June 2024

In this VETgirl online veterinary continuing education blog, Dr. Justine Lee, DACVECC, DABT talks about menopause signs and treatment options for our veterinary field.

By Dr. Justine Lee, DACVECC, DABT
Director of Medicine / CEO, VETgirl

Menopause Signs and Treatment Options for Women… And Why You Should Care as a Veterinarian or Veterinary Technician

Menopause is a natural part of aging for women. And as our veterinary profession is approaching 70% women, you need to care! Menopause is a biological event that bluntly… sucks.

Menopause can pose significant physical and emotional changes that can affect not only YOUR quality of life, but that of your family’s and your colleagues (indirectly!). The end of reproductive life can signal the development of hot flashes, sharp mood swings, lack of energy/libido, and joint pain, among other (sucky) symptoms that can be unpleasant. Though some women may choose to tolerate these symptoms (I tried to manage them for 11 months), others prefer medical interventions to make the transition smoother and more bearable. After all, YOUR quality of life is just as important!

So, in this VETgirl blog, I talk about the crappy menopause journey that I’m personally going through (You can read more about my perimenopause journey HERE and what I’ve done to attempt to naturally alleviate my symptoms HERE). Read on as I discuss the common signs of menopause and some treatment options for you to potentially consider (Obviously, talk to a trained professional about this – not a veterinarian or Dr. Google!) When in doubt, consider consulting with a North America Menopause Society (NAMS) Certified Human Medical OB-GYN.

OK, so let’s start with common menopause symptoms…

1. Irritability and mood swings:
A common symptom of menopause is mood swings, irritability, anxiety, and depression. For me, this was the #1 reason why I decided to go on high level estradiol and progesterone [which is slightly different than hormone replacement therapy (HRT), as I’ll discuss shortly]. I noticed myself over-responding inappropriately to my young child, and becoming really, (really) impatient, snappy, and “salty” to my loved ones. Plus, I was extra irritable from insomnia (see below)!

2. Difficulty sleeping:
OK, in full disclosure, I’m writing this blog at 4am. I can fall asleep, but then I’m wide awake from 1-4am. Then you have the vicious cycle of being irritable because you’re exhausted (while simultaneously jittery from drinking too much coffee… note to self). Insomnia and difficulty sleeping are super common during menopause. It’s not just the hot flashes or night sweats causing it. Fluctuating hormone levels can also affect the production of melatonin, an essential hormone for regulating sleep. While I tried adjusting my sleep hygiene (from opening the bedroom windows during Minnesota’s winter to taking melatonin to using eye shades to using white noise machines and fans, etc.), it hasn’t worked.

3. Hot flashes and night sweats:
Hot flashes and night sweats are the most common symptoms of menopause and can be pretty annoying… especially if you’re already scrubbed under hot surgical lights cutting a patient. I’ve tried the cooling neck fan and that helps to a degree, but I thought  I was going to die of hyperthermia and heat stroke while playing ice hockey and simultaneously hot flashing. Even my son notices when I’m “having an episode” and says, “Do you need your hot flash fan, mom?” Oy.

4. Joint pain and muscle aches:
The estrogen deficit during menopause can lead to joint pain, sometimes called menopausal arthritis. And I’m feeling it… especially as I age. It was so severe, I actually was medically tested to rule out rheumatoid arthritis and other inflammatory issues. Know that this menopause-related soreness and pain can be quite severe.

So, what are some treatment options available for menopause?

Gabapentin:
We use gabapentin all the time in veterinary medicine, but who knew it’s also used to treat menopause symptoms such as hot flashes and insomnia? Gabapentin is a medication commonly used in human medicine to treat neuropathic pain, seizures, and anxiety… and more recently, for menopause. When taken at night, gabapentin can help improve sleep quality. As it can cause excessive grogginess and sedation, its use is generally limited to sleep assistance and reducing night sweats/hot flashes.

Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs are a group of anti-depressants commonly used in human medicine to treat depression, anxiety, and other mental health conditions. They work by increasing the levels of serotonin and can also be used to treat menopause symptoms such as hot flashes and mood changes. Anecdotally, it’s hard to wean off them as your menopause symptoms subside years later.

Topiramate:
Topiramate is a medication commonly used in human medicine to treat epilepsy and migraines. Topiramate works by reducing the activity of certain neurotransmitters in the brain that are involved in seizures, pain, and other symptoms associated with menopause. It’s been used off-label in low doses to treat menopause symptoms such as hot flashes, tremors, and weight gain. It’s also called the “supermodel drug” as it has some potential adverse effects. My MD wasn’t huge on this one.

Other options:
Studies have shown that cognitive-behavioral therapy, relaxation techniques, and mindfulness practices such as yoga and meditation can also decrease menopause symptoms. (It’s on my list to do, but I’m too busy to relax right now, lol!)

Hormone Replacement Therapy (HRT):
HRT is a treatment option commonly used in human medicine to relieve menopause symptoms by replacing the hormones that we’re no longer making. HRT can be administered orally (e.g., low-dose equivalent of a birth control pill), topically (e.g., patch, creams, etc.), or even vaginally. HRT can be very effective in relieving menopause symptoms, but it also carries some risks, including an increased risk blood clots and cancer. That said, please know the NEWEST updates with HRT.

Image by Silvia from Pixabay

HRT WAS a controversial topic for decades. NOTE: WAS. The use of HRT started in the 1960s and became popular in the 1990s. The widespread use of HRT in the 1990s was partly due to the belief that it could prevent osteoporosis, cardiovascular disease, and dementia. However, after the Women’s Health Initiative (WHI) in 2002 revealed the potential risks of HRT (e.g., associated with breast cancer and cardiovascular disease), its use declined sharply; in other words, this study said the risks of HRT outweighed the benefits (Rossouw). Unfortunately, this (flawed) study “which was inadequately designed, evaluated, and reported” created panic and gave the erroneous message that HRT had more risks than benefits when used in women (Cagnacci). That said, more recent studies have discussed the controversies of the WHI study (Rossouw), saying “the epidemiological data were not strong enough to document a clear harm to women’s health.” (Cagnacci) Despite new studies proving its benefits for certain groups of women, the negative image of HRT still persists.

Years later, reanalysis of the WHI trial was done, and new studies found that the use of HRT in younger women (< 60 years of age) or in early postmenopausal women did actually have a beneficial effect! Not only did it alleviate some pretty miserable signs of menopause (a very important reason!), but it helped minimize osteoporosis (and potential osteoporotic fractures), minimize visceral/abdominal fat, and improve general well-being and quality of life in women. Further studies have found that HRT is “highly beneficial when given to symptomatic women within 10 years since the onset of menopause or to symptomatic women that are under 60 years of age.” (Cagnacci)

Despite the new evidence, the negative perception of HRT has not changed much, leading to important negative consequences for women’s health and quality of life. Women may avoid seeking HRT because of fear of side effects, unawareness of its potential benefits, or lack of support from healthcare professionals. Such avoidance can lead to unnecessary suffering and comorbidities.

The history of HRT is a complex and ongoing story that highlights the importance of evidence-based medicine and accurate communication of health information. The initial enthusiasm for HRT has shifted to cautious and selective use, but the negative image of HRT persists. Obviously, you want to informed decisions about HRT based on your individual needs, health status, and preferences. The use of HRT should not be a one-size-fits-all approach, but a personalized and evidence-based decision (e.g., if you smoke, have a family history of clots, suffer from obesity, etc., you’re likely not a good candidate for HRT). Women should have access to accurate and unbiased information about HRT and its potential risks and benefits. Improving the public perception of HRT can have a positive impact on women’s health and well-being.

In full disclosure, this is what my female family practitioner recommended (And I love and adore her!). Personally, I’m not on HRT yet, but higher hormone concentrations as I’m still perimenopausal. This is necessary to prevent break through cycling. Per my medical doctor, I need to transition to HRT in approximately 2 years (with the average full-blown-menopause stage being 52-years of age). But based on the recent literature, I’m planning on it!

When in doubt, know that you DO have options for treatment for menopause. It’s overwhelming and I hope listing out some of your options (e.g., gabapentin, SSRIs, topiramate, HRT, etc.) for menopause treatment helps. When in doubt, talk to your human MD (not a veterinarian like me!) about these commonly used treatment options so you weigh the benefits and risks. But no need to suffer, as menopause treatment is out there!

Weigh in – what worked for you?

Resources:
1. Rossouw JE, Anderson GL, Prentice RL, et al. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–333. doi: 10.1001/jama.288.3.321.
2. Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas).2019;55(9):602.
3. Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals Through Menopause and Beyond
4. https://livefeisty.com/category/podcasts/hit-play-not-pause/

  1. Thanks for writing this and broaching this topic!
    I have seen the study on use of hrt in women under 60 — and it irks me that that original very poor study has made SO many women suffer. And yet men don’t have testiculectomies () for their prostate cancer despite proof that that would be curative.
    I have been on HRT patches for about 10 years, but when I was perimenopausal at round 47-48 , my doc (female) put me back on birth control pills and they were a god send. I felt 1000% better. Strongly recommend if you did ok with them.
    I had taken them before for a long time with no SE but had stopped at 40 for no particular reason except that I thought I should. They made me stop the pill when was 52 out of principal. So I went on HRT bc of hideous night sweats ( the pill was helping with the early symptoms— sweats, insomnia, etc ) . Life saving — esp for the people around me.
    They say that that abt 15% of women never stop having getting sweats and I might be one based on family history. But I am tapering very gradually to lowest effective dose. I do take Prog abt every 3 months by patch — bc there is no real medical explanation to take it monthly. They say it is to protect the endometrium. Maybe so, but I had an endometrial ablation (I call it the barbecue — haha) bc of adenomyosis. I have very little endometrium whenever I have had an ultrasound. ‍♀️
    Nonetheless, my sister who is 4 yrs younger than me (had no kids, I have 2 so this could be a factor) was terrified of HRT and never took it and she has had osteoporosis for 3-4 years now requiring treatment. I managed to tear my hamstring off waterskiing when I was 59 — the tendon came off rather than the bone fracturing, so I’m thinking bones are not too bad — so far. (It’s been re-attached & I have been back to skiing)
    It is a very bumpy ride nonetheless. The Hrt makes it less bad. I have also read estrogen is important for muscle mass maintenance so yet another reason.
    I don’t think people need to be terrified of this — it’s worth a try. If you don’t like it, you can just stop.
    PS I took Prozac for other reasons and had obscene night sweats. My doc told that is one reason a lot of people don’t stop it so not necessarily the cure all for everyone …. (Now that I think abt it, I might start asking clients who have dogs on this if they have started panting at night — just to see. lol)
    Again thanks for your post!

  2. I was a late menopause lady. I skipped all the normal routes and at the age of 59 1/2 was in full menopause.
    I’m 61.5 yrs now and still working on something to help me with all the night sweat\ flashes etc.. The mirina and patches (3 types) different dosages haven’t worked. Not to mention trying to get into the Dr. appt in less than a month after your “here try this for a month” So, when I get my next appt. I now will ask for other options.
    Thank you for all the information. It makes it easier to know I am not a lone and the things I am going thru are crazy normal.

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