Maggie McKay (Host): This is Expert Insights with the Carle Foundation Hospital. I'm your host, Maggie McKay. Joining us today is Jamie Nixon, women's health nurse practitioner, to discuss women's health and menopause. Thank you so much for being here today, Jamie.

Jamie Nixon: Thank you for having me.

Host: Let's start with what is perimenopause, menopause, and post-menopause?

Jamie Nixon: Okay. So, perimenopause is that transitional stage that's leading up to menopause, where women's periods will start to get more irregular. They might notice some symptoms that are starting to change. Their hormone levels usually will start to fluctuate unpredictably. And usually, this can happen, in the late 30s, the mid-40s, usually about 10 years—it can happen up to 10 years before actual menopause happens.

And then, menopause is actually just that one day, out of your life when you have gone without a period for a year. So, it's just when your periods stop. So, we like to tell women to, you know, keep track of their periods because when they're getting irregular in that perimenopause state, you might have a period and then not have one for six months, and then have another one. So, you're still not technically menopausal yet because you've still had a period within a year. And that's the time when those hormones like the estrogen and progesterone are really gone after that, and that's where you start to feel and start to have more of those symptoms.

And then, post-menopause is just that time after menopause for the rest of their lives. And that's when we get concerned more about more health concerns of like osteoporosis, cardiovascular disease, vaginal, urinary symptoms of menopause, sexual health changes, changes in our metabolism. And then, there's usually some mood and sleep disorders that also go along with that.

Host: Jamie, what symptoms do we look for?

Jamie Nixon: So, symptoms you're going to want to look for in perimenopause and menopause, they can be physical, psychological. There can be social changes associated with menopause and the menopause transition. Some of the things that women will notice, we all hear about the vasomotor symptoms, which are like hot flashes, night sweats, which those can kind of affect people's anxiety, fatigue, difficulty concentrating and sleeping. It can cause difficulties at work if you're not getting enough sleep at home. And those usually occur in 80% of women for an average of about 10 years, which is a really long time.

And then, there's also what they call now genitourinary syndrome of menopause, which is like the vaginal dryness, the pain with intercourse, burning, irritation, urinary incontinence, and those symptoms seem to occur in about 50-70% of post-menopausal women. And then, you also have the psychological things like the mood disturbances, the anxiety, depression, irritability, and an overall feeling of just deteriorating mental and physical health.

Host: It sounds so unfair that women have to go through all this, because you think, Oh, "Oh, when I'm done with my period, it'll be great." No, there's a whole new set of concerns, right? But at least it seems like, currently, the whole discussion is out in the open now, whereas maybe even, I don't know, 10 or 15 years ago, no one talked about it. You're just on your own. But Jamie, could you talk about the newest recommendations for managing symptoms?

Jamie Nixon: Yeah. So, if you look at some of the major organizations like the Menopause Society or the International Menopause Society, a lot of them will recommend that you do individualized treatment based on the patient's symptoms, age, risk factors, and their goals. And a lot of the time, we're trying to do a lot of more preventative things for that late transition in life, the post-menopause, to help try to prevent some of those things from happening sooner than what they actually need to.

And, you know, really educating the patients. I think that's where we're lacking in, is the education part, because like you said, people didn't talk about it. So, a lot of providers weren't even taught that much about menopause when they went through school. So, we're all trying to relearn this so that we can give our patients the best information that's out there and not withhold treatment and things like that from them that we never knew about before.

There's a big push for like shared decision-making so that the patients have a say in their care and what happens to them. And it needs to be very individualized because everybody's different, and you can't treat everyone the same.

Host: Tell us some of the treatment options.

Jamie Nixon: So, some of the treatment options for perimenopause, menopause, post-menopause, they say that the best time to treat somebody for those is within a 10-year period of menopause—so, 10 years before, 10 years after. As long as you're staying in that window, that's when the treatment is the most beneficial for patients.

The hormonal thing is the first line. I mean, if you look at all the literature and everything, it's the first line recommendation for treatment of perimenopause and menopause. And that's estrogen therapy and progesterone therapy. And estrogen comes in many different forms. There's patches, there's pills, there's gels, there's sprays, there's vaginal creams, rings, and tablets. So, the newest recommendations are to start with the patches because they're less systemic than like an oral pill. So, you have less risk of, like, the stroke or the cardiovascular risks that can potentially come along with estrogen therapy.

So, a lot of people will start with the patches, or if people have risk factors, that's a good one to start with too. They have weekly patches that you change out every week, or they have twice weekly patches, and there's all different dosings for that. The vaginal creams, if you talk to some people, they say everybody should be on a vaginal estrogen just because of how protective it is. And they talk about it, like, we put lotion on our skin, why don't we put lotion on our vulva just to help protect the urethra and protect people from getting UTIs, bacterial infections, and just that tissue breakdown that happens when you start to lose estrogen.

And then, women who still have a uterus have to have progesterone along with the estrogen to help protect their endometrial lining. If they don't have progesterone, that estrogen will just thicken up that endometrium. And then, that can cause abnormal cell growth, which could lead to potentially endometrial cancer. So, we have to make sure we protect that lining. But the progesterone also will help with people that have a hard time sleeping, and it will help with some anxiety. And you take that at bedtime. If you don't have a uterus or you had a hysterectomy, you don't need that progesterone necessarily, but you could still use it if you were having issues with sleep and mood.

Host: You talked about goals earlier. How do we recognize when it's time to do preventative long-term health goals?

Jamie Nixon: I think mainly it's just on the patient's symptoms. A lot of times, what patients will do is, you know, even at just like their normal annual exam, you'll hear them talk about how they just don't feel like themselves anymore. A lot of people, the first signs that they notice are more brain-related, so like the mood changes, the brain fog, hot flashes. And things that you normally hear about are usually later in perimenopause or menopause even. So, I think it's just remembering to listen to patients and just to treat off of how they're feeling. Like I said, everybody's different, and it can start at any age, mid-30s to their 40s.

Host: So in closing, Jamie, is there anything else you'd like to add or you'd like people to know?

Jamie Nixon: You just have to remember there's also a lot of lifestyle. The hormone therapy is just one tool in the toolbox. Like, to do all this preventative stuff for the future, it's really important to also pay attention to your lifestyle. Women, it's really important for them to do some type of weightbearing exercise in their life They start to lose muscle at 35, and we lose it really significantly. Your muscle helps protect your bones or, you know, you don't want to fracture a hip or fall or all those things. So, that's really important. And then, just watching your nutrition and make sure you're feeding your body the way it needs to be fed to help with how you feel and reduce those other risk factors of the cardiovascular disease and the diabetes and the high blood pressure, cholesterol.

Women, unfortunately, I feel like we have a real disadvantage as we go through menopause because those estrogen receptors, I mean, they're literally all over our body, so they affect every part of our organs and our systems, and I don't know that a lot of people realize that.

And then, just also, including good sleep hygiene and stuff, because sleep is actually one of the best things that you can do for yourself because that's that time when your body repairs itself from the day or the stress that you've had over the day and things like that.

Host: That's amazing about the estrogen receptors. So, what should we be eating to take care of that?

Jamie Nixon: I mean, as far as nutrition, it's really important to get in—I'm sure everybody hears about it all the time now—protein. That's one of the biggest things that you can do. And they say that you should do a gram of protein for your weight that you want to be, like your goal weight. So if you're 120 and you want to stay at 120, you should probably getting in 120 grams of protein a day. Making sure we're eating calcium, a lot of calcium in our diet to help protect our bones and vitamin D. And then, fiber is really important for digestion and our GI system. It's really important, you know, to focus on foods that aren't processed with all that extra preservatives and things like that in them.

Host: That's so informative and helpful. Thank you so much for sharing your expertise today.

Jamie Nixon: Yeah, no problem. Thank you for having me.

Host: Of course. Again, that's Jamie Nixon. For more information and to get connected with one of our providers, please call carle.org. Or for a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Maggie McKay.