Menopause: One Size Doesn’t Fit All

Hot flashes, insomnia, vaginal dryness— menopause is a time in a woman’s life when her menstrual period ends and production of estrogen and progesterone decreases. According to Jay Greenberg, M.D., gynecologist with Meritus Women’s Health Specialists, to overcome menopausal symptoms is a very individualized decision.

The average age for menopause is 51 and while some women sail through it with little trouble, others find it a burden. Hormone therapy, medications containing female hormones, was once the standard of care for treating menopausal symptoms, but a large clinical study found that it posed a greater risk for heart disease, stroke, deep vein thrombosis and breast cancer.

“Hormone therapy was once thought to prevent heart disease and dementia, but today most women are nervous about taking it,” says Dr. Greenberg. His approach to treating menopausal symptoms is to review the patient’s medical history for cancer, heart disease or blood clots.

Dr. Greenberg offers these “dos and don’ts” for combatting menopausal symptoms:


  1. Talk to your gynecologist about the severity of your symptoms.
  2. Take the path of least risk. Non-hormonal treatments such Paxil, Effexor, Neurontin and Catapres can be used to treat insomnia, hot flashes, anxiety and mood swings.
  3. Consider low-dose vaginal products like Estrace, Premarin, Vagifem and nonestrogen lubricants for vaginal dryness.
  4. Make lifestyle changes such as limiting caffeine and alcohol—and if you smoke, quit.
  5. Go back to your gynecologist if symptoms don’t subside. Depending on your family medical history, your doctor may prescribe short-term systemic hormone therapy.

Systemic estrogen, which comes in the form of a pill, skin patch, spray or cream, is effective for the relief of menopausal symptoms. “Short-term systemic hormone therapy is OK for some women between the ages of 50-55, but it gets into the gray zone after age 55,” says Dr. Greenberg.


  1. Remain on systemic hormone therapy for a long period of time.
  2. Smoke while on hormone therapy.
  3. Use bioidentical hormone therapy custom-made by a pharmacist. Derived from plants, these medications vary in quality and dose and are not approved by the FDA.

Some natural products such as black cohosh, St. John’s wort and soy supplements may improve menopausal symptoms, but most studies show variable effectiveness. Dr. Greenberg cautions women to talk to their physicians before using these products.

Women eventually outgrow menopausal symptoms, but for some, it can take more than five years. In the meantime, seek advice from medical professionals, increase daily exercise and soldier on.

To make an appointment with Dr. Greenberg, call Meritus Women’s Health Specialists at 301-791-5555.