OB/GYN Offers New Treatments to Help Women End Menopause Suffering & Regain Their Vitality

Approximately 42-million American women are between 45 and 64 years of age – a time of life characterized by the physiological and psychological changes of the menopause transition.^[1] However, there are relatively few physicians who have become specially certified in helping them navigate this period. “They can have hot flashes and night sweats that make sleep difficult, vaginal dryness which may be associated with painful sexual intercourse leading to decreased libido, and mood changes,” says David Soper, M.D., Professor and Obstetrician Gynecologist (OB/GYN) at MUSC Women’s Health.

Soper is a Certified Menopause Practitioner through the North American Menopause Society (NAMS). “More than ever, women recognize the value of maintaining their health and wellness so they can have continued vitality as they age. Interventions are available to ameliorate symptoms associated with menopause and make those years every bit as satisfying as the years prior to this transition – which is important because women can spend about 40% of their lives in menopause.”

Hot flashes, insomnia, mood swings, vaginal dryness, and low libido are caused by declining estrogen levels. However, these symptoms do not occur in isolation from other biological, psychological, behavioral, and social changes that also take place in midlife.^[2],[3] Together, they can put women at risk for cardiovascular and orthopedic problems, new or worsening depression or anxiety, memory and cognition problems, and poor overall functioning.^[4],[5] Without appropriate, wholistic treatment, the combined impact can jeopardize women’s future health.

“Menopause is a normal transition from a reproductive to a post-reproductive life,” Soper says. “Advances in understanding the cause of vasomotor symptoms have given us more therapeutic alternatives. While hormone therapy remains the most effective treatment for hot flashes and night sweats, we have discovered that other nonhormonal medications can address multiple symptoms at once – agents like SSRIs (selective serotonin reuptake inhibitors) and gabapentin. Moreover, the effectiveness of a new drug class, the neurokinin-3 receptor (NK3R) antagonists, is being studied in clinical trials. These agents appear promising in terms of effectiveness and safety, and MUSC will be participating in these trials,” says Soper.

Studies find that many women are not satisfied with the way their health care provider addresses their needs during menopause.^[6],[7] “The landscape of OB/GYN providers with a special interest in the menopause transition is changing,” says Soper. “Menopausal medicine has become part of our residents’ curriculum. This important area of women’s health is now getting the attention it deserves. In addition, women should know there are online resources from NAMS at www.menopause.org which not only provide menopause education for women but also help them find an OB/GYN in their area who is a NAMS-certified menopause practitioner.”

The wide range of effective treatments with multiple routes of administration including oral, vaginal, and transdermal regimens also allow women with complex medical conditions to get relief from their menopause symptoms. “Finding the right regimen for each patient is a challenging but exciting part of menopausal medicine,” Soper says. “At MUSC we care for a diverse patient population. We see women with multiple medical problems who are taking multiple medications including women who have undergone an organ transplant. We can usually find a safe regimen to control their most bothersome menopause symptoms,” says Soper. “While there may be contraindications to hormone therapy, for example women who’ve had a DVT (deep vein thrombosis), pulmonary embolism, or significant liver disease, there are nonhormonal options, like SSRIs, that can help them.”

Soper and his colleagues in gynecology see their work as contributing to a sea-change in our cultural attitudes about aging. “Society views aging negatively. We want to help change this perception by improving how women navigate this time in their lives. Postmenopausal women need not skip a beat during the transition,” says Soper. “There is a window of opportunity from within two years of beginning menopause until around age 60 where starting hormone therapy provides clear-cut benefits with minimal risk. In addition, once a woman is on hormone therapy, there is no longer a magic age at which she needs to stop treatment. I have a number of patients who are continuing hormone therapy well into their 70s.”

By training residents in menopausal medicine, encouraging providers to become certified menopause practitioners, and raising awareness about the many available treatment options, MUSC Health is changing what’s possible for women.