Jaime Lewis (Host): Menopause is a subject shrouded in myth and mystery for many women, but it doesn't have to be. Today, we're talking with Dr. Anne Schreiber, a Gynecologist and the Division Chief for Women's and Children's Services at Duly Health and Care. She's going to debunk those myths about menopause and provide answers to common questions about this important phase in women's healthcare journey.

 This is Duly Noted, a health and care podcast from Duly Health Care. I'm Jaime Lewis. Dr. Schreiber, hello. Thanks for joining us.

Anne Schreiber, MD, NCMP: Thank you. Thank you for having me.

Host: I want to start first and foremost by asking, how do you advise your patients to prepare themselves as they approach menopause? I mean, how can they sift through all the misinformation to find reliable advice?

Anne Schreiber, MD, NCMP: I think finding advice and information from providers who are, who hold certifications from the Menopause Society, which was formerly called the North American Menopause Society, is a really a great place to get reliable information. Their website is menopause.org. And this is, I tell patients all the time, take a look at this.

This is an organization that collects our most recent data on menopause, on hormone therapy, on, risks and benefits to patients, and puts that together for providers.

Host: Fantastic. And menopause.org is very easy to remember. Well, I know that every woman's health journey is different, so how do symptoms of menopause vary from person to person, and what are some of the misconceptions about the universality of these symptoms?

Anne Schreiber, MD, NCMP: The symptoms women experience varies tremendously. Some women go through this transition and they don't bat an eye. It doesn't impact their life. There's other women who find that they don't sleep for a decade. There's a wide range of symptoms. Sometimes it takes a conversation to figure out what symptoms are related to menopause and what are related to other factors? About 75 to 80 percent of women are going to get hot flashes and night sweats and those sleep disturbances to some extent. Not everybody gets those. The symptoms of cycles change as women are going through this transition.

So the bleeding pattern changes, breast symptoms can change, mood fluctuations, whereas PMS or the mood stuff that happens right before a period can get much more intense as women are going through this transition. So it's about talking to your provider about what you're experiencing and whether or not it's attributed to that or can be attributed to a thyroid disorder or something else.

The vaginal symptoms that happen with menopause, though, do happen to everybody and those progress over time. They typically don't get bad until well after a woman stops having periods, but sometimes they can still be having periods and have vaginal dryness. But those you don't wanna just motor through those, those are gonna continue to get worse over time.

Host: I would imagine that a woman has the power to impact this transition with lifestyle choices. How do those lifestyle choices impact menopause symptoms, and what myths exist about natural remedies versus medical treatments?

Anne Schreiber, MD, NCMP: One of the myths is that something natural is gonna be better or safer than a medical treatment, and that's not necessarily true. Lifestyle choices have a huge impact on symptoms. Getting stress under control, getting weight under control, are really our keys. Know what your triggers are for eating, for stress.

Alcohol is going to make any menopausal symptom worse. A poor diet, which makes your gut not feel good, it's going to exacerbate hormonal symptoms. Anything that impacts your sleep pattern, sleep schedule. So, when women don't, if they do shift work and they're off sometimes at night, sometimes they work during the day, that can be really challenging when you throw hormonal fluctuations on top of that. There's lots of evidence for safety of the medical treatments. And I'm, I'm kind of primarily focusing on hormone therapy with that, but we really just have more evidence with our hormone therapies and with the FDA approved remedies. It doesn't mean natural remedies don't work. We don't have as much evidence that shows that they have a big impact.

 But there's nothing wrong, it really is, it depends on what your particular health history is, as to what the best option is for you, and the intensity of symptoms.

Host: I know you touched on mood earlier. I think many of us have heard myths suggesting that menopause related hormonal changes can lead to severe mood swings and depression. How do hormones actually affect mental health during menopause?

Anne Schreiber, MD, NCMP: Hormones are going to affect mental health in that, as I believe, it's primarily an impact on sleep for most women. It's you have a disrupted sleep pattern, you're, nothing works well, if you're not sleeping well, right? You're cranky, you want to eat poorly. It's hard to focus and cognition, you may feel like you're, it's hard to, put your thought together. But it's really the impact on sleep that impacts people a lot. It also, for women who tend toward having mood swings with their periods, those can often get much more intense.

Women who struggled with postpartum depression often struggle with mood as they go through this transition. I try to warn women who've had that history of be ready. It's the hormonal fluctuations that your body's going through that impact how your brain responds to that.

Host: There's a widespread belief that menopause leads to a severe decline in sexual function due to hormonal changes. Can you talk about the truths and myths related to sexual function during and after menopause?

Anne Schreiber, MD, NCMP: Well, I talked a little bit about the vaginal changes and this is what I was kind of getting at with that. And the, vagina loses its elasticity. The vagina doesn't lubricate as well. And those changes can often lead to pain with intercourse. And if you're having pain, you are not going to want to do that or look forward to it.

So it really does impact your ability to respond and to want to participate in sexual activity. The reality is that in women, about a third sexual function, or a third of libido, is biologic. It's a hormonal drive. That decreases both in men and in women as we get older. A third of it is about how we feel about ourselves.

It's, are we stressed? Are we distracted? Are we on a medication that is giving us a side effect. Are we not happy with what our body looks like? And are there body image issues? Those all can impact our desire or our libido and want to participate. And about a third of it has to do with our, how we feel about any particular partner.

So if there's conflict there, that impacts our brain's ability to get excited about having sex. So, there's a lot more that goes into it than just hormones, and as we get older, there's more of those other things, the things that distract us, the relationship issues, that type of thing. Unfortunately, it's just not as easy as in men where you get blood flow in the right place and you're good to go.

There's a lot more that goes into it.

Host: Right. Well, I know it's no surprise that many believe weight gain is inevitable during menopause due to hormonal shifts. So what is the truth behind hormones, metabolism, and weight management during this phase of a woman's life?

Anne Schreiber, MD, NCMP: Unfortunately, the reality is that if you do the same things, if you don't change anything, weight's going to go on. Because the reality is that women who are menopausal need about 300 calories a day less than women who aren't. At that same time, we're aging and we're losing muscle mass. So when women come in and say, I haven't changed anything and my weight has gone up, in my head, I'm thinking, well, you haven't changed anything and that's why your weight is going up.

So this is about being very aware of what we're eating. It's about making sure that we're getting enough protein and we're not taking in too many carbs. And this gives back to sleep, that if you're not sleeping, it's really hard to make those right choices, especially when that lack of sleep is going to drive us to the things that we shouldn't eat.

This is also a time where a lot of women get diagnosed with autoimmune diseases, and they have more inflammation in their bodies, and there are other things that can exacerbate and add to weight gain that are all happening at the same time. I believe as we get older, we have more food intolerances.

So if something's not agreeing with us, we should listen and avoid eating that, whether that's dairy, whether that's gluten, because those types of things also have an impact. We talked earlier about what do we do to prepare. This is where having a regular exercise routine and making sure that is part of your life and part of your routine is going to help keep weight under control.

But the reality is at this point, you're not going to exercise the weight off. If you want to lose, it's really about diet.

Host: Well, as we wrap up here, is there anything else that you'd like to add?

Anne Schreiber, MD, NCMP: I would like to encourage patients to seek out a provider who has an interest in menopause, has attended the Menopause Society's meetings, which you can see that on the Menopause Society website, or that holds certification. At Duly Health and Care, we have five providers in the western suburbs of Chicago that are Menopause Society certified. Dr. Scott Kagan, Dr. Mei Sue Lee, Vanessa Treps, and Lori O'Grady, and myself, the five of us all hold that certification. And so we make sure that we're educated and interested and really focused on helping women live their best lives as they go through this transition.

Host: Fantastic. Dr. Schreiber, thanks so much for debunking these myths for us. We really appreciate it.

Anne Schreiber, MD, NCMP: You're welcome. Thanks for having me.

Jaime Lewis (Host): That was Dr. Anne Schreiber, a Gynecologist and the Division Chief for Women's and Children's Services at Duly Health and Care. I'm your host, Jaime Lewis, and this is Duly Noted, a Health and Care podcast from Duly Health and Care, looking to learn more and take charge of your healthcare journey. Visit dulyhealthandcare.com to get started today.