The Menopause Experience
Menopause is the point in a woman’s life when menstruation stops permanently, signifying the end of fertility. It is considered official when a woman has been without her menstrual period for 1 year; meaning her ovaries stop releasing eggs and stop making the hormones estrogen and progesterone. In the US, this is generally around age 51, but can vary from 45-57. Often your mom's menopausal history will guide your own.
Perimenopause
Perimenopause is the transitional phase prior to natural menopause usually beginning three to five years prior to a woman’s final menstrual period. Fluctuations in hormone levels commonly characterize this phase. Many women start to experience hot flashes and night sweats during this time. Insomnia can be a heralding event. We try to find humor in this phase (like when you're in labor and waiting for the epidural --- not funny at the time, but a good story for your friends later.) Some patients find the very low dose birth control pill to help stabilize the consequences of labile hormones until age 50-51
Perimenopause might look like:
Menopause
Perimenopausal changes can go on for years, even after you are technically menopausal due to end of periods. Your mood changes and vasomotor symptoms (hot flashes and night sweats...) can regress and then come back with a vengeance over several years, depending on many factors. It may help to recognize specific triggers that worsen these symptoms for you, such as red wine, spicy foods, anxiety... so that you can try to exert control where able.
While there are blood tests sometimes advised to ‘confirm’ menopause, FSH (follicle-stimulating hormone) and estradiol, the are just a snapshot of one moment in time. In practice, we do not generally check these levels, unless one is in her late 30s/early 40s and trying to conceive. The standard way to diagnose menopause is to note when patient has gone 12 months without a period, and is in the right age range (>age 45.)
Postmenopause
Postmenopause follows menopause. Hormone production further decreases, which leads to bone loss and increased risk of heart disease. Approximately 36 million American women will live more than one-third of their lives beyond the onset of menopause.
This period of time is important to up our game in preventative care; we will consider with a bone density scan now to measure risk of hip fracture later, we recommend first colonoscopy at 45, unless there is a family history of colon cancer, and the mammogram warriors all agree: mammograms should start at 40 and be done yearly.
"As we grow old…the beauty steals inward" ~ Ralph Waldo Emerson
Do you need Hormone Replacement Therapy? Stay Open-minded
In the right patients, menopausal hormone replacement can be a lifesaver. We typically use transdermal estrogen (a small patch on your abdomen) combined with an oral plant-based progesterone to see if replacing estrogen helps symptoms such as hot flashes, night sweats, brain fog, joint pain, emotional lability that comes with the labile and decreasing naturally produced estrogen.
The issue of hormone therapy to treat menopausal symptoms used to be a simple one. You had hot flashes, sleep disturbances, vaginal changes—you took hormones. Worried about aging skin, libido, your bones and heart—you took hormones. All that changed in 2002 with the announcement of the results of part of the Women's Health Initiative (WHI), the first-ever, long-term study of the effects of hormone therapy on postmenopausal women. One of the study's main goals was to investigate whether using estrogen (Premarin) or estrogen plus progestin (Prempro) as part of a hormone therapy regimen could prevent coronary heart disease in healthy women between the ages of 50 to 79. Researchers abruptly ended the Prempro arm three years early, because initial results showed an increased risk of breast cancer, heart disease, blood clots in the lungs and stroke in women taking hormone therapy. You know what happened next — millions of women and their physicians panicked, stopped their hormone therapy and searched for alternatives. A couple of years later, when the estrogen-only (Premarin) arm of the WHI found an increased incidence of stroke in women on the drug with no cardiovascular benefits, and most women stopped their hormone therapy.
However, as researchers looked more closely at the WHI results, they found the data wasn't as dire as first presented. Experts note that the WHI study included women who were more than 10 years older (average age 64) than the average hormone therapy user. And, in fact, a 2006 publication based on data from the long-running Nurse's Health Study found that women who started hormone therapy soon after menopause reduced their risk of coronary heart disease 30 percent.
More recently the pendulum has swung back to the center, and mht is considered a reasonable way to manage menopausal symptoms in patients interested in trying it.
Do you want to try menopausal hormone replacement?
What you need to know based on extensive evaluation of existing data by the North American Menopause Society:
Are Bioidentical Hormones a Safer Option? In short, No.
There are literally dozens of hormone therapy formulations—from low-dose pills to patches, rings and even a clear, odorless gel you rub on your arm. The term “bioidentical hormone therapy” is often used to describe a medication containing estrogen, progesterone, or other hormones that are chemically exact duplicates of hormones produced by women, primarily in the ovaries.
Many of these bioidentical hormones (eg, estradiol, progesterone) are commercially available in several well-tested, FDA-approved, brand-name prescription drugs. A list of government-approved bioidentical hormone therapy products in the United States and Canada is listed on menopause.org.
Concern arises with the bioidentical hormone medications that are “custom-compounded” (custom-mixed) recipes prepared by a pharmacist following an individual prescriber’s order for a specific patient. These medications do not have FDA approval because individually mixed recipes have not been tested to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. Further, there is no scientific evidence about the effects of these compounded medications.
Ways to Cope with Menopause Symptoms in addition to or instead of hormone replacement:
Hot flashes and night sweats
Vaginal dryness
Sleep problems
Depression
Should I see a doctor?
If your periods start changing and you are 45 or older, you do not need to see your doctor or nurse. But you should see your doctor or nurse if you have symptoms that really bother you. For instance, you should see your doctor if you cannot sleep because of night sweats, if it is hard to work because of your hot flashes, or if you feel sad or blue and don't seem to enjoy things anymore. Come in for a visit if you experience:
Come in and Talk...
When you need to discuss options for some of the physical and emotional challenges of menopause, and to review whether a form of hormone replacement might help for a time, schedule an appointment to talk about your concerns and goals. We do not need to do a pap smear to listen to your concerns, and work with you to come up with a wellness plan for this chapter in your life.
Menopause is the point in a woman’s life when menstruation stops permanently, signifying the end of fertility. It is considered official when a woman has been without her menstrual period for 1 year; meaning her ovaries stop releasing eggs and stop making the hormones estrogen and progesterone. In the US, this is generally around age 51, but can vary from 45-57. Often your mom's menopausal history will guide your own.
Perimenopause
Perimenopause is the transitional phase prior to natural menopause usually beginning three to five years prior to a woman’s final menstrual period. Fluctuations in hormone levels commonly characterize this phase. Many women start to experience hot flashes and night sweats during this time. Insomnia can be a heralding event. We try to find humor in this phase (like when you're in labor and waiting for the epidural --- not funny at the time, but a good story for your friends later.) Some patients find the very low dose birth control pill to help stabilize the consequences of labile hormones until age 50-51
Perimenopause might look like:
- menses more or less often (eg. every 3 to 6 weeks instead of every 4)
- menses are changing: longer, heavier or lighter, shorter
- beginning to skip periods
- hot flashes, night sweats
- new-onset insomnia
- mood changes, emotional lability, short temper, depression
- decreased libido, unhappiness with body changing
- central weight gain
- decreased energy
Menopause
Perimenopausal changes can go on for years, even after you are technically menopausal due to end of periods. Your mood changes and vasomotor symptoms (hot flashes and night sweats...) can regress and then come back with a vengeance over several years, depending on many factors. It may help to recognize specific triggers that worsen these symptoms for you, such as red wine, spicy foods, anxiety... so that you can try to exert control where able.
While there are blood tests sometimes advised to ‘confirm’ menopause, FSH (follicle-stimulating hormone) and estradiol, the are just a snapshot of one moment in time. In practice, we do not generally check these levels, unless one is in her late 30s/early 40s and trying to conceive. The standard way to diagnose menopause is to note when patient has gone 12 months without a period, and is in the right age range (>age 45.)
Postmenopause
Postmenopause follows menopause. Hormone production further decreases, which leads to bone loss and increased risk of heart disease. Approximately 36 million American women will live more than one-third of their lives beyond the onset of menopause.
This period of time is important to up our game in preventative care; we will consider with a bone density scan now to measure risk of hip fracture later, we recommend first colonoscopy at 45, unless there is a family history of colon cancer, and the mammogram warriors all agree: mammograms should start at 40 and be done yearly.
"As we grow old…the beauty steals inward" ~ Ralph Waldo Emerson
Do you need Hormone Replacement Therapy? Stay Open-minded
In the right patients, menopausal hormone replacement can be a lifesaver. We typically use transdermal estrogen (a small patch on your abdomen) combined with an oral plant-based progesterone to see if replacing estrogen helps symptoms such as hot flashes, night sweats, brain fog, joint pain, emotional lability that comes with the labile and decreasing naturally produced estrogen.
The issue of hormone therapy to treat menopausal symptoms used to be a simple one. You had hot flashes, sleep disturbances, vaginal changes—you took hormones. Worried about aging skin, libido, your bones and heart—you took hormones. All that changed in 2002 with the announcement of the results of part of the Women's Health Initiative (WHI), the first-ever, long-term study of the effects of hormone therapy on postmenopausal women. One of the study's main goals was to investigate whether using estrogen (Premarin) or estrogen plus progestin (Prempro) as part of a hormone therapy regimen could prevent coronary heart disease in healthy women between the ages of 50 to 79. Researchers abruptly ended the Prempro arm three years early, because initial results showed an increased risk of breast cancer, heart disease, blood clots in the lungs and stroke in women taking hormone therapy. You know what happened next — millions of women and their physicians panicked, stopped their hormone therapy and searched for alternatives. A couple of years later, when the estrogen-only (Premarin) arm of the WHI found an increased incidence of stroke in women on the drug with no cardiovascular benefits, and most women stopped their hormone therapy.
However, as researchers looked more closely at the WHI results, they found the data wasn't as dire as first presented. Experts note that the WHI study included women who were more than 10 years older (average age 64) than the average hormone therapy user. And, in fact, a 2006 publication based on data from the long-running Nurse's Health Study found that women who started hormone therapy soon after menopause reduced their risk of coronary heart disease 30 percent.
More recently the pendulum has swung back to the center, and mht is considered a reasonable way to manage menopausal symptoms in patients interested in trying it.
Do you want to try menopausal hormone replacement?
What you need to know based on extensive evaluation of existing data by the North American Menopause Society:
- The primary reason to use hormone therapy—whether estrogen alone (for women without a uterus) or estrogen plus progesterone (for women with a uterus)— is for treatment of symptoms: primarily hot flashes, sleep disturbances from night sweats, brain fog, mood issues, joint pain and vaginal changes.
- If you use hormone therapy, start at the lowest dose needed to gain relief,, we titrate up and down, essentially tailoring the mht to you. The current thinking is that is if you wish to, you can use hormone therapy for an extended length of time.
- There are multiple appropriate forms of hormone therapy for your symptoms. For vaginal dryness, local intravaginal estrogen is the most effective.
- Hormone therapy can also be used to prevent osteoporosis for women at high risk of the condition (most forms of hormone therapy are approved for this purpose), even without the other symptoms of menopause.
Are Bioidentical Hormones a Safer Option? In short, No.
There are literally dozens of hormone therapy formulations—from low-dose pills to patches, rings and even a clear, odorless gel you rub on your arm. The term “bioidentical hormone therapy” is often used to describe a medication containing estrogen, progesterone, or other hormones that are chemically exact duplicates of hormones produced by women, primarily in the ovaries.
Many of these bioidentical hormones (eg, estradiol, progesterone) are commercially available in several well-tested, FDA-approved, brand-name prescription drugs. A list of government-approved bioidentical hormone therapy products in the United States and Canada is listed on menopause.org.
Concern arises with the bioidentical hormone medications that are “custom-compounded” (custom-mixed) recipes prepared by a pharmacist following an individual prescriber’s order for a specific patient. These medications do not have FDA approval because individually mixed recipes have not been tested to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. Further, there is no scientific evidence about the effects of these compounded medications.
Ways to Cope with Menopause Symptoms in addition to or instead of hormone replacement:
Hot flashes and night sweats
- Dress in breathable layers so you can take off clothes if you get hot.
- Keep the thermostat down and avoid hot drinks, such as coffee or tea, spicy foods.
- Put a cold, wet washcloth against your neck during hot flashes.
- Quit smoking, if you smoke. (Smoking makes hot flashes worse.)
- Desk and bedside fans go a long way!
Vaginal dryness
- Use lubricants for sex. (Silicone and hyaluronic-acid based ...)
- Let your partner know you are working on this.
- Consider vaginal estrogen.
- Vaginal laser therapy - not proven to help (can be referred to local physician for procedure.)
Sleep problems
- Practice good sleep hygiene: go to sleep and get up at the same time every day, even when you don't sleep well. Minimize screen time, caffeine, exercise in the hours before your bedtime.
- Naps can make the problem worse.
- Avoid caffeine in the afternoon and don't drink much alcohol.
- Keep room cool, sleep in cotton, consider lighter blankets layered.
- Guided Meditation as you go to sleep can work wonders. (YouTube, headspace, buddhify...)
- Deep breathing exercises as you unwind.
Depression
- Stay active. Exercise helps ward off depression.
- Get out in nature (having a dog to walk can help!)
- Seek social support from your friends and family..
- Gratitude journal (or app). Every day write down 3 specific things you are grateful for that day.
- Protect yourself from too much news and negative external influences.
- Therapy can help reframe one’s problems.
Should I see a doctor?
If your periods start changing and you are 45 or older, you do not need to see your doctor or nurse. But you should see your doctor or nurse if you have symptoms that really bother you. For instance, you should see your doctor if you cannot sleep because of night sweats, if it is hard to work because of your hot flashes, or if you feel sad or blue and don't seem to enjoy things anymore. Come in for a visit if you experience:
- your period comes more often than every 3 weeks
- very heavy bleeding during your period
- spotting between your periods
- bleeding after menopause (any bleeding after 12 months without a menses is abnormal, and worth discussion.)
Come in and Talk...
When you need to discuss options for some of the physical and emotional challenges of menopause, and to review whether a form of hormone replacement might help for a time, schedule an appointment to talk about your concerns and goals. We do not need to do a pap smear to listen to your concerns, and work with you to come up with a wellness plan for this chapter in your life.
|
Susan Malley, MD
Pediatric, Adolescent & Adult Gynecology |
Summit Health
3030 Westchester Avenue Purchase, NY 914.848.8800 |
Summit Health
1 Theall Road Rye, NY 914.848.8800 |
"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow." MA Radmacher