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Understanding Menopause and How to Treat It
It's a rite of passage for women that usually occurs in your 40s or 50s and while you may not look forward to it, it is a natural biological process. Dr. Nidhi Shah discusses menopause, why it occurs, possible symptoms and treatment options, and more.
Featured Speaker:
Nidhi Shah, MD
Dr. Nidhi Shah is an obstetrician and gynecologist. She earned her Bachelor of Science from Stony Brook University. After that, she completed a Master’s of Science, earned her medical degree, and completed her residency training at New York Medical College. Dr. Shah is originally from Jamaica, NY, and is happy to serve her hometown and community. She hopes to provide exceptional care to her patients and continue to work toward improving women’s health Transcription:
Understanding Menopause and How to Treat It
Cheryl Martin: It's a rite of passage for women that usually occurs in our 40s and 50s. We don't look forward to it, but it's a natural biological process. Coming up next, understanding menopause and how to treat it.
This is Jamaica Hospital Med Talk. I'm Cheryl Martin. And I'm delighted to have with me Dr. Nidhi Shah, an obstetrician and gynecologist with Jamaica Hospital Medical Center. Thanks for being with us.
Dr. Nidhi Shah: Thank you for having me.
Cheryl Martin: Doctor, I'd like for us to start with you addressing why a woman experiences menopause.
Dr. Nidhi Shah: So menopause is defined as a time in a woman's life where their ovaries stop producing eggs or stop ovulating as we say. And as a result, menstrual periods end. So after menopause, a woman can no longer get pregnant. This whole process occurs from declining levels of a hormone in the body called estrogen as a woman ages.
Cheryl Martin: What are the symptoms of menopause?
Dr. Nidhi Shah: Menopause doesn't happen suddenly. Most women experience several years of changes in their menstrual periods before they stop completely. So during this time, you can have periods that are more irregular, either they're coming once a month or once every other month. And at the same time, you can start having the classic menopausal symptoms. So these include hot flashes, night sweats, changes in mood, sleep problems, and vaginal dryness.
Cheryl Martin: So when do most women experience menopause naturally? And how long do symptoms typically last?
Dr. Nidhi Shah: The average age for a woman to stop having periods is about 51 years old, so usually it occurs anywhere from 45 to 55 years. A woman is said to have completely undergone menopause when she's gone a full year without having a period. So some women have few or no menopausal symptoms while others have bothersome symptoms that interfere with their lives. Typically, these symptoms last about five to seven years after your periods have stopped. But for others, it can last longer.
Cheryl Martin: So what are some of the outside factors that could lead to a woman experiencing early menopause?
Dr. Nidhi Shah: So women who go through menopause before the age of 40, they're considered to have an abnormally early menopause, and we call that premature ovarian failure or primary ovarian insufficiency. At this point, the ovaries stop producing estrogen at a younger age. So these patients can experience these symptoms well before others in their peer group.
For women who undergo a hysterectomy where their uterus is removed, but ovaries are preserved, they'll go through menopause when the ovaries stop producing eggs. So it's hard to know when this happens because they won't have menstrual periods, but they'll start having symptoms of menopause around the standard age of 45 to 55, and we can say that their overages have stopped producing estrogen. If a woman has a hysterectomy where the ovaries are removed, or any other indicated procedures in which both ovaries are removed, then menopause can be triggered early. And at this point, women will start experiencing these symptoms very abruptly.
Cheryl Martin: What are some of the home or lifestyle treatment options that can help a woman minimize the severity of her symptoms?
Dr. Nidhi Shah: So there are a lot of common lifestyle solutions that can be done to help resolve some of these symptoms. Those include layering of clothing so that if their hot flashes occur, you can remove layers to help control body temperature. Women can maintain a lower ambient temperature either with a fan or an air conditioner. They can consume more colder beverages that can assist with hot flashes. Drinking less alcohol and less caffeine can also improve these symptoms. Stress management, relaxation, deep breathing, aerobic exercises and yoga have been shown to improve quality of life and mood in women who are undergoing menopause. For other symptoms like vaginal dryness, there are multiple vaginal moisturizers that can help with irritation. So over-the-counter brands to consider are Replens, Vagisil. You can even use vaginal lubricants to assist with dryness if encountered during intercourse.
Aside from that, there are many plant-derived estrogens, which have been marketed as natural or safer alternatives to hormones. They're found in a lot of common food groups that some people might not be aware of like soybeans, chickpeas, lentils, flaxseed. Even some fruits and vegetables have these natural estrogens. There are supplements that contain a specific plant-derived estrogen called isoflavone that can be purchased in health food stores or over-the-counter to help assist with these symptoms.
Historically, there are also a lot of herbal treatments that have been used to treat menopausal symptoms, including some Chinese herbal medications, Black cohosh, ginseng, St. John's wort ginkgo biloba. There isn't really any scientific evidence to support the use of these medications for menopausal symptoms. And if you are using these herbs, you should consult your doctor about any potential side effects and interactions that can happen with other medications you could be taking.
Cheryl Martin: When you mentioned certain foods, like you mentioned lentils, for example, how often should she eat them to help her with her menopausal symptoms?
Dr. Nidhi Shah: Yeah, you can consume these foods on a daily basis. If you're having improvement of your menopausal symptoms, but you haven't reached your goal of comfort yet, you can increase the amount that you're eating to two times a day. But at least once a day eating appropriate soybeans, chickpeas, lentils can help reduce these symptoms.
Cheryl Martin: Now, what treatment options to help can a doctor offer?
Dr. Nidhi Shah: If home remedies and behavioral modifications don't fully resolve symptoms, there are medical options that are also available. There are non-hormonal medications that can help with these symptoms such as antidepressants, for example, SSRIs like paroxetine, that's recommended as a first-line treatment for hot flashes in women who can't take hormonal therapy. And they can also assist in mood changes, depression or anxiety that's associated with menopause.
Other medications that have been used to treat hot flashes are gabapentin, oxybutynin. Again, for women who can't take estrogen for whatever reason, they can try these medications if all other options have not helped.
Menopausal hormone therapy has been historically used to treat these symptoms as well. Estrogen and progesterone are given to relieve a majority of these symptoms, like hot flashes, sleep changes, anxiety. Estrogen is available in many different forms, either a patch, a pill, or a vaginal suppository. The preferred root for most gynecologists is the estrogen patch. And for women who still have a uterus, they'll usually also receive progesterone as well to balance out the effects of the estrogen. There's also low-dose vaginal estrogen. That's very effective treatment for vaginal dryness or pain with intercourse as a result of menopause.
Cheryl Martin: So there's been some talk about the potential risks of taking hormone therapy. Can you address that?
Dr. Nidhi Shah: Of course. So the Women's Health Initiative or the WHI trial was a very large study that was designed to find out if hormone therapy would reduce other risks for women, such as the risk of heart attacks after menopause. But what the study found out was that taking estrogen and progesterone in combination actually increases the risk of heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women. So the results of those patients that are taking only estrogen in the study were different. Those women had a small increase in the risk of stroke and blood clots, but there was no increased risk of heart attacks. And on top of that, there was a decreased risk of breast cancer for these patients.
So after this trial, there was a lot of concern for providers giving women these hormonal therapies because the side effects seem to be quite severe. But what later became clear is that hormone therapy is safe for a specific cohort of women, particularly healthy women, who have menopausal symptoms and are within the first 10 years of the onset of menopause. So for these women, we can start hormone therapy and safely continue it for at least five years, and then start tapering down the treatment to a level where they're not experiencing these severe symptoms, and at the same time, they don't require hormone therapy.
So hormone therapy is not recommended for women with a current history or a previous history of breast cancer. If they have coronary heart disease, history of blood clot, history of a heart attack or a stroke, or women who are at high risk for having these complications. So you can discuss your individual risk profile for hormone therapy with your primary gynecologist.
Cheryl Martin: When you talked about the study and it mentioned there was more risk for older women, what age was that?
Dr. Nidhi Shah: That was from 60 to 65 years.
Cheryl Martin: Okay. Now, are there any dangers associated with menopause? And if so, when should a woman seek medical attention?
Dr. Nidhi Shah: Most commonly menopausal symptoms are considered bothersome if they affect day to day activities or your relationship with your partners, with your family, at work. So long-term consequences of menopause generally results from the lack of estrogen in the body. And over time, it can lead to things such as osteoporosis, cardiovascular disease, and dementia. So this is why even after menopause, we urge patients to continue to see their primary gynecologist to evaluate the need for hormone therapy or other treatments to counteract these long-term consequences.
Cheryl Martin: Anything else in closing you wanted to add just about understanding menopause and how to treat it?
Dr. Nidhi Shah: Menopause is a natural part of a woman's life. It's the phase that, you know, most women are not anticipating because they're scared of these side effects of these symptoms, but they are manageable. So I really encourage if you're having these symptoms or you feel like you're close to entering menopause and you're concerned about your risk factors, to go and see your primary care doctor or your primary gynecologist and get evaluated. There are a lot of things now that providers can offer to help assist with these symptoms. You don't have to just keep suffering because of age. There are things now that we can do to help.
Cheryl Martin: Dr. Nidhi Shah, so glad you were on today to allay any fears that women may have and also help us understand better, as you said, this natural process.
To make an appointment at the Jamaica Hospital Women's Health Department, please call 718-291-3276. That's 718-291-3276. And for more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts.
All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or adopting any of the suggestions discussed on this podcast. Thanks so much for listening to this edition of Jamaica Hospital Med Talk.
Understanding Menopause and How to Treat It
Cheryl Martin: It's a rite of passage for women that usually occurs in our 40s and 50s. We don't look forward to it, but it's a natural biological process. Coming up next, understanding menopause and how to treat it.
This is Jamaica Hospital Med Talk. I'm Cheryl Martin. And I'm delighted to have with me Dr. Nidhi Shah, an obstetrician and gynecologist with Jamaica Hospital Medical Center. Thanks for being with us.
Dr. Nidhi Shah: Thank you for having me.
Cheryl Martin: Doctor, I'd like for us to start with you addressing why a woman experiences menopause.
Dr. Nidhi Shah: So menopause is defined as a time in a woman's life where their ovaries stop producing eggs or stop ovulating as we say. And as a result, menstrual periods end. So after menopause, a woman can no longer get pregnant. This whole process occurs from declining levels of a hormone in the body called estrogen as a woman ages.
Cheryl Martin: What are the symptoms of menopause?
Dr. Nidhi Shah: Menopause doesn't happen suddenly. Most women experience several years of changes in their menstrual periods before they stop completely. So during this time, you can have periods that are more irregular, either they're coming once a month or once every other month. And at the same time, you can start having the classic menopausal symptoms. So these include hot flashes, night sweats, changes in mood, sleep problems, and vaginal dryness.
Cheryl Martin: So when do most women experience menopause naturally? And how long do symptoms typically last?
Dr. Nidhi Shah: The average age for a woman to stop having periods is about 51 years old, so usually it occurs anywhere from 45 to 55 years. A woman is said to have completely undergone menopause when she's gone a full year without having a period. So some women have few or no menopausal symptoms while others have bothersome symptoms that interfere with their lives. Typically, these symptoms last about five to seven years after your periods have stopped. But for others, it can last longer.
Cheryl Martin: So what are some of the outside factors that could lead to a woman experiencing early menopause?
Dr. Nidhi Shah: So women who go through menopause before the age of 40, they're considered to have an abnormally early menopause, and we call that premature ovarian failure or primary ovarian insufficiency. At this point, the ovaries stop producing estrogen at a younger age. So these patients can experience these symptoms well before others in their peer group.
For women who undergo a hysterectomy where their uterus is removed, but ovaries are preserved, they'll go through menopause when the ovaries stop producing eggs. So it's hard to know when this happens because they won't have menstrual periods, but they'll start having symptoms of menopause around the standard age of 45 to 55, and we can say that their overages have stopped producing estrogen. If a woman has a hysterectomy where the ovaries are removed, or any other indicated procedures in which both ovaries are removed, then menopause can be triggered early. And at this point, women will start experiencing these symptoms very abruptly.
Cheryl Martin: What are some of the home or lifestyle treatment options that can help a woman minimize the severity of her symptoms?
Dr. Nidhi Shah: So there are a lot of common lifestyle solutions that can be done to help resolve some of these symptoms. Those include layering of clothing so that if their hot flashes occur, you can remove layers to help control body temperature. Women can maintain a lower ambient temperature either with a fan or an air conditioner. They can consume more colder beverages that can assist with hot flashes. Drinking less alcohol and less caffeine can also improve these symptoms. Stress management, relaxation, deep breathing, aerobic exercises and yoga have been shown to improve quality of life and mood in women who are undergoing menopause. For other symptoms like vaginal dryness, there are multiple vaginal moisturizers that can help with irritation. So over-the-counter brands to consider are Replens, Vagisil. You can even use vaginal lubricants to assist with dryness if encountered during intercourse.
Aside from that, there are many plant-derived estrogens, which have been marketed as natural or safer alternatives to hormones. They're found in a lot of common food groups that some people might not be aware of like soybeans, chickpeas, lentils, flaxseed. Even some fruits and vegetables have these natural estrogens. There are supplements that contain a specific plant-derived estrogen called isoflavone that can be purchased in health food stores or over-the-counter to help assist with these symptoms.
Historically, there are also a lot of herbal treatments that have been used to treat menopausal symptoms, including some Chinese herbal medications, Black cohosh, ginseng, St. John's wort ginkgo biloba. There isn't really any scientific evidence to support the use of these medications for menopausal symptoms. And if you are using these herbs, you should consult your doctor about any potential side effects and interactions that can happen with other medications you could be taking.
Cheryl Martin: When you mentioned certain foods, like you mentioned lentils, for example, how often should she eat them to help her with her menopausal symptoms?
Dr. Nidhi Shah: Yeah, you can consume these foods on a daily basis. If you're having improvement of your menopausal symptoms, but you haven't reached your goal of comfort yet, you can increase the amount that you're eating to two times a day. But at least once a day eating appropriate soybeans, chickpeas, lentils can help reduce these symptoms.
Cheryl Martin: Now, what treatment options to help can a doctor offer?
Dr. Nidhi Shah: If home remedies and behavioral modifications don't fully resolve symptoms, there are medical options that are also available. There are non-hormonal medications that can help with these symptoms such as antidepressants, for example, SSRIs like paroxetine, that's recommended as a first-line treatment for hot flashes in women who can't take hormonal therapy. And they can also assist in mood changes, depression or anxiety that's associated with menopause.
Other medications that have been used to treat hot flashes are gabapentin, oxybutynin. Again, for women who can't take estrogen for whatever reason, they can try these medications if all other options have not helped.
Menopausal hormone therapy has been historically used to treat these symptoms as well. Estrogen and progesterone are given to relieve a majority of these symptoms, like hot flashes, sleep changes, anxiety. Estrogen is available in many different forms, either a patch, a pill, or a vaginal suppository. The preferred root for most gynecologists is the estrogen patch. And for women who still have a uterus, they'll usually also receive progesterone as well to balance out the effects of the estrogen. There's also low-dose vaginal estrogen. That's very effective treatment for vaginal dryness or pain with intercourse as a result of menopause.
Cheryl Martin: So there's been some talk about the potential risks of taking hormone therapy. Can you address that?
Dr. Nidhi Shah: Of course. So the Women's Health Initiative or the WHI trial was a very large study that was designed to find out if hormone therapy would reduce other risks for women, such as the risk of heart attacks after menopause. But what the study found out was that taking estrogen and progesterone in combination actually increases the risk of heart attacks, breast cancer, blood clots, and strokes in older postmenopausal women. So the results of those patients that are taking only estrogen in the study were different. Those women had a small increase in the risk of stroke and blood clots, but there was no increased risk of heart attacks. And on top of that, there was a decreased risk of breast cancer for these patients.
So after this trial, there was a lot of concern for providers giving women these hormonal therapies because the side effects seem to be quite severe. But what later became clear is that hormone therapy is safe for a specific cohort of women, particularly healthy women, who have menopausal symptoms and are within the first 10 years of the onset of menopause. So for these women, we can start hormone therapy and safely continue it for at least five years, and then start tapering down the treatment to a level where they're not experiencing these severe symptoms, and at the same time, they don't require hormone therapy.
So hormone therapy is not recommended for women with a current history or a previous history of breast cancer. If they have coronary heart disease, history of blood clot, history of a heart attack or a stroke, or women who are at high risk for having these complications. So you can discuss your individual risk profile for hormone therapy with your primary gynecologist.
Cheryl Martin: When you talked about the study and it mentioned there was more risk for older women, what age was that?
Dr. Nidhi Shah: That was from 60 to 65 years.
Cheryl Martin: Okay. Now, are there any dangers associated with menopause? And if so, when should a woman seek medical attention?
Dr. Nidhi Shah: Most commonly menopausal symptoms are considered bothersome if they affect day to day activities or your relationship with your partners, with your family, at work. So long-term consequences of menopause generally results from the lack of estrogen in the body. And over time, it can lead to things such as osteoporosis, cardiovascular disease, and dementia. So this is why even after menopause, we urge patients to continue to see their primary gynecologist to evaluate the need for hormone therapy or other treatments to counteract these long-term consequences.
Cheryl Martin: Anything else in closing you wanted to add just about understanding menopause and how to treat it?
Dr. Nidhi Shah: Menopause is a natural part of a woman's life. It's the phase that, you know, most women are not anticipating because they're scared of these side effects of these symptoms, but they are manageable. So I really encourage if you're having these symptoms or you feel like you're close to entering menopause and you're concerned about your risk factors, to go and see your primary care doctor or your primary gynecologist and get evaluated. There are a lot of things now that providers can offer to help assist with these symptoms. You don't have to just keep suffering because of age. There are things now that we can do to help.
Cheryl Martin: Dr. Nidhi Shah, so glad you were on today to allay any fears that women may have and also help us understand better, as you said, this natural process.
To make an appointment at the Jamaica Hospital Women's Health Department, please call 718-291-3276. That's 718-291-3276. And for more information about the services Jamaica Hospital offers, visit our website at jamaicahospital.org/podcasts.
All content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or adopting any of the suggestions discussed on this podcast. Thanks so much for listening to this edition of Jamaica Hospital Med Talk.