Amanda Wilde (Host): When menstrual cycles have stopped for 12 consecutive months, that's menopause. Sounds simple. All the physical, mental and emotional changes, not so simple. Stay tuned for an enlightening conversation about navigating menopause with Dr. Christine Skorberg, Medical Director for Obstetrics and Gynecology at Jefferson Healthcare.

 This is To Your Health, a podcast from Jefferson Healthcare. I'm Amanda Wilde. Welcome Dr. Skorberg. Thank you for being here.

Christine Skorberg, MD, FACOG: Thank you. Happy to be here.

Host: Besides no longer having the ability to get pregnant, how does menopause change how your body operates?

Christine Skorberg, MD, FACOG: Well, like you mentioned, we say that 12 months straight without a menstrual cycle is the definition of menopause. However, women can have change of life babies, so I wouldn't say that you can no longer get pregnant cause I've had patients who are menopausal, in that they've gone 12 months straight without a menstrual cycle, actually get pregnant.

And that's why we do recommend some form of birth control after you've gone through 12 months straight without a menstrual cycle for one to two years, so that doesn't happen and you have an unplanned pregnancy.

Host: So let's back up. What exactly happens during menopause?

Christine Skorberg, MD, FACOG: Well, there's the perimenopausal period, which is the four and a half to five years before you actually stop your periods for a year and then women can have all kinds of symptoms during that time. Emotional ups and down, insomnia, hot flashes, night sweats, increased sex drive, decreased sex drive, and irregular bleeding, and then often, that's a worse time period for them than after their menstrual cycle has completely stopped.

And a lot of women who can't lose weight at all when they're perimenopausal, end up dropping weight when they're finally finished because their body sort of settles in. But there are certain symptoms that women can have when they're postmenopausal that bring them to me, wanting some relief. And that would be hot flashes, night sweats, irritability, insomnia.

Host: So the similar symptoms to the perimenopausal period that have continued?

Christine Skorberg, MD, FACOG: Mm-hmm. But more so women who do nothing, who go on no hormone replacement therapy or do nothing, then they come to me; their main symptoms are either pain with sex, or they start to leak urine on their way to the bathroom, and none of this is necessary. We have all kinds of things to help women with these symptoms so that you can navigate your life and feel comfortable.

Host: Is there something we should look at as the first signs of menopause?

Christine Skorberg, MD, FACOG: Well, you could have an increase in a blood hormone called FSH. You could have an increase or a decrease in your estrogen level. So you can draw blood to see that, but actually depending, even if the blood level of the FSH is what we call shows that you're menopausal, which means it's over 40, you still might still be having periods.

So it's not exact science, and I think that women just have to kind of be tuned into their own bodies and watch for how they're feeling. And if they're feeling fine, there's nothing that we need to do.

Host: So every woman's different, would you say, cause some people have an easier time with menopause, some people have symptoms that are ongoing.

Christine Skorberg, MD, FACOG: Absolutely. Every woman is different and every body is different.

Host: How do you recommend women who have symptoms manage those symptoms?

Christine Skorberg, MD, FACOG: Well, the WHI study started in the 1990s and that's when we were putting everybody on hormone replacement therapy because the number one killer of women, it still is, in the United States, 50 and older is heart attack. So we figured, oh, it must have something to do with menopause and if we put them on hormone replacement therapy, that would prevent them from having heart attacks.

Well, that study wasn't put together well, originally, and they stopped the study midstream because they found out that actually there was a slight increase of heart attack and stroke and even breast cancer. But now we know that, that study was not set up correctly and there were so many women who loved their hormone replacement therapy because they felt better, that the study has continued even to this day with many different spokes.

So, I talk to women when they're menopausal and they haven't had a period for 12 months. I'll ask them if they want to be on hormone replacement therapy, and I don't think it's a bad thing and they can go on it for a year, two years, or even five years. And we start, if you have a uterus, we need to put you on estrogen and progesterone because the estrogen alone will hyperstimulate the uterus and we don't want that to happen cause it could lead to abnormalities in the uterine lining.

So I say, why don't we try it and see if you feel better. If they're irritable or having hot flashes or mood swings, or any of those things; most women feel better on it and you start with the lowest dose that they feel better on, cause less is more with hormone replacement therapy. But even then we can go to a higher dose, which is still low dose to get you feeling fine.

The new recommendations are, once you've been without a period for a year, within 10 years of that time, you can start combination hormone replacement therapy if you have a uterus and then estrogen only if you don't have a uterus, and you can be on the combination safely for five years.

And then we revisit how you're feeling at that time, because after five years it does increase a tiny bit, your increased risk of heart attack, stroke, and breast cancer. But you're talking about a change of a couple of patients per a hundred thousand, which is statistically significant, but not very much.

So some women pick to stay on their hormone replacement therapy, and then we reevaluate every year up to the time they're 65. But I have some women who are in their eighties who still want to be on their hormone replacement therapy, and we let them.

Host: Well, you said women felt so much better. What do you see that lets you know that HRT is working?

Christine Skorberg, MD, FACOG: Well, because the patient comes in and goes I feel so much better. I'm sleeping better and sex is better. And you know, I'm not so irritable all the time. That's what they say.

Host: And so symptoms do disappear a bit.

Christine Skorberg, MD, FACOG: Correct.

Host: Is hormone replacement therapy, a therapy that's proved to be good for everyone going through menopause, having symptoms?

Christine Skorberg, MD, FACOG: Well, if they have symptoms, yes. And I say to women who are going through menopause, if they're having no symptoms, if it's not broken, why fix it? You're fine, but the women who don't go on anything, eventually come to me and their main symptoms are vaginal dryness, which causes pain with sex and maybe leaking urine on their way to the bathroom.

And if those are their only two symptoms, the recommendation is they just use vaginal estrogen, which acts locally in the vagina. It doesn't get out in the bloodstream. So even women who have a history of breast cancer can be on vaginal estrogen.

Host: So it sounds like with estrogen in any form, a little does go a long way.

Christine Skorberg, MD, FACOG: Yes, estrogen is golden.

Host: How has menopause treatment evolved over the years?

Christine Skorberg, MD, FACOG: Well, from the 1990s, we were putting everybody on combination hormone replacement therapy, estrogen and progesterone, and we were cycling them with menstrual cycles, which was terrible. Women in their late sixties and seventies, we were giving them periods again. So now we know that we don't need to do that at all, and we also know that it is safe when it is started, within 10 years of your menstrual cycle, stopping. So those are important things to know. And the other thing is, is if you don't have a uterus and you take estrogen only, it actually protects you from symptoms of menopause and it gives you some protection from heart attack, stroke, and breast cancer.

Host: So we were talking about managing symptoms and we've talked about HRT. Are there any natural things we can also do to keep the symptoms to a minimum?

Christine Skorberg, MD, FACOG: I do think that exercise and diet are important. Not eating tons of sugar is helpful and exercising daily, yoga, meditation, jogging, swimming, a little bit of cardiovascular, a little bit of weight lifting will help prevent osteoporosis. So all of those things do help. They also have pharmacies that make bioidentical hormones, that is derived from sweet potatoes and soy products, and some women prefer those. There are some over the counter herbal supplements like Estrovan that can give women some relief from hot flashes.

Host: Well, it sounds to me like seeing a doctor like you is a great first step in managing menopause.

Christine Skorberg, MD, FACOG: Well, thank you. I do think that it's helpful to come to somebody who this is all we do and we can help you so that you can be comfortable.

Host: Well, thank you for your expertise and for these insights to guide us through menopause, a major life cycle event.

Christine Skorberg, MD, FACOG: Thank you, Amanda. Thank you.

Host: That was Dr. Christine Skorberg, Medical Director for Obstetrics and Gynecology at Jefferson Healthcare. For more information, go to jeffersonhealthcare.org. And if you found this podcast helpful, please share it on your social channels.

You can check out the full podcast library at jeffersonhealthcare.org. This is To Your Health, a podcast from Jefferson Healthcare. Thanks for listening and be well.