Transcription:
Menopause: Symptoms, Treatments and Benefits

Deborah Howell: You know, if you're a woman of a certain age, you will undoubtedly feel some of the changes your body's going through. So how much do we really know about menopause and perimenopause? And is there anything we can do to find some ways to help manage all the things that come with this time of life? Let's find out with Dr. Christina Thomas, an obstetrician-gynecologist with Concord OB/GYN, affiliated with Emerson Health. This is Health Works Here, the podcast from Emerson Hospital and I'm Deborah Howell. Welcome, Dr. Thomas.

Dr. Christina Thomas: Hi. Thank you, Deborah, for having me today.

Deborah Howell: Such a treat to have you on with us for a few minutes. Let's dive in with a question, at what age does menopause start?

Dr. Christina Thomas: That's a great question. So the average age of menopause is about 51 years old. And now, women can start having symptoms as early as late 30s or early 40s and sometimes menopause doesn't really start until later 50s. But 51 is the average age. And menopause is defined as no menstrual period for one year. But again, like I said, some of these awful symptoms, most of them will characterize them as awful, can start a lot a little bit before, can continue after. But about later 40s, early 50s is when women will really, truly start to feel the symptoms of menopause.

Deborah Howell: Let's talk about this awfulness. What are some of the symptoms?

Dr. Christina Thomas: So, you know, the most common one is those hot flushes or hot flashes. About 87% of women will complain of them. And it's really just a sensation of extreme heat, mostly in their face, their upper body, basically you see the women ripping off their sweater, using a fan, you know. Coworkers who have to leave and get some air. They actually can also present as some anxiety. And a lot of times, these will also happen at night. And so my patients will complain of, "Windows open. I rip the covers off. I need to put them back on because then I'm chilly. I have to change my pajamas, change my sheets." And so these hot flashes, night sweats can be very impactful in a woman's daily life.

The other big one that a lot of women don't want to talk about is vaginal dryness and that's a very common complaint, but one complaint that maybe they're embarrassed or they don't want to say, "Oh gosh, my vagina's not feeling very nice. Like what's going on?" And it's really the lack of the estrogen and progesterone that significantly decreases during this time that causes these changes in the vagina. And so the dryness, there could be itching and really painful intercourse. But women are embarrassed to say anything about that. And again, more symptoms I hear about, hair loss, especially on the head or hair growth on the face, skin changes, sometimes acne will come back, a decrease in libido is a big one and just not interested in being intimate with their partner, mental health changes, anxiety, anger, a mental fog. Like they're just like, "I just can't concentrate during the day," memory impairment. There's a big spectrum of symptoms that women can sometimes suffer from. And then I have other patients who are like, "Yeah, didn't even feel anything."

Deborah Howell: Who are they? I've never met them.

Dr. Christina Thomas: Yeah, exactly. You know, like it's very rare, but they're like, "Yeah, it was fine. I had a period one day and then I didn't." And it can last anywhere from a couple years after that last period to their whole life. I mean, I have women in their 70s just still complaining that they're having hot flashes.

Deborah Howell: Really?

Dr. Christina Thomas: Yeah. So it can be pretty significant.

Deborah Howell: And can it come and go?

Dr. Christina Thomas: It can, especially when we're in this perimenopause and that's really like, "Okay, my period comes one month, then I don't have a period for three months. And then all of a sudden, I get hot flushes. I feel kind of crampy. Am I going to get a period? And I have a period." So it's this ebbs and flows of the hormones that causes the coming and going of the symptoms. And again, when you start spacing out your periods, that menopause probably is coming in the next one to two years. We don't have a crystal ball. Just like having a baby, we have the due date, but you never know, right? So you would think it's coming, but we don't know when. And so it's really just trying to manage how we're feeling during this time.

Deborah Howell: And let's have a definition if you would, of perimenopause.

Dr. Christina Thomas: Basically, it's that time before menopause truly starts. So it's that time when you're still menstruating, although it could be irregular and you could be starting to have a hot flash or difficulty sleeping or really significant anxiety or emotional changes is one of the bigger complaints that I have. And again, it's those physical symptoms too, like the metabolism slowing down. I have a lot of women say, "I can't lose the weight like I used to. I used to be able to cut out sugar for two months and I dropped that five pounds and now I can't." And it's really just all these changes again, it's all through the decrease in the estrogen and progesterone that happens as your ovaries start to kind of wind down and your reproductive lifespan is decreasing. So all good, right?

Deborah Howell: Yeah. What's not to love? But are there any benefits of menopause?

Dr. Christina Thomas: I have to look at it as like this next change in your life, right? Like you have this huge span of reproductive years where you potentially can have children, you have a family, and then that starts to wind down and you enter this different stage. So some of my patients who have quite awful periods, heavy, painful, very hard to deal with each month, actually welcome this change of not having a period. And a lot of times, if they have say fibroids, which are kind of benign growths in the uterus, they could become quite large in a woman. These tend to shrink and not cause symptoms, so maybe they don't need surgery because menopause is coming and close to where she is. And, also you don't have to take birth control anymore. There's no risk of pregnancy. So that's a huge piece too and that's like not a worry. So those are the main benefits I would say.

Deborah Howell: Okay. Do I need to think about any other screening tests in menopause?

Dr. Christina Thomas: So I think in just terms of any woman's life, you always want to do your annual visit with either your primary OB-GYN. Pap smears are every three to five years, you know, depending on your history of Pap smears. Mammograms are yearly typically in your 50s. You also want to think about osteoporosis and your bone health. Because as you enter menopause, your bones, the density decrease, and so we want to stay on top of that, making sure you're taking the calcium and vitamin D. And you can also do a bone scan, which typically we do a baseline at age 60. Also talking to your primary about a colonoscopy, any cardiovascular health. Any follow up tests that you need for that. And also just a reminder for women, if you have any bleeding after that year of not having a period, you definitely need to report that to your primary or your OB-GYN, because that can be significant and mean something quite serious.

Deborah Howell: Okay. And you spoke of calcium. How much should a woman in menopause be taking daily?

Dr. Christina Thomas: Typically, 1000 milligrams of calcium and then, the vitamin D supplement, a lot of times they come together in a supplement.

Deborah Howell: And the vitamin D just helps the calcium become absorbed?

Dr. Christina Thomas: Yeah, exactly. And then, especially if you live in the Northeast or the north where there's not a lot of sunlight, especially in the wintertime, you might need to increase your vitamin D. But you could talk with your primary care about that too.

Deborah Howell: Now, if a woman has severe symptoms during menopause, what treatments are available?

Dr. Christina Thomas: There's a lot of different types of treatments. The gold standard for severe hot flashes is the hormone replacement therapy. And there's been a lot of back and forth. There was a big women's health initiative study that came out in the 2000s that really frowned upon hormone therapy with the big study that they did. But after they kind of teased everything out and did some more retrospective analysis, we do know now that hormone therapy can be very beneficial especially in a woman who's transitioning, so going right into menopause.

And so that hormone therapy, meaning giving estrogen and progesterone in certain formulations to decrease those hot flashes. And the recommendation is typically the lowest dose that helps the woman with the shortest amount of time. And so typically, we like to say five years or less, but I have many patients who don't want to come off their hormones because they feel great. And so it does help with the hot flashes, that mental fog, they feel better. It helps with libido, helps with that vaginal dryness. But it does come with some risks and, just touching upon those, can be increase risk of breast cancer, a blood clot, potential stroke, any cardiovascular disease. It's really patient specific, so I would encourage any woman to speak with their OB-GYN about if they are a candidate for hormone therapy. And there are some women who can't take estrogen and progesterone. And so then we look at other alternative forms of help and that could be gabapentin, which is actually a neurology medicine, helps with a bunch of different things, but can help with the hot flashes. There's a medicine called Clonidine and also the SSRIs, like Prozac or Zoloft, can actually help with those vasomotor symptoms or the hot flashes. So there is treatment.

Deborah Howell: I did not know that. I did not know Zoloft. Who would've thought?

Dr. Christina Thomas: Yeah. And then, that would also help with a little bit of mood or anxiety. So that could have two benefits in one medicine. And if a woman doesn't want to take anything systemic, but really has significant vaginal dryness, we have localized vaginal estrogen that can especially help with painful intercourse, with preventing urinary tract infections and that's really a local treatment that most women can take and not have any of the risks associated with that and very helpful. There's also vaginal lubricants.

Deborah Howell: Well, that's a good news.

Dr. Christina Thomas: Yeah. So there is treatment and we were scared off 10, 20 years ago, and now we've kind of been working our way back and saying, "Okay, well we can treat these women. We can help them and help them feel better and ease the transition a little bit."

Deborah Howell: Great. I have just a couple more questions for you, if you don't mind.

Dr. Christina Thomas: Yeah. Sure.

Deborah Howell: What are bioidentical hormones?

Dr. Christina Thomas: So bioidentical hormones, everyone references Suzanne Somers back how many years ago, basically they're plant-derived hormones, which are chemically similar to your body's estrogen and progesterone. There are some FDA commercial products out there that we use. But when patients ask about bioidenticals, they're referencing like the compounded preparations and these aren't regulated by the FDA. So they haven't gone under rigorous testing or safety or efficacy. And a lot of times these compound pharmacies throw a little bit of this, throw a little bit of that. So are you underdosing? Are you overdosing? They come in creams and pellets. So it's one thing to go on. I have some patients on it and they understand the risk and they are the same risks. They're the same risks with just generalized hormone therapy that we just spoke about. I want to just make it clear that they do carry the same risk. Some of my patients say, "Oh no, my doctor said that this is risk free," and it's really not. But they're also very helpful and they do the same thing. They try to help with all those menopause symptoms and the hot flashes and the libido. So just make sure that you do some research on it and know and understand the risks and benefits.

Deborah Howell: Got it. Are there any natural treatments that can help women ease their transition?

Dr. Christina Thomas: I love this question, because I'm such a fan of anything natural or organic. And I love when my patients ask me this too, because I'm like, "Let's just get out and walk." Exercise, you know, just helps everyone feel a little bit better with the endorphins. Exercise can help with weight loss. There's acupuncture you can try. Hypnosis, meditation and any stress reduction, because sometimes when a woman is stressed, a lot of things happen in their body and they can actually have more hot flushes and just not sleep very well. There also can be some food triggers like caffeine and alcohol, that if you decrease those, that could help.

And then there's those natural supplements that you could try. Black cohosh, evening primroses, if there's any soy products, different vitamins that you can try, that sometimes my patients will tell me, "Yeah, that really helped." And I'm like, "Great." And sometimes they're like, "No, they didn't really do anything. So I think really just leading a healthy lifestyle too, and doing your best to just exercise, stress reduction, all the stuff we know we're supposed to do, right? That sometimes can be a little daunting.

Deborah Howell: Yeah, of course. That's why all of us are like suddenly playing pickleball and crafting and doing all these things.

Dr. Christina Thomas: Yeah. Exactly.

Deborah Howell: "What's wrong with her?" "Well, she's got menopausal." "Okay. I understand completely." She's gone all the way down the rabbit hole with pickleball. Okay. So, this has been fascinating and just lovely having you where can I go for more information and our listeners as well?

Dr. Christina Thomas: Yeah. So there's a great website www.menopause.org. This is put out by the North American Menopause Society. There's actually a guidebook for patients, video series and just information on menopause that is medically sound advice and has good information. And then, speak with your OB/GYN or your primary care. If you'd like to see me or have a consult with me, happy to see you. My office number is 978-369-7627. It's Concord OB/GYN. And we can kind of talk about what's been going on.

Deborah Howell: That is so lovely. I'm going to give the number again in case people missed it. It is 978-369-7627 to make an appointment with Dr. Thomas.

Dr. Christina Thomas: Perfect.

Deborah Howell: Thank you so much for your time. I'm going to get you back to your very busy day, Dr. Thomas, all right?

Dr. Christina Thomas: Deborah, thank you for having me. This was great. So much fun.

Deborah Howell: That is Dr. Christina Thomas, an obstetrician gynecologist with Concord OB/GYN, affiliated with Emerson Health and someone who can make menopause fun. Not many people can do that. Thanks for listening to Emerson's Health Works Here podcast from Emerson Hospital. Subscribe to this podcast on your favorite podcast source, including Apple Podcast, Google Play Music and Spotify. And if you like what you've heard, please share it on your social channels. And also make sure to check out the full podcast library for topics that might be of interest to you. I'm Deborah Howell. Have yourself a terrific day.