Maggie McKay (Host): Menopause, not a topic typically brought up in conversation. So when you're approaching it, how do you know what to expect? Joining us today is Elizabeth Haun, a board-certified family nurse practitioner to discuss supporting your body through menopause.

Welcome to Mountain Medicine, a podcast from Northern Inyo Healthcare. I'm Maggie McKay. So great to have you here today, Elizabeth.

Elizabeth Haun: Thank you, Maggie.

Host: Each stage of menopause is different. So, let's take the stages one by one and discuss what to expect. But first in general, what is menopause?

Elizabeth Haun: So, menopause, as a woman, as you move into middle age and later stages of life, your ovaries stop producing the hormones that are needed to reproduce, to get pregnant and have babies. So, what that means is that you lose your estrogen, you lose your progesterone, and you start having changes in your cycle and, eventually, stop cycling and you go into this later phase of menopause where there's all sorts of changes. It's not just that you lose your progesterone and your estrogen, you start to become symptomatic in certain areas. And generally this happens, I think, the average age is about 51. So, that's basically menopause. It's just kind of a general term for what happens when you start to lose the hormones needed for childbirth.

Host: And as if that's not bad enough, it goes on for years, right? Like 14, 15 years, something like that, the three stages.

Elizabeth Haun: It can. It's different for each person. Some women barely feel it at all. And some women, I've met some patients in their eighties who are still having symptoms. So, it just depends.

Host: Oh, my goodness.

Elizabeth Haun: I know.

Host: Okay. That one I didn't need to know, Elizabeth. I'm kidding you. So, let's start with perimenopause, the transition. What do we expect for that?

Elizabeth Haun: So, this is a time where it could be as early as your mid-30s or it could be later in your 40s when you start to have menstrual changes. Your period might change in some way, become heavier, lighter, it might come more frequently or farther apart. As you get closer to the actual menopause, you might start to feel some symptoms such as, hot flashes or night sweats or vaginal dryness, vaginal pain, urinary tract infections, this kind of stuff. So as you move towards menopause, you just start to notice changes.

Host: And then, what about when you're right in the middle of it, menopause itself? What transitions should we expect?

Elizabeth Haun: So once you get to the point where you're not really producing much estrogen or progesterone anymore, then you start to really notice changes in your menses in terms of skipping periods. You might get a period for two weeks or, you know, those changes that you noticed earlier just start to get worse and worse. Hot flashes become more frequent, night sweats. And let me just say that that is if you are going to get the symptoms, you might not. But generally, with the menstrual cycle, you'll notice changes even if you're not getting the hot flashes or the night sweats. And then, at some point, all of this, your menstruation will stop. And when you are without a menstruation for one year, that's when you go into the next phase and you're considered postmenopausal. But it has to be about one year. I mean, I met a woman once who, she went for nine months without a period, and she thought she was through it, and then she had a period. So then, she had to count over again for, you know, another year before she could consider herself postmenopausal. Actually, on a personal note, one of my aunts, she turned 52 and had not had a period for one year and thought that she was clear and ended up getting pregnant, so...

Host: Uh-oh. We hear that one.

Elizabeth Haun: Yeah.

Host: So, I did not know, something you just said, about some people have symptoms, some don't. So if you're not having symptoms, how do you even know you're going through menopause?

Elizabeth Haun: Generally, you would have the menstrual changes. Your period would change, it would get heavier or lighter, you'd start skipping months or, you know, you get them more frequently, that kind of stuff. So, the menstrual cycle is the main, because you're not producing the hormones that make the menstrual cycle happen regularly anymore.

Host: Okay. So, you're saying that some lucky few don't get hot sweats and they're not irritable, and all those other things that can come with it. Not everybody gets that for sure.

Elizabeth Haun: Exactly.

Host: What about post menopause?

Elizabeth Haun: So, postmenopause is when your period stops, you kind of move into this period of experiencing the other symptoms, what we call the vasomotor symptoms, if you're going to feel them, which would be the hot flashes, the night sweats, the vaginal dryness, the irritability, achy joints, all those very pleasant things that your grandmother never talked about.

Host: And now we know why. Yeah, I'm glad I never heard all that. I didn't want to anticipate that for years. So, is there anything we can do to lessen the possible symptoms, or it's just something that everybody is different?

Elizabeth Haun: No. You don't have to live with this. So if your symptoms are severe, that it's really affecting your daily life and your quality of living, there's definitely things to be done. And this is what I encourage people to do. I encourage people, women, to reach out to their primary care providers, their OB-GYNs, and tell them what's going on because there are medications. There's the hormone replacement therapy, which has gotten a bad reputation lately. Although because of this big study that was done, you know, 20 or so years ago, we do know more and more about how to manage the hormone replacement therapy safely. So, I encourage women to reach out and get help because there are multiple things that can be done as well as, you know, taking hormones orally. There's also ways that you can address the vaginal dryness with suppositories, which can also help to prevent urinary tract infections and other problems with the changes in the pH of the vagina due to the loss of the estrogen.

Host: If you've had a hysterectomy, do you still have to go through menopause?

Elizabeth Haun: Yes. So, a partial hysterectomy is just when the uterus is removed, a total hysterectomy is when the uterus and cervix are removed, but you still have your ovaries. And the ovaries are what produce the hormones. So even if you have had a hysterectomy, you can get hot flashes and the night sweats and the irritability and the vaginal dryness and all that.

Now, if you had a hysterectomy where they also removed the ovaries, then you go through what we call a medical or forced menopause. So, the minute they remove those ovaries, you're in menopause, you're postmenopausal at that point. And generally, we will put you on a hormone replacement therapy for a while.

Host: So in closing, is there anything else you'd like to add that we should know?

Elizabeth Haun: I think mostly, as I said earlier, just reach out to your primary care provider or your OB-GYN and just let them know that you're uncomfortable and you're having changes and you need help. There's a lot of help out there, and this is not something that we need to be ashamed of or not talk about. It is helpful when women talk about these things with each other and understand that there is something that can be done out there that can help them.

Host: It is, because I always think my friends are so dramatic and they scare me. So, I always think, "I'll take it with a grain of salt and ask my doctor."

Elizabeth Haun: Yeah, it's very manageable these days, and safely, too.

Host: All right. Well, that's great. Thank you so much for making the time to talk with us about some of the myths of menopause and some of the facts.

Elizabeth Haun: My pleasure.

Host: Again, that's Elizabeth Haun. To learn more about family medicine services at Northern Inyo Health Care District, visit nih.org/ruralhealthclinic, that's nih.org/ruralhealthclinic, or call 760-873-2849. And 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 MacKay. Thanks for listening. This is Mountain Medicine, presented by Northern Inyo Healthcare District.