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Scott Webb: Though menopause is a part of life and aging for women living with it can be unpleasant. And my guest today wants women to know that there is help available. And I'm joined today by Dr. Ashley Hothem. She's an OB GYN with Genesis. This is Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Doctor, thanks so much for your time today. We're gonna talk about menopause and I have a wife. I have a mom, so I'm a little familiar with menopause, but great to have your expertise. As we start here. What is menopause?

Dr. Ashley Hothem: So menopause is the period of time once a woman's period is stopped for at least 12 months, for most women that happens around age 51 to 52, but there can be some variation as early as 45 as late as 55.

Scott Webb: Yeah. So let's talk about the signs, what are the first signs a woman might have if they're experiencing menopause?

Dr. Ashley Hothem: So most women's first signs that they're getting closer to menopause will be some changes in their menstrual period. For most women, that's gonna be some shortening of their cycles or possibly skipping cycles. Some women that can even mean heavier bleeding, can have a lot of variation there. The other common sign is hot flashes, which most experience is getting kind of flushed and hot all of a sudden, can come at different points and times. And not all women experience the symptoms, but those are the two most common signs and they can happen quite a few years before menopause even occurs.

Scott Webb: Yeah. Wondering, is there an actual test for menopause or is it mostly patient history in a conversation with patients?

Dr. Ashley Hothem: So menopause is actually diagnosed after your period stopped for 12 months. So it's kind of a retrospective meaning kind of looking back diagnosis. However, a lot of women wanna know as they're having those changes and experiences, if they're menopause. Honestly, the answer is not really, we can test hormones, but if we test your estrogen or your FSH level, it just tells me what it is that day. It can change the next month. So there's not a perfect test out there. They've studied a lot of different things, but nothing is really hand out to be able to project when menopause is gonna occur.

Scott Webb: It's interesting what you're saying there, about how things change sometimes minute by minute, day by day, again, with a wife and a mom, I can attest to that, that sometimes hot, sometimes cold, minute by minute, day by day, for sure. And I've heard folks talk about para menopause. What is that?

Dr. Ashley Hothem: So that's when people start to notice those symptoms I was talking about a little bit earlier. It can happen on average. It's about four years before people stop their periods, but I've seen some women notice changes even before that. It is that time when people actually usually come in to see us gynecologist that's when they have problems with their hot flashes, other changes to their sleep maybe or mood symptoms. They can even have vaginal dryness. You can see changes in their cholesterol. So lots of different things kind of happen during that perimenopausal time, it gets a lot more talk and it's a lot of the time when we see the women in the office.

Scott Webb: Yeah. And, maybe you can put an average number on this when we think about, because you say there can be early signs or symptoms maybe, and can start earlier for some and some may not have the signs and symptoms and so on, but generally speaking, how long does menopause last?

Dr. Ashley Hothem: So that is actually an interesting question, because I get that a lot, but it's not a good number out there. And even when you look at studies and stuff, there's a big fluctuation. So I usually tell people you can notice symptoms from before to even after anywhere between five to 10 years. However, some women will continue to have things like hot flashes for a long time, throughout the kind of their life after menopause.

And there's some symptoms that come soon after menopause like the hot flashes and sleep problems. And then there's symptoms that show up later after menopause like vaginal dryness, and issues with sexual function. So it can be quite a variation. So I usually tell people like five to 10, because that's something they can kind of keep in their mind, but it may be even more variable than that.

Scott Webb: Yeah. And I definitely remember being in the car with my mom when she was going through menopause and the hot flashes, and we would have the air conditioning on in the winter, you know? So I'm familiar with sort of the accommodations that have to be made. And as you say, there's a lot of variables and can be five to 10, but maybe longer. I know you mentioned that some women may experienced para menopause earlier than others, but is that a reason for concern?

Dr. Ashley Hothem: It can be, if the periods truly stop, particularly under the age of 45. Then I worry about lack of estrogen and risk for earlier osteoporosis or bone problems or heart disease. So if women's periods have stopped before they've even become 45, then yes, that can be an issue.

Scott Webb: Are there things that women can do to address the signs and symptoms of menopause, the hot flashes night sweats, things like that?

Dr. Ashley Hothem: Yeah, there are things that people can do. I talk about that a lot with women about different ways that they sleep, different things that they can do throughout the day. There are medications that we can use to treat the different symptoms of menopause, not just the hot flashes and not just hormones. Lots of different things that we can use to address it. A lot of it is what, like you talked about turning on the air conditioning in the car, even in the winter, those kind of things. But there are things beyond that medications,, that you could talk to your doctor abou t possibly starting.

Scott Webb: Yeah, good to know that there are some options besides just freezing in the car, but if that's what you have to do, that's what you have to do. Right. All right. So let's talk about hormone replacement therapy. What is that? And do you recommend it?

Dr. Ashley Hothem: So hormone replacement therapy is when we give combinations of either estrogen progestion or estrogen alone, if someone has had a hysterectomy, to help with the symptoms of menopause, I am not opposed to hormone replacement in any way for the right patient. So that's something that really has to be talked about with your doctor. We wanna start it in patients who are having significant symptoms so that we can improve their quality of life.

However, we don't wanna cause any harm. So we do things like we calculate their heart disease risk, and we look at their family history of things like breast cancer, and then we decide who is right for that and who is not. So that's something that I think is a good option for women, because no one wants to suffer. And it can kind of balance things. If you're the right person.

Scott Webb: Yeah. And you use the word suffer there and just anecdotally, you don't hear a lot of good things about menopause. Women who've been through menopause, rarely tell you how easy it was, how pleasurable it was. So as women head into their forties and they know 45 could be the onset of para menopause, or they get closer to 50, as you said earlier as we wrap up here, what would be your thoughts about menopause, about recognizing it, diagnosing it, and then ultimately sort of dealing with it, managing it, living with it, until the end of menopause?

Dr. Ashley Hothem: Usually, what I tell people is that menopause is a natural part of aging, it is. However, it comes with some very unpleasant side effects. So, If someone is having enough side effects that it's affecting their life, they can't sleep. They' are having problems with their jobs and emotional problems, then they need to come talk to their doctor. Because like I said, there are options to treat them hormones, other medications, and things that we can use to help them out. Cause I feel like a lot of women are just like, oh, this is just normal and they just suffer.

So we do want them to come and talk to us because like, I said earlier, becomes very individualized based on a lot of different factors, on what medication or what treatment might be best for them. So that's one of the things that you kind of have to sit down and have of an in depth conversation about.

Scott Webb: Yeah, absolutely. Right. That's usually the best advice. Speak with a provider. So start with your primary OB GYN. Women don't have to suffer in my experience. They're not so much suffering in silence. There's a lot of sharing of the suffering, but from what I've heard how unpleasant it is, I completely understand. Right. And men need to be sort of understanding and accommodating, but there's, as you say, a lot of variables and a lot of things that can be done to help with the suffering. So thanks so much for your time today, doctor, you stay well.

Dr. Ashley Hothem: You too. Thank you.

Scott Webb: And for more information, visit genesishcs.org. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.