Transcription:
A Holistic Approach to Menopause

Melanie Cole (Host):  Menopause – the time in a woman’s life when menstruation ends – is a normal and natural stage of life and it usually occurs around the age of 50. Over the next two decades, 40 million American women will experience this important change of life and by the year 2020, 60 million women will be at or through menopause. While this transition can be a pleasant experience for some women many, unfortunately, experience significant discomfort. My guest today is Dr. Deborah Bell. She specializes in family medicine and integrative medicine at Allina Healthy Penny George Institute. Welcome to the show, Dr. Bell. Tell us, how does a woman know when she’s getting ready, when her body’s just starting that change? 

Dr. Deborah Bell (Guest):  Well, some women do notice some changes in their period or they might notice some changes in their weight or some pre-menstrual changes. Some women, however, will just have their periods stop and then they know that they’re done. It really is very variable and that’s the tricky part about perimenopause and menopause is that it’s different for almost every woman.

Melanie:  How do we know?  I mean do you go see a doctor and is there a test to tell us if you’re in there?  Some women have irregular periods all the time anyway.

Dr. Bell:  Well, that’s true and because menopause and perimenopause, in my opinion, are not diseases and in integrated medicine, we treat them as a natural process in life. Really, the only reason to address menopause is if one is having problems. So, if you’re not having any symptoms and you’re not having significant changes that are disruptive with your menstrual cycle, then it doesn’t really matter whether or not you’re in menopause or perimenopause. So, really, the issue is if you are noticing some changes that are difficult or changes that you’re just wondering whether or not the changes are part of perimenopause or menopause. If they are, yes, sometimes there is testing that we do and sometimes it’s just a matter of speaking with a professional to know whether or not the cluster of symptoms you are experiencing are from the hormonal changes that happen as our reproductive cycle is ending.

Melanie:  When a woman figures out that she is in this--so she’s in perimenopause, does that mean she can no longer conceive?

Dr. Bell:  Right. So, technically, the definition of menopause is that the menstrual cycles have stopped for a full year. Perimenopause is a period of time working up to the time when the menstrual cycle discontinues for a year. What’s happening at that time is that the ovaries now are no longer producing eggs; the woman is no longer ovulating which would mean that she’s no longer able to conceive and become pregnant.

Melanie:  Women experience a myriad in range of different symptoms. Explain some of the symptoms that you see on a regular basis for women and some of the myths that surround ways to deal with these symptoms.

Dr. Bell:  Sure. The most common symptom for menopause would be hot flashes. Hot flashes can happen during the day and they can also happen at night. They can, again, vary from feeling a little bit warm to people drenching in sweat, feeling like they absolutely have to take their outer shirt off and their face turns red and they feel very uncomfortable. So, that’s the most common but there are a lot of other common symptoms that some people don’t realize. People can begin to have sleep disruption. Many women, or most women, will have some lower abdominal weight gain. We can have some mood changes or feeling more irritable or feeling more anxious or just a little bit more moody. Women can also have some tingling sensations; they can have breast tenderness; they can begin to have headaches; and they can have body aches. Also, there are a number of different symptoms that are associated with the hormonal changes that occur during menopause that are all pretty common. Women can have palpitations and there are a lot of women who actually end up having a cardiology workup because they’ve been having heart palpitations and really it’s just because they’re becoming menopausal.

Melanie:  Wow. That is just so interesting because so many of those mimic other things. Then, what do you recommend people do about it?  Some treatments – we’ve heard about black cohosh. There’s estrogen replacement therapy and bioidentical hormones. It’s just dizzying, Dr. Bell. So, what do you tell people about the ways to approach these things?

Dr. Bell:  First of all, one of the things that we’re starting to do at the Penny George Clinic is called a “shared medical office visit” and we are going to be running some on menopause. We’ve done them before and this is a series of shared visits where each time, we talk about some different approaches that women can take to help with their menopause as well as their education about what kinds of symptoms might be associated with menopause. That’s a nice way of really getting a full picture. There are a lot of different things. What I always start with with integrated medicine is, in looking at the whole picture, is really looking at the fundamental things for health and these really do have an impact on the symptoms for menopause and perimenopause. That would be diet and nutrition. So, healthy diet that is avoiding additives, the biggest triggers for menopause symptoms for women are the things that are not really food--artificial color, artificial flavor--but especially the refined sweets, coffee and caffeine and alcohol. There are a number of women who say, “Well, if I don’t eat sweets and I don’t drink coffee my hot flashes are almost gone.”  So, healthy nutrition, regular exercise, healthy sleep and stress reduction are primary things that sometimes make a dramatic difference in the symptoms that women experience. Then, there are number of other modalities. There are herbal therapies. Black cohosh is one of them. There are a number of other herbs. There’s an herb called Vitex, the common name is Chaste Tree Berry. We use that a lot in perimenopause. The herbs sometimes work best together. We use the big term synergistically so that one herb alone might not work as well as several herbs together. So, deciding which of those are helpful for you sometimes takes a professional to help but starting with black cohosh alone, if you’re not on any other medicines and you don’t have any other health problems, is perfectly safe to do. Then there are a number of other just dietary supplements that can be helpful. Chinese medicine is also very helpful. There’s some very good scientific data supporting the use of acupuncture for hot flashes and menopausal symptoms. There are essential oils that can be helpful. Then, there are some mind-body techniques of guided imagery and meditation practices and what we call “mindfulness” practices that are also helpful tools.

Melanie:  When should a woman worry that the symptoms are getting out of hand?  I mean, if they’re bleeding a lot, iron deficiency, anemia--when do you go to your doctor and say, “Okay it’s enough now”?

Dr. Bell:  I think that actually you said it. It’s if the symptoms are disruptive. So, if a woman is having heavy periods such that it’s difficult for her to function in the day such that she has to plan around the timing of her menstrual cycle; if the menstrual cycles are coming close together; if she’s experiencing a lot of cramping or abdominal pain or fatigue, those would be reasons to seek medical attention. Similarly, I think the same is true for other symptoms of menopause once the menstrual cycle has discontinued in terms of hot flashes or mood changes. I think that 10-15 years ago, when there was a large use of conventional hormone replacement therapy and we discovered that that was maybe not so healthy for us, that a lot of women got this idea that they just had to grin and bear it and make their way through and suffer through menopause. I don’t think that that’s at all the case. We have a lot of very safe and effective methods to help women with their symptoms. My marker for that is just whether or not the symptoms are disruptive. So, women who are waking during the night and they’re feeling exhausted. I’ve had some women who are teachers and they get up to lecture and they start sweating from their hot flashes and that’s just not workable for them. So, when the symptoms are bothersome that’s a reason to seek help.

Melanie:  We don’t have a lot of time but what a fascinating topic and I can tell that you’re just an amazing physician to work with women. In this age of all of the different hormones and information, what do you tell women as an integrated physician about that hormone replacement and all of the risks that they carry and the myths that we hear. What do you tell them about that?

Dr. Bell:  Well, what I say is that, again, the point is symptom relief and if we’re not getting symptom relief from something else, then hormone replacement therapy can be very helpful. We use what’s called “bioidentical hormone replacement therapy” meaning that the hormones are the same chemical structure of what women have in their body. I try to use them as a patch or as a cream through the skin rather than orally as I feel the data is suggesting that this might be the most effective and safest way to use it. So, we use the least dose with a choice of hormones that seems to be the safest just to achieve symptom relief and not for any other kind of prevention or for cosmetic reasons. I feel that that can be done safely and we use it just for the period of time that the woman needs, for the shortest period of time that the woman needs for symptom relief, which is anywhere from 1-5 years depending the person. I feel quite comfortable with using hormone replacement therapy when the person needs it and there are ways of choosing to use it in the most safe way possible.

Melanie:  In just the last minute here, your best advice for women entering this change and, as you said at the beginning, it is not a disease. It’s a normal part of life. So, give them you’re best advice about kind of charging through it and being a part of it.

Dr. Bell:  I think that like many different stages in our life, that menopause is an opportunity for embracing health for the next half of our life. So, beginning to appreciate that and look at all of the things in our life that can help up to feel well, which would be healthy nutrition and exercise and sleep, paying attention to the things that we experience joy, having a sense of purpose in our lives, our mental health, our spiritual well-being, that that’s the beginning and that then, if we begin to have symptoms to in the safest way and healthiest way possible to learn from professionals about different modalities we can use to relieve our symptoms so that we can continue to feel well.

Melanie:  Fantastic information. Thank you so much for being with us. You’re listening to The Wellcast with Allina Health. For more information, you can go to allinahealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.