapentin (Neurontin®): Gabapentin (Neurontin®) is approved to treat seizures, but it also has been reported to significantly reduce hot flashes. Side effects include drowsiness, sedation, blurred vision, nausea, vomiting, or tremor.
  • Clonidine (Catapres®): Clonidine (Catapres®) is typically used to treat high blood pressure. However clonidine may significantly reduce the frequency of hot flashes. Side effects include slow heart rate, low blood pressure, fatigue, dizziness, headache, constipation, nausea, vomiting, diarrhea, insomnia, or a dry mouth.
  • Bisphosphonates: Alendronate (Fosamax®), risedronate (Actonel®), ibandronate (Boniva®), and zoledronate (Zometa®) are approved by the U.S. Food and Drug Administration (FDA) for the prevention and treatment of osteoporosis in postmenopausal women. Alendronate has been approved for management of osteoporosis in men. Both alendronate and risedronate are approved for the prevention and treatment of steroid-induced osteoporosis in men and women. Bisphosphonates help slow down bone loss and have been shown to decrease the risk of fractures. All are taken on an empty stomach with water. Because bisphosphonates have the potential for irritating the esophagus, remaining upright for at least an hour after taking these medications is recommended by healthcare professionals. Alendronate and risedronate can be taken once a week, while ibandronate can be taken once a month. An IV form of ibandronate, given through the vein every three months, also has been FDA-approved for the management of osteoporosis. Another IV bisphosphonate being studied for osteoporosis is zoledronic acid or zoledronate (Zometa®). This form is injected once yearly.
  • Side effects, which can be severe, include nausea, abdominal pain, and the risk of an inflamed esophagus or esophageal ulcers, especially if the individual has had acid reflux or ulcers in the past. If individuals cannot tolerate oral bisphosphonates, the doctor may recommend the periodic intravenous infusions of a bisphosphonate.
  • Use of bisphosphonates in women who are pregnant or breastfeeding is not well studied. Blood calcium levels in women who take bisphosphonates during pregnancy are usually monitored. Individuals using Boniva® injection will have blood levels of creatinine measured prior to each dose to determine kidney function. Creatinine is measured using blood tests.
  • Selective estrogen receptor modulators (SERMs): Selective estrogen receptor modulators (SERMS) mimic the positive effects of estrogen on bones without some of the serious side effects such as breast cancer and stroke. Raloxifene (Evista®) decreases spine fractures in women. Hot flashes are a common side effect of raloxifene, and individuals with a history of blood clots should not use this drug.
  • Vaginal estrogen: To relieve vaginal dryness, estrogen can be administered locally in the vagina using a vaginal tablet (Vagifem®), ring (Nuvaring®), or cream (Premarin® vaginal cream). This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse, and some urinary symptoms.
  • PMS and related conditions of hormonal imbalances :
  • Studies have reported that women with PMS should consider treatment if they notice any of the following, especially one to two weeks before their period: poor performance at school or at work as a result of difficulty concentrating, irritability, or fatigue; disturbing physical symptoms, such as breast tenderness, bloating, hot flashes, and headaches; problems in social life, such as damaged relationships with spouses, friends, lovers, and colleagues; difficulty parenting; and suicidal thoughts - suicidal thoughts are common in women with severe PMS.
  • Diet and physical activity: Diet and physical activity changes are the preferred method for treating symptoms of PMS. Eating a healthy diet is important for general health and may also help relieve PMS symptoms such as bloating, breast tenderness, weight gain, irritability, and headaches. A healthy diet includes eating foods high in complex carbohydrates, like whole grains and fresh fruits and vegetables, and avoiding saturated fats. It may also help to avoid salt, sugar, caffeine, alcohol, red meat, and sometimes dairy products. Eating more small meals each day instead of three large meals may reduce food cravings and mood swings.
  • Most women report that exercise improves their PMS symptoms. It is especially helpful in relieving stress, improving mood, and preventing weight gain. Physically activity should include exercise for at least 30 minutes on most days of the week throughout the menstrual cycle. Walking or other moderate physical activity may be enough, but some women find they need more vigorous aerobic exercise, such as jogging, biking, swimming, or climbing stairs.
  • Anti-inflammatory drugs: Over-the-counter (OTC) drugs such as aspirin and nonsteroidal anti-inflammatory drugs (NSAID), such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®) may be used for symptoms of dysmenorrhea (painful menstruation) and associated headaches.
  • Progesterone: Progesterone can be delivered using suppositories (a suppository is a drug delivery system that is inserted either into the rectum, vagina, or urethra where it dissolves), an oral form (by mouth), or topically (applied to the skin). Progesterone products can be purchased from compounding pharmacies. Compounded progesterone creams usually contain pharmaceutical progesterone mixed with other natural progesterone sources, including plants.
  • Oral contraceptives: Oral contraceptives, or birth control pills, stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms. Yaz®, a newer type of birth control pill that is a combination of the hormones drospirenone and ethinyl estradiol, has been reported to be effective in reducing the physical and emotional symptoms of premenstrual dysphoric disorder (PMDD). Yaz® is the first oral contraceptive to be approved for this use. For severe cramping, a doctor might recommend low-dose oral contraceptives to prevent ovulation, which may reduce the production of prostaglandins and therefore the severity of cramping. Low-dose oral contraceptives (such as Loestrin®) may increase risk for heart attack or stroke (neurological damage due to lack of oxygen to the brain).
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac®, Sarafem®), paroxetine (Paxil®), and sertraline (Zoloft®), have been successful in reducing symptoms such as fatigue, food cravings, and sleep problems. These drugs are generally taken daily, and may cause side effects such as sedation, insomnia, and weight gain. For some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
  • Medroxyprogesterone acetate (Depo-Provera®): Medroxyprogesterone (Depo-Provera®) is used for severe PMS or PMDD. Depo-Provera® is an injection that can be used to temporarily stop ovulation. However, Depo-Provera® may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache, and depressed mood.
  • Diuretics: Diuretic medications help relieve the body of excess fluid. Excess fluid causes symptoms of bloating and swelling (especially in the feet and ankles). Diuretics include hydrochlorothiazide (Hydroduiril®) and furosemide (Lasix®). Some diuretics may deplete the body of electrolytes, such as potassium. A healthcare professional will advise the patient if potassium supplements are needed. Often, adding potassium rich foods to the diet, such as bananas, is sufficient.
  • Anti-anxiety medicines: If antidepressant medications are not helpful for anxiety, anti-anxiety medicines can be used to relieve anxiety associated with PMS. The one most commonly used is alprazolam (Xanax®). It is in the class of medicines called benzodiazepines and increases the amount of the neurotransmitter GABA. Side effects include drowsiness, sedation, and blurred vision. It is recommended to use caution when driving an automobile or operating heavy machinery if taking benzodiazepines. Because benzodiazepines can be addictive, they must be used cautiously.
  • Another anti-anxiety medicine, buspirone (BuSpar®), may also help reduce anxiety and depression in PMS. It is not addictive and has less severe side effects than the benzodiazepines.
  • GnRH agonists: Gonadotropin-releasing hormones (GnRH) suppress the hormones that cause ovulation - follicle stimulating hormone (FSH) and luteinizing hormone (LH). GnRH agonists are drugs that cause a temporary menopause-like state (lack of menstruation). They are highly effective in treating PMS, including breast tenderness, irritability, and fatigue. However, GnRH agonists can also cause menopausal symptoms, such as hot flashes and vaginal dryness. In addition, long-term use (more than six months) is associated with bone loss (osteoporosis). Small doses of estrogen and progesterone can be given in addition to GnRH agonists to lessen these side effects and allow long-term use. GnRH agonists include goserelin (Zoladex®, available as an implant), leuprolide (Leupron®, available as an injection), and naferelin (Synarel®, available in a nasal spray).
  • Anti-infectives: If a vaginal yeast infection is present, drugs prescribed may involve antifungal creams and suppositories, antibiotics, and other prescription drugs. Vaginal creams and vaginal applications are often recommended first rather than oral medication. Common medications used include: the prescription antifungal medications metronidazole (Flagyl®) and fluconazole (Diflucan®); antibiotics including doxycycline (Doryx®, Vibramycin®) and azithromycin (Zithromax®); and over-the-counter (OTC) antifungal medications such as miconazole (Monistat®).
  • Some self-care techniques include vinegar douches or sitz baths in a solution of one teaspoon of vinegar for every gallon of water, and eating yogurt containing live acidophilus (probiotic) cultures. It is recommended by healthcare professionals to abstain from sexual intercourse until treatment is completed.
  • Hysterectomy: If the individual's menstruation (periods) are heavy, not regular, or last for many days each cycle and nonsurgical methods have not helped to control bleeding, a hysterectomy may bring relief. A hysterectomy is the complete removal of the uterus (womb). The ovaries and fallopian tubes may also be removed if necessary. Hysterectomies are very common. One in three women in the United States has had a hysterectomy by age 60. A hysterectomy will stop the menstruation (period) and the individual will no longer be able to become pregnant. Symptoms of menopause may also begin, such as hot flashes, irritability, and vaginal dryness. Individuals should discuss a hysterectomy carefully with a doctor, family members, and counselor if needed.
  • Hysterectomies are performed in a hospital. Hysterectomies involve a cut in the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy). Sometimes an instrument called a laparoscope is used to help see inside the abdomen during vaginal hysterectomy. The type of surgery that is done depends on the reason for the surgery. Abdominal hysterectomies are more common and usually require a longer recovery time. An abdominal hysterectomy may also cause greater discomfort than following a vaginal procedure and a visible scar on the abdomen may be present.
  • Recovery from a hysterectomy generally takes four to six weeks.
  • A hysterectomy is generally very safe, but as with any major surgery, there are risks of complications. Such complications include blood clots, infection, excessive bleeding, or an adverse reaction to the anesthesia. Other risks of hysterectomy are: damage to the urinary tract, bladder, or rectum during surgery, which may require further surgical repair; loss of ovarian function; or early onset of menopause.
  • Other reasons to perform a hysterectomy in women include: fibroids (tumors); endometriosis not cured by medicine or surgery; uterine prolapse or when the uterus drops into the vagina; cancer of the uterus, cervix, or ovaries; vaginal bleeding that persists despite treatment; and chronic pelvic pain. Surgery is usually a last resort.
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Prevention
  • Fortunately, many of the signs and symptoms associated with women's hormonal imbalances are temporary. Take these steps to help reduce or prevent the unwanted symptoms of menopause and/or premenstrual syndrome (PMS):
  • Decreasing hot flashes: Hot flashes are caused by rapid decreases in estrogen levels. Although hot flashes cannot be prevented, they can be helped and made less uncomfortable. Techniques that can help individuals deal with hot flashes include: wearing loose clothing and dressing in layers so the layers of clothing can be peeled off during a hot flash; wearing fabrics that absorb moisture and dry quickly; avoiding foods that may trigger hot flashes, such as hot drinks and spicy foods; splashing the face with cool water at the start of a flash; and avoiding stress.
  • Decreasing vaginal discomfort: Using over-the-counter (OTC) water-based vaginal lubricants (Astroglide®, K-Y®) or moisturizers (Replens®, Vagisil®) can help relieve vaginal dryness associated with low estrogen levels that may accompany menopause. Staying sexually active also helps with dryness.
  • Optimizing sleep: Healthcare professionals recommend avoiding caffeine, especially in the evening and at night. Exercising during the day can also help improve sleep. Relaxation techniques, such as deep breathing, guided imagery, and progressive muscle relaxation, can be very helpful.
  • Strengthening pelvic muscles: Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence. The exercises consist of the regular clenching and unclenching of the sex muscles that form part of the pelvic floor (sometimes called the "Kegel muscles").
  • Diet: Eating a balanced diet that includes a variety of fruits, vegetables, and whole grains and that limits saturated fats, oils, and sugars is recommended by healthcare professionals. It is also recommended to consume 1,200-1,500 milligrams of calcium and 800 I.U. (international units) of vitamin D a day. Eating smaller, more frequent meals each day may reduce bloating and the sensation of fullness.
  • A high protein diet or high coffee consumption increases calcium excretion and may increase the calcium needs for the body. Fiber, oxalates (in rhubarb, spinach, beets, celery, greens, berries, nuts, tea, cocoa), and high zinc foods (such as oysters and red meats) decrease absorption, requiring more calcium as a dietary supplement. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures, particularly in the first 10 years after menopause.
  • It is recommended to limit salt and salty foods to reduce bloating and fluid retention, to choose foods high in complex carbohydrates, such as fruits, vegetables, and whole grains, and to choose foods rich in calcium. If the woman cannot tolerate dairy products or is not getting adequate calcium in the diet, a daily calcium supplement may be needed.
  • Excessive alcohol has been associated with osteoporosis due to the degenerative metabolic effects of alcohol. Alcohol excess may inhibit calcium absorption and bone formation.
  • Weight control: Being underweight is a risk factor for osteoporosis. Staying within a healthy weight for an individual is important. Extreme thinness is a risk factor for osteoporosis. The onset of anorexia nervosa frequently occurs during puberty, the time of life when maximal bone mass accrual occurs, thereby putting adolescent girls with anorexia nervosa at high risk.
  • Smoking cessation: Smoking increases the risk of heart disease, stroke, osteoporosis, cancer, and a range of other health problems. It may also increase hot flashes and bring on earlier menopause. It is never too late to benefit from stopping smoking. Smokers lose bone more rapidly than nonsmokers. Among 80 year olds, smokers have up to 10% lower bone mineral density, which translates into twice the risk of spinal fractures and a 50% increase in risk of hip fracture. Fractures heal slower in smokers, and are more apt to heal improperly.
  • Regular exercise: It is recommended by healthcare professionals to get at least 30 minutes of moderate-intensity physical activity on most days to protect against cardiovascular disease, diabetes, osteoporosis, and other conditions associated with aging in women. More vigorous exercise for longer periods may provide further benefit and is particularly important if the individual is trying to lose weight. Exercise can also help reduce stress.
  • Regular checkups: A doctor can advise the individual about how mammograms, Pap tests, lipid level (cholesterol and triglyceride) testing, and other screening tests.
References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  • American College of Obstetricians and Gynecologists. . Accessed May 10, 2009.
  • Bertone-Johnson ER, Hankinson SE, Bendich A, et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-52. View Abstract
  • Bruno D, Feeney KJ. Management of postmenopausal symptoms in breast cancer survivors. Semin Oncol. 2006;33(6):696-707. View Abstract
  • Centers for Disease Control and Prevention. . Accessed May 10, 2009.
  • Douglas S. Premenstrual syndrome. Evidence-based treatment in family practice. Can Fam Physician. 2002 Nov;48:1789-97. View Abstract
  • Harman SM. Estrogen replacement in menopausal women: recent and current prospective studies, the WHI and the KEEPS. Gend Med. 2006;3(4):254-69. View Abstract
  • Lata PF, Elliott ME. Patient assessment in the diagnosis, prevention, and treatment of osteoporosis. Nutr Clin Pract. 2007;22(3):261-75. View Abstract
  • Middleton ET, Steel SA. The effects of short-term hormone replacement therapy on long-term bone mineral density. Climacteric. 2007;10(3):257-63. View Abstract
  • National Women's Health Center. . Accessed May 10, 2009.
  • Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 10, 2009.
  • North American Menopause Society. . Accessed May 10, 2009.
  • Rosano GM, Vitale C, Marazzi G, et al. Menopause and cardiovascular disease: the evidence. Climacteric. 2007;10 Suppl 1:19-24. View Abstract
  • Women's Health America. . Accessed May 10, 2009.