Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Maggie McKay (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Menopause can be a dreaded topic, but the more you know, the better you can plan and know what to expect. So today we're joined by Donna Lee, a member of the Women's Health team at Skagit Regional Health, who will fill us in on what we need to know. 

Welcome to Be Well with Skagit Regional Health. I'm Maggie McKay. Thank you so much for being here today, Donna. I can't wait to talk more with you about this important topic. 

Donna Lee, ARNP: Thank you for having me.

Maggie McKay (Host): I think a lot of women don't know the definition of menopause until they're approaching it. So let's start with that. How is menopause defined?

Donna Lee, ARNP: So technically menopause is defined as one full year without any menses or any period. And we don't know when that year is up until you've had those 12 months. So you could go 10 months and think, oh, I'm finally in menopause. And then you have another period, and then your clock starts over from that month. And you need to go another 12 months without a period to officially be in menopause.

Maggie McKay (Host): And tell me about the stages of menopause. Once I was watching Oprah years ago, actually decades, and there was an expert on and they said, from beginning to end, it takes about 14 years. And I was horrified. I think I was in my twenties maybe, so tell us about the stages. There's perimenopause and menopause and postmenopause, right? 

Donna Lee, ARNP: Yes, I guess if you could say it's 14 years. The time from age 40, a woman can be entering menopause and perimenopause. Perimenopause is defined as, when the menstrual cycles start to become more irregular. Women could start to have periods that are further apart, or a little bit longer in length or skipping an entire month. And this can go on for several years. And then menopause is, any time after the 12 months without a period, then you're officially in menopause. And any time after that is considered postmenopausal.

Maggie McKay (Host): That just doesn't seem fair that we have to even have postmenopause. We already went through the other two. What's the point? What is the point of postmenopause? 

Donna Lee, ARNP: Well, I think it just defines your state of you're postmenopausal. So you do not have periods anymore.

Maggie McKay (Host): So what are the symptoms of all these stages? 

Donna Lee, ARNP: Symptoms can start very slowly in the forties. And we see a lot of women that have symptoms but are still having regular periods. And this could be women that have a hot flash occasionally, but not regularly, periods that are irregular and vaginal dryness can also be a symptom and these symptoms can wax and wane.

A couple of hot flashes does not necessarily mean a woman will be in menopause within a couple of months. It's just a symptom of the perimenopausal period.

Maggie McKay (Host): You mentioned that the average age is maybe beginning at 40. Is that pretty much across the board for experiencing symptoms at least?

Donna Lee, ARNP: It's normally age 45. But we do see symptoms starting at age 40, so age 45, and typically menopause is age 51.

Maggie McKay (Host): And what about prevention or treatments? What are available for the symptoms? 

Donna Lee, ARNP: Well, the best early prevention for menopausal symptoms is just having good health habits. So this can mean exercising regularly. Maintaining a healthy diet and quitting smoking. And those three things will keep you in the best health going into and through menopause. 

Maggie McKay (Host): Donna, what are some treatments that are available for symptoms?

Donna Lee, ARNP: So, for hot flashes, or hot flushes, a lot of lifestyle changes can be helpful to help with hot flushes. This would include changing bedding, avoiding alcohol before bedtime, different sheets and even sleeping with a fan. That can be very helpful. We try these lifestyle changes before we try other methods to help with hot flushes.

And for vaginal dryness, there are over-the-counter remedies we can try. And there are also vaginal estrogen creams we can use that are very helpful for vaginal dryness.

Maggie McKay (Host): So hormone therapy, I know there are pros and cons and we hear a lot of good things and a lot of bad things. So what is the actual story on that?

Donna Lee, ARNP: Hormone therapy can be very helpful for the right women. Some women are not good candidates for hormone therapy, and this would be women who may have had a prior history of breast cancer, a prior history of stroke, heart attack or blood clots. Those women would not be good candidates, but they can certainly talk to their health professionals about hormone therapy.

The ideal woman for hormone therapy would be someone who's less than 10 years away from their final period. So they are in the first 10 years of menopause, and they don't have high blood pressure or uncontrolled cholesterol. And they're suffering from symptoms such as hot flashes that are causing sleep disturbance or vaginal dryness. And even if they're at high risk for osteoporosis, those women would be good candidates for hormone therapy.

Maggie McKay (Host): And what are the pros and cons of hormone therapy?

Donna Lee, ARNP: The pros, I will tell you that it does help with hot flashes, vaginal dryness and prevention of osteoporosis. It also has been shown to reduce the risk of colon cancer. So those are the pros of hormone therapy. The cons are that there is an increased risk of breast cancer in women who use hormone therapy. The risk is that 8 additional women in 10,000 will get an invasive breast cancer. It also increases the risk of heart attack, and it's another very small percentage. It's an additional 7 women out of 10,000. And it also increases the risk of stroke and blood clots.

Maggie McKay (Host): That sounds scary. I mean, you can understand why people think, uh, maybe I'll just take my chances. 

Donna Lee, ARNP: Yes, it does, and a lot of the studies, a study that was released 20 years ago, did look at women who were using hormone therapy and came up with some of these numbers that pointed to the increased risk. However, when we looked at the numbers further, we saw that the risk was increased for women who were in menopause and starting hormone therapy later than 10 years after menopause. So these were women who were starting hormone therapy at age 60 or even 70, and it increases your risk. But if you are starting hormone therapy within that 10-year or five-year age from the start of menopause, the risk is greatly reduced.

Maggie McKay (Host): Donna, how does sexual health change after menopause?

Donna Lee, ARNP: Well as we discussed, there is an increase of vaginal dryness in menopause and we treat this by vaginal estrogen, which is not an oral estrogen, and so it's much safer for women who can't tolerate or shouldn't have oral estrogen. So vaginal estrogen can be inserted and used two to three times per week. We also really encourage the use of vaginal lubricants, which can be purchased over the counter. And understanding that there's still sexual life after the age of 50 or 60.

Maggie McKay (Host): Look at the Golden Bachelor.

Donna Lee, ARNP: Exactly, exactly. Look at them.

Maggie McKay (Host): Oh my goodness. So should women still have annual checkups and regular pap smears once they enter menopause? Is that still necessary? 

Donna Lee, ARNP: Absolutely. And it does get to be more important as there are changes that you don't necessarily bring up with your primary care provider. Pap smears can end at age 65 as long as the most recent pap smears have been normal. So those can end. However, we still recommend a pelvic exam every year, and there are many reasons for this.

We want to look at the tissue, and as we discussed, the woman may need some vaginal estrogen. We also check for any lesions. There are vulvar cancers. We talk about incontinence and pelvic floor. How's the pelvic floor health? And we also look at prolapse, which is the pelvic floor prolapse which we can treat with exercise and sometimes surgery.

Maggie McKay (Host): There's so much going on in our bodies. It's just, it's mind-blowing actually. Well, this has been such useful information. Thank you so much for sharing your expertise. We really appreciate it. 

Donna Lee, ARNP: Thank you very much for having me.

Maggie McKay (Host): Again, that's Donna Lee. If you'd like to learn more, please visit SkagitRegionalHealth.org. 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 McKay. Thanks for listening. This is Be Well with Skagit Regional Health.