Managing Menopause: Treatments for Hot Flashes, Insomnia, Brain Fog and More

Menopause is having a moment.

From Amy Schumer’s humorous role in the TV ad for the virtual menopause clinic Midi Health, to Drew Barrymore’s candid discussion about having hot flashes while interviewing her guests, talking about menopause has become mainstream.

And that’s something Ingrid Kotch, MD is happy about. 

Dr. Kotch, who is Chief of Obstetrics/Gynecology at the Women’s Center of South Shore Medical Center, applauds efforts to shine a light on this natural mid-life “change” and focus attention on menopause care.

“Women should know menopause is a safe thing to talk about and that they are not alone,” she said. “Most women experience some effects while going through menopause.” 

Dr. Kotch encourages women to speak to their healthcare provider about any symptoms they are experiencing and discuss an individualized treatment plan that can help manage them effectively. 

To keep this important conversation going, Dr. Kotch answers questions about common menopause symptoms, medical treatments and Women’s Health services at South Shore Health.

When does menopause start and how long does it last?

Menopause begins when a woman has had no menstrual period for 12 consecutive months.  The average age for the start of menopause is 52, and it usually occurs between ages 45 and 55.

Perimenopause describes the 7-10 years leading up to menopause, when women may begin to have irregular periods and experience other menopause symptoms such as hot flashes and mood swings.

After menopause starts, symptoms usually last for 3-5 years. The duration, type and severity of effects can vary greatly, with some women experiencing hot flashes for a few months and others dealing with them for 7-10 years or more. 

Every woman’s journey through menopause is unique. Not everyone experiences the same symptoms, which is why treatment is very individualized. 

What are the most common menopause symptoms?

Common menopause symptoms include:

• Hot flashes, night sweats
• Sleep disturbances
• Mood changes
• Anxiety
• Brain fog
• Fatigue
• Weight gain
• Joint pain
• Vaginal dryness
• Painful intercourse
• Lack of libido
• Urinary tract infections, incontinence

These symptoms are a result of the hormonal changes women experience during menopause. The depletion of ovarian follicles, leading to decreased estrogen and progesterone levels can bring about physical and emotional changes along with the symptoms listed above.

What medical treatments are available for menopause symptoms? 

FDA-approved for both menopause symptoms and osteoporosis prevention, menopausal hormone therapy (MHT) is the most effective treatment for hot flashes, mood swings, sleep disturbances and sexual dysfunction. 

Menopausal hormone therapies are prescription medications available as pills, patches, creams, gels, sprays or a vaginal ring. 

Medications can be used systematically to deliver hormones throughout the body, or locally to target specific symptoms such as vaginal dryness or painful intercourse due to thinning vaginal tissue. 

Estrogen therapy is prescribed for women who don’t have a uterus. Women with a uterus are given a combination of estrogen and progesterone to protect the uterus from endometrial cancer.

For patients who are not good candidates for hormone therapies, or prefer not to use them, there are other treatment options. 

Anti-anxiety medications known as selective serotonin-reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) can help with mood, sleep and vasomotor symptoms (hot flashes, night sweats). 

Newer, FDA-approved non-hormonal medications, like Lynkuet and Veozah target the brain’s thermoregulatory center and have been found effective in reducing hot flashes and night sweats.

Cognitive behavioral therapy for insomnia can also help with sleep and hot flash management.

There are many different options available for managing menopause; it really depends on the patient’s individual symptoms and goals of treatment. 

I always say, we have a lot of tools in the toolkit, it’s just a matter of finding the right tools that work for you.  

What are the concerns/risks with menopausal hormone therapy?

Risks associated with menopausal hormone therapy include heart disease, stroke, blood clots and breast cancer, although transdermal MHT methods (patches, gels, creams, tablets and rings) show lower cardiovascular and clotting risks than oral forms.

Because these risks increase with age and longer use of hormone therapy, starting treatment is recommended within 10 years of the onset of menopause, typically between ages 50-60. 

Side effects when starting hormone therapy can include skin irritation (if using the patch), headaches, breast tenderness, and bloating. Women who still have a uterus may experience spotting, similar to a period. These side effects generally resolve within a couple of months. 

How do I know if menopausal hormone therapy is right for me?

MHT is not for people who have had estrogen-related cancers such breast or uterine cancer, significant heart disease, blood clots or a family history of blood clots. 

Choosing a treatment for menopause symptoms should begin with a conversation with your provider about the specific symptoms you’re experiencing and want to resolve. 

Treatment is not “one size fits all.” Your provider can work with you on an individualized risk-benefit assessment to determine the best menopause care plan for you.

How does a healthy diet and active lifestyle help during menopause?

Consuming a diet (such as the Mediterranean diet) that’s rich in lean protein, fruits, vegetables, calcium, vitamin D and omega-3, along with regular weight bearing/strength training and aerobic exercise can help you maintain a healthy weight, preserve bone density and muscle mass and improve mood and sleep.  

A healthy diet may also help with hot flashes and night sweats. For some women, alcohol, caffeine, hot drinks and spicy foods may trigger symptoms or make them worse, so they should avoid them or limit consumption -- particularly before bedtime.

Sleep disturbances, including insomnia and night sweats are a major menopausal complaint. Practicing good sleep hygiene and incorporating relaxation techniques like gentle yoga, meditation and breathing exercises into your bedtime routine can help manage early morning awakenings. 

How can I become a patient of the Women’s Center 

The Women’s Center of South Shore Medical Center provides comprehensive, individualized care for women at all stages of life – including menopause.

Women’s Center practices are located in Plymouth, Quincy, Whitman and Weymouth, and we have recently expanded OB/GYN services to SSMC Norwell. 

Several of our providers are currently accepting new patients. To become a patient, call 781-682-8000 and speak to our patient registration team.

Ingrid E. Kotch, MD, is the Chief of Obstetrics/Gynecology Ambulatory Care at the Women’s Center of South Shore Medical Center and a member of The Menopause Society. Learn more about Women’s Health and available providers at South Shore Health.