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Menopause Q & A with Dr. John Wooley

Menopause Q & A session with Dr. John Wooley
Menopause Q & A session with Dr. John Wooley

What are some of the common symptoms associated with menopause?

The menopause transition most often begins between ages 45 and 55.  A woman is menopausal by definition 12 months after her last menstrual period.  The average age is 51.  The most common menopausal symptoms are vasomotor symptoms (VMS), hot flashes, or night sweats.  They occur in approximately 75% of women and can last an average of 7 years.  Night sweats can lead to sleep disruption resulting in decreased deep REM (rapid eye movement) sleep.  This can contribute to mood swings, irritability, lack of concentration, and “brain fog.”   Depression and anxiety can also be exacerbated by the hormonal changes of the climacteric.

 Estrogen deficiency results in vaginal atrophy and symptoms of vaginal dryness, painful intercourse, urinary frequency, urgency, vulvar itching, and irritation.  These symptoms are now called genitourinary symptoms of menopause (GSM).

 Weight gain, particularly around the mid-abdomen, is a more common complaint related to aging and lifestyle than menopausal hormonal changes.  Starting at about age 40, we all start losing muscle mass, resulting in a decreased metabolic rate and weight gain.  Studies have confirmed that increasing high-intensity aerobic exercise and resistance training can help maintain one’s muscle mass.  Dietary modifications such as decreasing portion sizes in your diet, cutting back on carbohydrates, and limiting alcohol can all moderate age-related weight gain.  Weight gain is not inevitable, just harder to prevent.

Sexual issues common in menopause include decreased libido and decreased sexual responsiveness, leading to decreased frequency of sexual relations.  The lower estrogen levels of menopause result in vaginal atrophy or thinning of the vagina resulting in decreased lubrication and elasticity.  For some couples, this vicious cycle of decreased libido, vaginal atrophy, and associated loss of elasticity results in reduced frequency of intercourse resulting in vaginal narrowing and even worsening symptoms.  Fortunately, there are numerous treatment options to avoid this scenario.

What treatments are available for managing menopause symptoms?

For women who have mild vasomotor symptoms, over-the-counter (OTC) preparations and herbal supplements containing soy or black cohosh may offer significant relief.  While providing effective relief to some women, there is a paucity of evidence-based studies documenting all benefits.  Examples of these preparations are Amberen, Estroven, and Remifemin.
 
For healthy women under 60 years of age or who are within ten years of entering menopause, Hormone Replacement Therapy (HRT) can offer significant improvement or resolution of menopausal symptoms.  For women with a history of breast cancer or women over 60, or those more than ten years after menopause, the risk of hormone replacement therapy may lead to choosing alternative methods of treatment.  The dangers of HRT, which increase with age, include increased chances of heart disease, strokes, blood clots, and a possible increased risk of dementia.  While there is some evidence that testosterone therapy may benefit patients with female sexual interest/arousal disorder, it is essential to note that there is no direct correlation between testosterone levels and libido.
 
Nonhormonal medical therapies, including antidepressants (SSRI or SNRI) such as Paroxetine or Venlafaxine or anti-epileptics such as Gabapentin, are options for those women who are not candidates for hormone therapy.
 
GSM symptoms (vaginal dryness or discomfort during intercourse) may initially be treated with over-the-counter vaginal moisturizers and lubricants for women with systemic therapy not indicated.  However, long-term low-dose local estrogen therapy may be more beneficial.  Other systemic medications, alternatives to estrogens, and Osphena selective estrogen modulators (SERMs) may result in improved vaginal moisture, elasticity, and improved sexual function.
 

What do you think is the biggest misconception about menopause?

“All hot flashes are the same”– While some women have severe symptoms and need treatment, others have minimal symptoms and do not seek therapy.  While 75% of women experience vasomotor symptoms, only 25% of women seek treatment.  Risk factors for more severe menopausal symptoms include sedentary lifestyle, cigarette smoking, obesity, and severe symptoms are more common in the African American and Hispanic populations.
 
“There are no effective treatments”– Bioidentical estradiol is available in multiple FDA-approved delivery systems, including oral preparations, patches, sprays, gels, lotions, and vaginal rings.  And oral bio-identical progesterone is also available.  In addition to hormonal therapy, cognitive behavioral therapy, mindfullness, yoga, exercise, and in some cases, specialized pelvic floor physical therapy may result in significant benefits.
 
“Compounded “bioidentical” hormone therapies are safer and more effective than FDA-approved medications.”  There is no evidence to support this.  FDA-approved and compounded hormone therapy comes from the same precursors and has the same potential risk.  FDA-approved bioidentical hormones have been tested for safety, proven to contain consistent, adequate levels of hormones, and are monitored by the FDA.
 
“Indications for and dosing modifications of hormone therapy are based primarily on lab values” – The indication for initiating hormone replacement therapy is moderate to severe symptoms.  Dosing adjustments are based primarily on symptoms and response to treatment, not lab values.  While labs are helpful sometimes, most lab values are predictable, especially in postmenopausal patients.  
 

Are there any lifestyle changes that can help ease the transition into menopause?

Lifestyle changes are significant in managing the changes and challenges of menopause.  Simple things help.  Dressing in layers, turning the thermostat down at night, using fans, avoiding triggers (spicy foods, hot beverages, stressful situations), and limiting alcohol which can exacerbate symptoms.  Cognitive Behavioral Therapy (CBT) and Vitamin E have also been utilized despite limited evidence of efficacy.
 
Evidence-based studies confirm that regular high-intensity exercise and maintaining a healthy weight have improved menopausal symptoms and sexual function.
 

Have you found any helpful tips or tricks for managing menopause symptoms?

There are inevitable changes that come with a midlife climacteric of menopause.  No two patients are the same.  It has been said that “getting older is not for Sissys,” but ironically, studies have confirmed that many find this stage of life may be their happiest.  There is a multitude of treatment options available to manage the variety of emotional and physical symptoms of menopause.  Whether hormonal therapy, behavioral therapy, counseling, or physical therapy.  Diet, exercise, and maintaining a healthy lifestyle play a critical role in managing the emotional and physical challenges of menopause.
 

What other things can you offer?

The goal of our physicians here at the Woman’s Clinic is to help educate and assist all our patients through all the stages of their lives.  That is the most rewarding aspect of our specialty. We assist patients throughout their entire life journey…. from adolescence to young adulthood, through the childbearing years, into the transition from peri menopause to menopausal years, and encourage our patients to make evidence-based decisions regarding screenings and treatments.  We recommend cancer screenings (pap smears, mammograms, colon cancer screenings) and screenings for other health-related risks (blood pressure, diabetes, lipids, bone density, and mood disorders).  

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