Selected Podcast
Managing Menopause and Its Symptoms
Menopause is a natural part of midlife for all women, but the stigma around it leads to confusion and misinformation. Talking about it openly can help women better understand how to support their bodies through midlife and beyond. Certified menopause provider Heather Wahl, MD, FACOG, NCMP, explains menopause, its symptoms and its treatments.
Featured Speaker:
Heather Wahl, MD, FACOG, NCMP
Heather Wahl, MD, FACOG, NCMP, is board-certified and fellowship-trained in minimally invasive gynecologic surgery and chronic pelvic pain. She is also a certified menopause provider by the North American Menopause Society. Dr. Wahl completed her residency in obstetrics and gynecology at University of Michigan Health Systems, Ann Arbor, Michigan. Transcription:
Managing Menopause and Its Symptoms
Joey Wahler (Host): It's a significant body change that women will eventually experience. So, we're discussing managing menopause. Our guest, Dr. Heather Wahl, she's a gynecologist with Promedica. This is Happily Ever After 40, a podcast from ProMedica. Where we discuss midwife health and wellbeing. Thanks for listening. I'm Joey Wahler. Hi, Dr. Wahl. Thanks for joining us.
Heather Wahl, MD: Hi. Thanks for having me.
Host: Great to have you. So first, simply put, when a woman reaches menopause, what exactly is happening to her body and what are the usual symptoms?
Heather Wahl, MD: Yeah, great question. So I think first and foremost, it's important to note that menopause is not a disease. It is a normal, natural event to go through menopause. menopause is defined as 12 consecutive months without having a period in the absence of other causes, and it marks the permanent end of fertility. Most often menopause occurs between the ages of 45 to 55. And in the United States, the average age of menopause is between 50 to 52. So, I think it's important to know that every woman's experience is different. So, not every woman will experience physical changes when she goes through menopause. That being said, kind of some common symptoms include irregular menstrual periods, hot flashes, difficulty sleeping, memory problems, mood disturbances, vaginal dryness, changes in weight, specifically kind of weight gain, as well as skin and hair changes.
Host: And how long does that period of those symptoms typically last?
Heather Wahl, MD: Yeah. So, specifically with hot flashes, we initially used to think that they only occurred maybe six months to two years, and now we actually know better. We're starting to get more and more information, do more research on this topic. And it's actually now felt that hot flashes can occur for some women for seven to 10 years on average. In African American women, on average, hot flashes may be 10 to 13 years. And there's actually a small portion of women who may continue to experience hot flashes lifelong. But in that kind of small subgroup of women, their hot flashes are typically not super bothersome, even if they are experiencing them lifelong,. You know, with the symptoms of difficulty sleeping, memory problems, mood disturbances, so again, some of these can just be natural aging symptoms, you know, not associated with menopause. That being said, it is felt that those kind of mood changes, difficulty sleeping may improve after a woman has kind of gone through the menopause transition.
Host: Wow. So, let me ask you about women that have the hot flashes, for instance, for a period of several years, as you just said. Does that mean technically speaking that they're still in menopause or has menopause ended and that's just a continued residual effect?
Heather Wahl, MD: So, they are still considered menopausal. So, yes, you can have hot flashes before going through menopause, which is known as perimenopause. Once you go through menopause, which again, the definition is 12 consecutive months without a period, then you are said to have gone through menopause. The hot flashes can last even after going through menopause. So, I know it can kind of be confusing for some women, because they're like, "Well, am I menopausal because I'm having hot flashes, but I'm still having my period?" The answer is no, you're perimenopausal.
Host: Gotcha. So, we hear so much about these hot flashes. Even as a guy, I've heard about them for some time about women going through them. For those unfamiliar, give us an idea, please. In a nutshell, what do we mean by a hot flash? What does it feel like? How long does it typically last?
Heather Wahl, MD: Well, that's also really individualized for a woman. So for some women, they may only experience a few hot flashes a day. For others, they may experience multiple hot flashes. And basically, what a hot flash is, is when you feel your body getting very warm. Now, for some women, that may start in their face and kind of transition down to the rest of their body. For other women, they may report that their hot flashes kind of started in their feet and then worked their way up to their face, to their head. The experience can be different. Often women report a flushing-like sensation. Perspiration or sweating is also really common. For some women, hot flashes may just last a few Minutes. For others, they may last several minutes. So again, it can really vary. Hot flashes not only occur during the day, but for some women, they also occur during the night, typically referred to as night sweats in that situation. Some women report that they wake up just completely drenched from their night sweats. So again, it's a really individualized experience.
Host: So whether it's the hot flashes or some of the other common symptoms you mentioned, how treatable are some of these things like hot flashes and what is the treatment?
Heather Wahl, MD: Yeah, great question. So, first and foremost, very treatable. People do not have to be miserable with their symptoms. So, their hormone therapy is considered a treatment for bothersome hot flashes that are significantly impacting a woman's quality of life. That being said, obviously, not every woman is a good candidate for hormone therapy. So, there are prescription non-hormonal treatment options for hot flashes. There's hopefully going to be another treatment, a non-hormonal, FDA-approved prescription treatment available later this year to treat hot flashes. So again, that's going to be really good for those women that are not candidates for hormone therapy. When it comes to kind of the sleeping issues, if a woman is having a lot of hot flashes that are, you know, the cause of her significantly impacted sleep, then we know that treating the hot flashes has kind of that domino effect. It will help sleep because then if we decrease hot flashes, sleep should get better. We know that mood and memory are also kind of directly tied with poor sleep. So again, if all of those issues are related to getting poor sleep because of frequent hot flashes, then we also expect that mood and memory can improve with improved sleep. Now, not every woman has those sleep issues related to hot flashes. So again, we can't guarantee that hormone therapy or those non-hormonal therapy options that treat hot flashes are going to improve those other symptoms. So, there may need to be other treatments for those particular issues if they're separate.
Host: Switching gears a little bit. During menopause, what about changes that women might notice to their skin or their hair and how are those things, if they materialize, addressed as well?
Heather Wahl, MD: Yeah. So, it's really common, separate from menopause, just kind of in the normal aging process, that our skin begins to lose collagen and elasticity. So, it's really normal that all people, men included, feel that their skin is drier, that they lose kind of the plumpness of their skin. So, it's really important to kind of use products that help maintain the moisture to our skin. With regards to hair changes, it's very common that hair can get thinner and can fall out more easily. There is female pattern hair loss that can occur separate from menopause, just as a normal aging process that, in female pattern hair loss, the parts in a woman's hair tend to get larger. And so, sometimes, women can benefit from meeting with a dermatologist to just make sure that there's not a skin condition that they have separate from the normal aging process that's a cause of hair loss.
Host: Gotcha. So, what you're saying there, it seems in a nutshell, am I right, is that some of these things you just mentioned occurred during menopause, but they might actually just be part of aging, not menopause per se.
Heather Wahl, MD: Correct. Yeah. So, it can be kind of a mixture of both of these things.
Host: Right. Couple of other things. How about the importance of a healthy lifestyle during menopause, regarding diet and exercise in particular?
Heather Wahl, MD: Very important. Cannot be overstated the importance of diet and exercise. So, it does get harder to lose weight as we age. Metabolism starts to slow. Again, with those hormonal changes that take place, weight gain is very common. On average, women gain 10 pounds after going through menopause. Now, that doesn't happen, obviously all at once. But it takes time, so over a course of several years. But it's not uncommon to have a 10-pound weight gain. I often hear from patients, "I'm exercising, I'm doing all of the same things that I used to do and I'm still gaining weight." So sometimes, that can be a really difficult discussion because we have to talk about potentially needing to do even more than what you were doing.
So, what the American Heart Association recommends is that at least 150 minutes of moderate activity exercise on a weekly basis is what's recommended to maintain weight. So if somebody's trying to lose weight, they have to do more than that. And when we talk about moderate activity, I mean this is when you're kind of you're breathing heavily, it's hard to carry on a conversation because you're really working out. Diet is also important. Obviously, kind of everything in moderation. This is why there are kind of health clinics that have been developed to help patients with their weight loss goals. So, sometimes, you know, if I do have a patient that's, again, really dieting, exercising, doing all of the right things and still having a difficult time, then I may need to refer that patient to a weight management clinic to assist with weight loss.
Host: And finally, obviously from this discussion, it's clear that when menopause does start, it's a lot to be coming at a woman all at one time, a lot of newness, I'm sure, a lot of confusion. Why do you think having discussions about menopause like this one, especially with a professional experienced in this area like yourself, why is it so important to talk about these things?
Heather Wahl, MD: I think it's important because we need to keep in mind that more than 1 million women in the United States will experience menopause each year. That's a huge number. And by 2030, the world population of menopausal and post-menopausal women is projected to increase to 1.2 billion. That's with a B. So again, a lot of women are experiencing menopause and are going to be experiencing menopause. And these women make up a large amount of our workforce. And we want to, again, make sure that if a woman is having really bothersome symptoms that are not only just like affecting her daily life, but also impacting her work, her family, herself, we want those symptoms to be addressed. And so, that's why, you know, working with a menopause specialist is really important because we are aware of kind of the newer things coming to market that are available. We discuss the safety of treatment options for a woman. Because, as I've mentioned, not every woman is a good candidate for hormone therapy, so we kind of have that discussion. And being a menopause specialist means that you have to stay up-to-date on these topics in caring for women with these symptoms. So, I think that's why it's important to kind of work with a certified menopause specialist.
Host: And when you mentioned over a billion, as you said with a B, menopausal women by 2030, that's a lot of potential hot flashes and mood swings. So, we want these women to be ready, right?
Heather Wahl, MD: Yes, absolutely. I have a lot of conversations with patients who have not gone through menopause, but they just want to meet with me to say, "Okay, what are some of the things that I can do kind of even beforehand?" You don't have to be menopausal to meet with a menopause specialist, I think is also important to keep in mind.
Host: Absolutely. Great point to wrap on. So folks, we trust you are now more familiar with managing menopause. Dr. Heather Wahl, very informative. Thanks so much again.
Heather Wahl, MD: Thanks for having me.
Host: And for more information, please visit promedica.org. Again, that's promedica.org. Now, if you found this podcast helpful, please do share it on your social media. And until next time, stay happily ever after 40. I'm Joey Wahler.
Managing Menopause and Its Symptoms
Joey Wahler (Host): It's a significant body change that women will eventually experience. So, we're discussing managing menopause. Our guest, Dr. Heather Wahl, she's a gynecologist with Promedica. This is Happily Ever After 40, a podcast from ProMedica. Where we discuss midwife health and wellbeing. Thanks for listening. I'm Joey Wahler. Hi, Dr. Wahl. Thanks for joining us.
Heather Wahl, MD: Hi. Thanks for having me.
Host: Great to have you. So first, simply put, when a woman reaches menopause, what exactly is happening to her body and what are the usual symptoms?
Heather Wahl, MD: Yeah, great question. So I think first and foremost, it's important to note that menopause is not a disease. It is a normal, natural event to go through menopause. menopause is defined as 12 consecutive months without having a period in the absence of other causes, and it marks the permanent end of fertility. Most often menopause occurs between the ages of 45 to 55. And in the United States, the average age of menopause is between 50 to 52. So, I think it's important to know that every woman's experience is different. So, not every woman will experience physical changes when she goes through menopause. That being said, kind of some common symptoms include irregular menstrual periods, hot flashes, difficulty sleeping, memory problems, mood disturbances, vaginal dryness, changes in weight, specifically kind of weight gain, as well as skin and hair changes.
Host: And how long does that period of those symptoms typically last?
Heather Wahl, MD: Yeah. So, specifically with hot flashes, we initially used to think that they only occurred maybe six months to two years, and now we actually know better. We're starting to get more and more information, do more research on this topic. And it's actually now felt that hot flashes can occur for some women for seven to 10 years on average. In African American women, on average, hot flashes may be 10 to 13 years. And there's actually a small portion of women who may continue to experience hot flashes lifelong. But in that kind of small subgroup of women, their hot flashes are typically not super bothersome, even if they are experiencing them lifelong,. You know, with the symptoms of difficulty sleeping, memory problems, mood disturbances, so again, some of these can just be natural aging symptoms, you know, not associated with menopause. That being said, it is felt that those kind of mood changes, difficulty sleeping may improve after a woman has kind of gone through the menopause transition.
Host: Wow. So, let me ask you about women that have the hot flashes, for instance, for a period of several years, as you just said. Does that mean technically speaking that they're still in menopause or has menopause ended and that's just a continued residual effect?
Heather Wahl, MD: So, they are still considered menopausal. So, yes, you can have hot flashes before going through menopause, which is known as perimenopause. Once you go through menopause, which again, the definition is 12 consecutive months without a period, then you are said to have gone through menopause. The hot flashes can last even after going through menopause. So, I know it can kind of be confusing for some women, because they're like, "Well, am I menopausal because I'm having hot flashes, but I'm still having my period?" The answer is no, you're perimenopausal.
Host: Gotcha. So, we hear so much about these hot flashes. Even as a guy, I've heard about them for some time about women going through them. For those unfamiliar, give us an idea, please. In a nutshell, what do we mean by a hot flash? What does it feel like? How long does it typically last?
Heather Wahl, MD: Well, that's also really individualized for a woman. So for some women, they may only experience a few hot flashes a day. For others, they may experience multiple hot flashes. And basically, what a hot flash is, is when you feel your body getting very warm. Now, for some women, that may start in their face and kind of transition down to the rest of their body. For other women, they may report that their hot flashes kind of started in their feet and then worked their way up to their face, to their head. The experience can be different. Often women report a flushing-like sensation. Perspiration or sweating is also really common. For some women, hot flashes may just last a few Minutes. For others, they may last several minutes. So again, it can really vary. Hot flashes not only occur during the day, but for some women, they also occur during the night, typically referred to as night sweats in that situation. Some women report that they wake up just completely drenched from their night sweats. So again, it's a really individualized experience.
Host: So whether it's the hot flashes or some of the other common symptoms you mentioned, how treatable are some of these things like hot flashes and what is the treatment?
Heather Wahl, MD: Yeah, great question. So, first and foremost, very treatable. People do not have to be miserable with their symptoms. So, their hormone therapy is considered a treatment for bothersome hot flashes that are significantly impacting a woman's quality of life. That being said, obviously, not every woman is a good candidate for hormone therapy. So, there are prescription non-hormonal treatment options for hot flashes. There's hopefully going to be another treatment, a non-hormonal, FDA-approved prescription treatment available later this year to treat hot flashes. So again, that's going to be really good for those women that are not candidates for hormone therapy. When it comes to kind of the sleeping issues, if a woman is having a lot of hot flashes that are, you know, the cause of her significantly impacted sleep, then we know that treating the hot flashes has kind of that domino effect. It will help sleep because then if we decrease hot flashes, sleep should get better. We know that mood and memory are also kind of directly tied with poor sleep. So again, if all of those issues are related to getting poor sleep because of frequent hot flashes, then we also expect that mood and memory can improve with improved sleep. Now, not every woman has those sleep issues related to hot flashes. So again, we can't guarantee that hormone therapy or those non-hormonal therapy options that treat hot flashes are going to improve those other symptoms. So, there may need to be other treatments for those particular issues if they're separate.
Host: Switching gears a little bit. During menopause, what about changes that women might notice to their skin or their hair and how are those things, if they materialize, addressed as well?
Heather Wahl, MD: Yeah. So, it's really common, separate from menopause, just kind of in the normal aging process, that our skin begins to lose collagen and elasticity. So, it's really normal that all people, men included, feel that their skin is drier, that they lose kind of the plumpness of their skin. So, it's really important to kind of use products that help maintain the moisture to our skin. With regards to hair changes, it's very common that hair can get thinner and can fall out more easily. There is female pattern hair loss that can occur separate from menopause, just as a normal aging process that, in female pattern hair loss, the parts in a woman's hair tend to get larger. And so, sometimes, women can benefit from meeting with a dermatologist to just make sure that there's not a skin condition that they have separate from the normal aging process that's a cause of hair loss.
Host: Gotcha. So, what you're saying there, it seems in a nutshell, am I right, is that some of these things you just mentioned occurred during menopause, but they might actually just be part of aging, not menopause per se.
Heather Wahl, MD: Correct. Yeah. So, it can be kind of a mixture of both of these things.
Host: Right. Couple of other things. How about the importance of a healthy lifestyle during menopause, regarding diet and exercise in particular?
Heather Wahl, MD: Very important. Cannot be overstated the importance of diet and exercise. So, it does get harder to lose weight as we age. Metabolism starts to slow. Again, with those hormonal changes that take place, weight gain is very common. On average, women gain 10 pounds after going through menopause. Now, that doesn't happen, obviously all at once. But it takes time, so over a course of several years. But it's not uncommon to have a 10-pound weight gain. I often hear from patients, "I'm exercising, I'm doing all of the same things that I used to do and I'm still gaining weight." So sometimes, that can be a really difficult discussion because we have to talk about potentially needing to do even more than what you were doing.
So, what the American Heart Association recommends is that at least 150 minutes of moderate activity exercise on a weekly basis is what's recommended to maintain weight. So if somebody's trying to lose weight, they have to do more than that. And when we talk about moderate activity, I mean this is when you're kind of you're breathing heavily, it's hard to carry on a conversation because you're really working out. Diet is also important. Obviously, kind of everything in moderation. This is why there are kind of health clinics that have been developed to help patients with their weight loss goals. So, sometimes, you know, if I do have a patient that's, again, really dieting, exercising, doing all of the right things and still having a difficult time, then I may need to refer that patient to a weight management clinic to assist with weight loss.
Host: And finally, obviously from this discussion, it's clear that when menopause does start, it's a lot to be coming at a woman all at one time, a lot of newness, I'm sure, a lot of confusion. Why do you think having discussions about menopause like this one, especially with a professional experienced in this area like yourself, why is it so important to talk about these things?
Heather Wahl, MD: I think it's important because we need to keep in mind that more than 1 million women in the United States will experience menopause each year. That's a huge number. And by 2030, the world population of menopausal and post-menopausal women is projected to increase to 1.2 billion. That's with a B. So again, a lot of women are experiencing menopause and are going to be experiencing menopause. And these women make up a large amount of our workforce. And we want to, again, make sure that if a woman is having really bothersome symptoms that are not only just like affecting her daily life, but also impacting her work, her family, herself, we want those symptoms to be addressed. And so, that's why, you know, working with a menopause specialist is really important because we are aware of kind of the newer things coming to market that are available. We discuss the safety of treatment options for a woman. Because, as I've mentioned, not every woman is a good candidate for hormone therapy, so we kind of have that discussion. And being a menopause specialist means that you have to stay up-to-date on these topics in caring for women with these symptoms. So, I think that's why it's important to kind of work with a certified menopause specialist.
Host: And when you mentioned over a billion, as you said with a B, menopausal women by 2030, that's a lot of potential hot flashes and mood swings. So, we want these women to be ready, right?
Heather Wahl, MD: Yes, absolutely. I have a lot of conversations with patients who have not gone through menopause, but they just want to meet with me to say, "Okay, what are some of the things that I can do kind of even beforehand?" You don't have to be menopausal to meet with a menopause specialist, I think is also important to keep in mind.
Host: Absolutely. Great point to wrap on. So folks, we trust you are now more familiar with managing menopause. Dr. Heather Wahl, very informative. Thanks so much again.
Heather Wahl, MD: Thanks for having me.
Host: And for more information, please visit promedica.org. Again, that's promedica.org. Now, if you found this podcast helpful, please do share it on your social media. And until next time, stay happily ever after 40. I'm Joey Wahler.