Maggie McKay (Host): Welcome to Wellness in Reach, a Mount Carmel podcast. I'm your host, Maggie McKay. If you're a woman and you live long enough, chances are you'll experience menopause. So today, we'll find out more about it with Dr. Cory Bennett, OB-GYN at Mount Carmel Medical Group. Thank you so much for joining us today, Dr. Bennett.

Cory Bennett, DO: Thank you, Maggie, for having me.

Host: Absolutely. So, menopause seems to be getting more of a spotlight lately, but there's always more to learn. Let's begin with what is menopause and when does it typically begin?

Cory Bennett, DO: Yeah, great questions. So, menopause is, like you said in your intro, if we're lucky enough in our life to get there, and so that's the first blessing, but it's when we run out of follicles within our ovaries. So when we're born, we have as many follicles as we'll have. And then, as we go through life, we use those follicles. And then, around midlife is when we have that depletion of follicles and results in a depletion of estrogen. So, that is characterized by menopause.

And you asked when does it happen? Yeah, good question again. So, statistically, our average age of menopause is 51. But women definitely have symptoms prior to that. So, they have perimenopause as they transition into that menopause, and then ultimately post-menopausal state.

Host: So, what is the difference between perimenopause, menopause and postmenopause? Because I long ago saw an episode of Oprah-- that tells you how long ago-- and they said the whole process takes something like 14 years and I was horrified. So, what is the story on those three?

Cory Bennett, DO: Well, I'd definitely say 14 years seems like on the longer side of anything that I've encountered. But perimenopause is when your body starts to notice that you're having decreased ovarian reserve. So everyone, it looks a little bit different. Textbook answer is that your menstrual cycles tend to change. So, maybe they get a little bit closer together, maybe they get a little bit farther apart. Also, sometimes some bleeding with your menses changes as well, maybe a little bit heavier or lighter.

Some women also start to get symptoms of menopause in their perimenopausal state, so they might start getting night sweats, it's usually the first thing. They might also get hot flashes during the day, especially during some episodes of stress. So, that's kind of that perimenopause.

 Menopause is when a woman has officially not had a period for a whole year. So, as you can see that the perimenopause is kind of that leading up to that and eventually not having a period for a whole year. Followed by that, you're considered postmenopausal.

Host: And what are the common symptoms of menopause? How can they affect a woman's daily life?

Cory Bennett, DO: What's so interesting is, and you know, everyone is affected by so many different conditions differently. I think the most common symptoms of menopause are definitely night sweats, hot flashes. Some of the more uncommon ones that you wouldn't anticipate are like palpitations, worsening of anxiety, insomnia. Also, stiff joints and muscles, those are just to name a few. But there's definitely so many ways that menopause and that decreased estrogen can affect women.

Host: Let's talk about mental health challenges. I don't know that most people consider that when we talk about menopause. Are mental health challenges associated with it, and how can they be effectively managed?

Cory Bennett, DO: Yeah, that's a big question and can go a lot of different ways. So, I think that midlife is a challenging time for a lot of people, right? So, maybe some mental health issues come up about, because of just the struggles maybe of midlife and obligations to family.

Specifically with menopause, I think the biggest thing that comes to mind is, like I had mentioned, possibly increased anxiety with the change in hormones. I also think a lot of women who have trouble sleeping, whether that's because of night sweats or just because of the hormone changes, and I think how that can affect their mental health during the day. So, maybe they're a little bit more irritable. Maybe they have depression at baseline and then that's worsening the symptoms. So, those are kind of the first things that come to mind.

When you talked about how to treat that, well, obviously, always getting your provider in communication with your symptoms and the severity of your symptoms, I think that's so important. I think focusing on your sleep, whether that looks like just having good sleep habits or sleep environment can be really helpful for mental health. And then, obviously, you know, thinking about possibly hormone therapy as an option to assist with sleep or to assist with some of those changes that happen during midlife.

Host: It seems so unfair, Dr. Bennett, that, well, all the things we go through in life medically as women, like at the the last chapters of your life-- that's not a good way to put it-- but then this gets thrown at you. So, what lifestyle changes can help ease the transition through menopause and improve overall quality of life?

Cory Bennett, DO: I really enjoy this part of medicine. I enjoy talking to women at this time of life because I do think that midlife is an opportunity to take a moment and think about your health and what you want your 70s and 80s and hopefully 90s And beyond to look like. And so, I think just focusing on all the wellness things that we know about, good sleep habits and adequate sleep and exercise.

And I really talk to a lot of women. I know it's also kind of in the news, but weightlifting, we know that that helps with metabolism and helps with our bone health. I think taking that also into account of looking at our bone health at this time of life as well. But reducing stress, good nutrition. So, I think all of these things really come into view when women are in midlife. And sometimes it shows up differently for each woman, but it's a good chance to really examine what they've been doing and then what could be changed and how that could make effects for the future.

Host: So, it is manageable and we can live with it and do things to make it less taxing, I guess you'd say.

Cory Bennett, DO: Yeah.

Host: That's reassuring. Can women differentiate between menopause symptoms and indicators of other medical conditions that might require attention?

Cory Bennett, DO: We talked about there's so many different symptoms every woman has and how it presents in their body differently. Taking a step back, I think the best thing for any woman to do at this time of life is maybe some journaling and keeping track of those symptoms and just checking in with your body. So many times, I think medical conditions could be maybe caught a little bit early or addressed earlier if people are paying attention to their health and going to their physicians regularly. So, I think in that instance, maybe everyone's not expected to know the answer to that, but incorporating your physician in your care and having a kind of pointed conversation about, "These are the symptoms I'm having." And then, hopefully, most providers will be able to kind of differentiate what feels alarming or what feels kind of normal for women.

Host: What myths and misconceptions about menopause still persist? How can healthcare providers help debunk them?

Cory Bennett, DO: There's so much to that. So, I think that the Women's Health Initiative in the early 2000s really played a big impact in kind of the medical knowledge and kind of the direction of hormone therapy. I think the biggest misconception that I encounter is that women at least deserve a conversation about treatment options for their symptoms. And so for some women, that might involve hormone therapy or non-hormonal options. But I think that the misconception that women should just tolerate through this or that it's kind of normal and they just need to get through it, and that it's not treatable, I think are the biggest misconceptions. So, that's really my hope going forward, is that whether it's their family provider, their OB-GYN, or even an online provider that they have vetted, I think just allowing women to express their symptoms and deserve a conversation about treatment options, if that's warranted or wanted.

Host: That's a good optimistic view and I'm sure, like we said earlier, reassuring to people going through it or about to or right in the middle of it. Did you happen to see that special-- speaking of Oprah again-- but it was Brooke Shields and maybe Naomi Watts, like, I don't know, they're all writing books on menopause all of a sudden. And I think it's great, because they're kind of women of all ages and they're bringing the conversation to the forefront, which it to me, in my lifetime at least, it seems like people never talked about it. It hits, you go through it and, like you said, that's it, you just deal with it. But now, it seems like it's a much more open topic. Do you find that?

Cory Bennett, DO: I do. Yeah, and I feel like my patients are coming in with just even more information so they feel more empowered. And so, I really like that. And I still feel like there's a good need for physicians, obviously. But I think that it's such a good coming in with a base of knowledge and then talking with a physician to complement that regarding their specifics of their health.

So, I think it's a really neat space we're in. I think there's a lot of great opportunity for education, because a lot of providers, it's a nuanced care of midlife women and hormone therapy and just menopause and even non-hormone therapy. But just allowing people to be more empowered with the information that they can get on their own, I think, is great.

Host: Well, this has been so educational and helpful. Thank you so much for sharing your expertise.

Cory Bennett, DO: Oh, you're welcome. Thanks for having me.

Host: Of course. Again, that's Dr. Cory Bennett. For more information or to schedule an appointment, visit mountcarmelhealth.com/womens-health. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wellness in Reach, a Mount Carmel podcast.