Melanie Cole, MS (Host): Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today, we're talking about managing menopause. Joining me is Victoria Schooler. She's a physician assistant with Henry Mayo Newhall OB-GYN. Victoria, welcome. I'm so glad you could join us today. So let's talk about menopause.

Tell us what it is. We hear about this change of life. We hear the terms perimenopause, postmenopause, menopause. Give us a little explanation of what those words mean.

Victoria Schooler, PA-C: Yeah. Menopause is diagnosed clinically after an entire year without a period. and then perimenopause is just what that word is. Peri, so around menopause. A couple years before someone completely stops their cycles, they might experience changes from the fluctuating hormone levels. so that's what perimenopause is

Melanie Cole, MS (Host): And then post-menopause would be the right after the fact. So it's already happened,

right? Okay. So before-- You said it was a diagnosis. So before we talk about symptoms and things, tell us what that means when you say diagnosis. How is it diagnosed? How do we know whether we're in perimenopause or menopause or whether we're completely done and considered, you know, over the hill and post-menopause?

Victoria Schooler, PA-C: Yeah. Perimenopause is, more on symptoms, of how someone's periods are acting, if they're getting irregular, more spaced out. When someone starts getting symptoms like hot flashes, mood changes, that's when I would suspect that someone's in perimenopause. Menopause is that, like I said, that entire year without the period.

And then sometimes we can get blood work to confirm that someone's in menopause completely, like we're not expecting any more periods. But it's a little bit difficult to use blood work and labs to determine perimenopause because the hormones are just fluctuating all over the place, where, you know, one day your hormones might be one thing, and then the next day it would be something completely different.

So blood work doesn't tell us the entire picture. It's more on symptoms

Melanie Cole, MS (Host): So let's talk about some of those symptoms. Now, I myself, I'm 62, so I've been there, done that, and I was a lucky one. I didn't have a lot of the symptoms that you're gonna tell us about right now, but many women experience this whole big range of symptoms. I mean, they can be pretty severe, and then they can also be pretty mild.

So what are we looking for to start perimenopause? as far as symptoms, we've heard night sweats and hot flashes. What else is going on?

Victoria Schooler, PA-C: Yeah. I'm glad you mentioned that range too, because, you know, someone can experience it, go through perimenopause and menopause and experience nothing. Like, I didn't even know it happened. And then someone might experience some symptoms, and then someone might experience everything. So it's very different for everyone.

And some of those common symptoms, aside from hot flashes and night sweats, might be, brain fog, forgetfulness, even joint pain is a common one that I hear, mood changes, so more anxiety. A lot of women sometimes get a little bit more depressed during perimenopause and menopause as well, which can then affect our sleep.

So difficulty sleeping, staying asleep, falling asleep. Other things that we might experience, losing our hair, our skin gets super dry and thin. those are just some other common things there

Melanie Cole, MS (Host): Well, for anyone who hasn't gone through it, you're making it sound like a lovely time. It's

really... no.

I'm, I'm just messing with you. It's, it is really-- I look at it as actually an exciting time because it is when our bodies are changing, the estrogen levels are, you know, dropping, and our hormones are changing, but it's also tells us that we are on this different path, a little bit of a different journey than we've had when we're your age.

So it's really not all bad. And you mentioned the mood changes. I'd like to touch on that for a minute. When women come to you and talk to you about these mood changes, because we could be all over the place, and I'm really glad you mentioned brain fog because I did experience that. I was like, "What? Wait a minute.

What?" You know. So when women come to you about those mood changes, specifically those, what do you tell them about things that they can do to help? And we're going to talk about other symptoms, but specifically those. Do you-- Is it counseling time? Are there medications required? What do you tell women to do?

Victoria Schooler, PA-C: Yeah. At first, I think the biggest, biggest thing are just the lifestyle changes. The little things that we can do in our day that can, can improve our mood. our bodies and life is kind of just one circle really. That's the way I think about it. Our eating habits, our exercise habits, they affect our sleep.

If we have, we don't move our bodies, we don't eat well, we don't sleep well. But if you eat well, you move your body, your body need, will need that rest, so you'll sleep well, which will in turn improve your energy, which would in turn improve your overall mood. At least that's the hope. so that's the start.

If we're at a point where, you know, I've done all those things, I'm, I'm really trying and I, I just not getting better, we do have, medication that can help as well. Or maybe one outlook that would help someone would be therapy. You know, talking to an out- like a, secondary resource and just being able to talk it out.

That's really helpful as well

Melanie Cole, MS (Host): No, you're exactly right, and that's great advice because exercise, and I'm an exercise physiologist, so of course I'm always going to, you know, recommend

that. But it does help with the sleep. It does help to regulate those hormones and, and with those mood changes. and, sleep, as you mentioned, is just such an elusive thing.

And we think of it like, "Oh my goodness, you know, now I'm not going to be able to sleep," and then that contributes to it. So that was really good advice that you just gave. Now, when we come to you and we say, "Okay, some of these symptoms are untenable," and you talk about medications, one of the ones that women want to know about, Victoria, is estrogen.

They want to know about estrogen replacement therapy. Can you tell us a little bit about hormone replacement therapy? What's kind of going on in that world, and what do you tell women that have questions?

Victoria Schooler, PA-C: Yeah. As far as estrogen replacement, the biggest symptom that, it really helps with are those hot flashes and the hot flashes and sleep. A lot of times people would have hot flashes at night. You can't sleep because you're having a hot flash all night. You're sweating. A lot of people are soaking through their clothes.

So the reason why people are having that is that fluctuation in estrogen, especially that drop in estrogen that's causing the hot flashes. And so replacing the estrogen really helps with the hot flashes, which I would hope in turn helps with sleep and all the other downside effects of that.

Melanie Cole, MS (Host): And it's not for everybody. It's

certainly Not a choice for everybody, right? But while we're making those decisions, who should be on our care team, Victoria? Who is it that we really want as kind of in our corner while we're going through this journey?

Victoria Schooler, PA-C: typically, you know, you might have your generalist, your primary care provider, you might have your gynecologist, me. you might have the behavioral health team along, and then all some other common symptoms that people might experience, frequent UTIs, so maybe we have a urologist on board, and then pelvic floor physical therapy because of the bladder symptoms that someone might have.

So, depending on symptoms and severity, we might have a whole team on board. But usually, you know, coming to see a generalist gynecologist is a great start

Melanie Cole, MS (Host): Well, it certainly is, and having someone like you on the-- on their team is really gonna help because I can tell already that you're really supportive and compassionate, and it can be, for some women, a little bit of a scary time. For me, I was so happy to ditch the tampons, I can't even tell you. I was... You know.

But the bleeding can be pretty heavy during those perimenopause and menopause times as well. So having someone like you in our corner is just so helpful. What do you tell women that are anxious? They're a little bit worried. They're not sure because, let's be honest here, because you and I are talking about this, it does increase our risk for other diseases.

It is a big change in our lives. How do you work with your patients, Victoria, and tell them it's gonna be okay because women have been doing it a thousand years?

Victoria Schooler, PA-C: Yeah. Yeah. You touched on it a little bit earlier, and I like what you said about how, menopause, All women go through it I like to remind people that what they're experiencing and what they're feeling, if you feel like you don't feel like yourself or you feel different, that's real.

That's real. You, you are going something, through something, your body is going through something. And this is also a very optimal time to, you know, focus on yourself, sleeping well, eating well, because it's not just about perimenopause and menopause. It's about your late 50s, 60s, and 70s and living well through those years as well

Melanie Cole, MS (Host): I like that you said that it's time to take care of ourselves because especially at that time of our lives, if we don't take care of ourselves, we can't take care of the ones that we love. And so while we're going through this unusual change in our bodies, really doing a little self-care, you know, whether it's mental health or talking to our physicians or exercise, nutrition, pelvic floor, physical therapy, all those things that you said are so important for us.

So if you could leave one message for the women out there and even for their partners that love them, that are gonna be kind of, you know, adjacent in this journey of menopause, perimenopause, and then, then into the post time. They're, adjacent to those people that love us, and maybe they are even at the brunt of our mood changes.

Sometimes we yell at them for no reason.

Victoria Schooler, PA-C: experience it the most.

Melanie Cole, MS (Host): They do. So what is gonna be your message? What do you want us to know about this time of life and how you and our team really

Victoria Schooler, PA-C: Yeah.

Melanie Cole, MS (Host): through that?

Victoria Schooler, PA-C: My biggest message, I think, is that you're not alone in this. There are people that you can talk to about what you're going through. There's people who can help you through what you're going through and you know, you don't have to go through this alone. You don't have to be confused about all your symptoms.

And there's people and resources out there that can help you

Melanie Cole, MS (Host): Well, there certainly are. And thank you so much, Victoria, for joining us. You really explained everything well and laid it out for us and gave options to talk to our physicians and our physician assistant, our care team, and that's what's so important. Thank you again for joining us. And you can always visit our website at henrimayo.com/medicalservices/obgyn for more information and to get connected with one of our providers.

Of course, you can always visit the free Henry Mayo Newhall Hospital online health information library at library.henrimayo.com. That wraps up this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Thanks so much for joining us today.