Scott Webb (Host): Perimenopause, menopause, and hot flashes are normal parts of aging for women, but my guest today wants you to know that you don't have to suffer. And joining me today is Dr. Rachel Beck. She's an OB-GYN with Salinas Valley Health.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about some worthy things for listeners, for women, menopause, perimenopause, and all the ins and outs, if you will. So, let's start there. What is perimenopause? And also, what is menopause?

Dr. Rachel Beck: Great question. So, perimenopause is just the five to 10 years preceding menopause. It's the beginning of that transition. As women, we know our ovaries are making estrogen and progesterone each month. That's what creates our menstrual cycle. And as the ovaries start to stop making these hormones, the estrogen and progesterone levels start to decrease, that is the transition which we call perimenopause. Once a woman is in menopause, her ovaries have completely stopped making estrogen and progesterone. And they stop having periods altogether, but it's interesting that menopause isn't actually recognized until a woman has gone for a full year without a period. So, we diagnose menopause after the fact. So, perimenopause is really just the transition of those years prior to the complete cessation of menses.

Host: Yeah, I'm with you. So, it's those five to 10 years before, but then has to be a full 12 months before menopause can really be diagnosed. And as you say, it's sort of diagnosed after the fact. So then, let's talk about the signs and symptoms that women experience during perimenopause.

Dr. Rachel Beck: So, the most common symptom that women experience are hot flashes. The studies show anywhere from 50-80% of women will have some form of hot flashes. And these can be during the daytime, hot flashes, or at night time, which we call night sweats. Some of the other symptoms of perimenopause, the next most common symptom is irregular periods. Sometimes women will skip a period or their periods will start to become irregular. Lucky women, their periods start to get lighter and less frequent. Some of the less fortunate women, their periods tend to get heavier, longer, more frequent. So, we have these menstrual irregularities and hot flashes being the most common symptoms of the perimenopause. But then, there's other symptoms that some women experience, women can have mood swings, sleep disorders, weight gain, quite a variety of symptoms. But the most common are the hot flashes and the irregular menstrual cycles.

Host: Yeah. And my wife is in her early 50s. So, I am familiar with the hot flashes and the night sweats. And where we live in the Midwest, she would prefer that it's much colder in the house than my daughter and I would prefer. So, there's a lot of battling over the furnace and the temperature, but that's maybe a different podcast.

Scott Webb: So, uh,

Host: Staying with the hot flashes, what are hot flashes exactly? And is there treatment available? How long do they typically last, and so forth?

Dr. Rachel Beck: Yeah. So, hot flashes are so variable. As I said, 50-80% of women experience hot flashes, but their experiences can be so different. Some women will just have the occasional hot flash here and there. Other women are just debilitated by the hot flashes. And so, we don't understand 100% what causes hot flashes, but we know that there is some sort of disruption in the thermoregulator centers in our brain. So, these thermoregulator centers just get dysregulated and they're frazzled. They don't know if the body's hot or cold. So, the brain is telling the body, "Oh, you're cold. I'm going to make you warm." But the body's not actually cold. And so, the brain is sending these signals to warm up the body, and then that creates this hot flash. And it's interesting we don't understand really why they happen more at night, or for some women they are so much more debilitating than other women, but there's definitely a lot of studies going on since it is such a big deal.

And as far as treatments, the most common would be just wear layers at nighttime, have covers on, covers off, having a fan, just those simple treatments; avoiding certain triggers. Sometimes hot fluids, hot liquids, caffeine alcohol can be triggers for hot flashes. So, every woman figures out what triggers are triggering for them and avoiding those triggers.

But then, there are medications and prescription and non-prescription treatment options. The most effective treatment option really are hormones, right? Because we know that these hot flashes are coming because we're going through this hormonal transition. And so, sometimes normalizing those hormone levels will help with the hot flashes. And we found that is generally the most effective treatment, but there are some women who cannot take hormones, women who have had breast cancer, women who have conditions that predispose them to blood clots or strokes. We can't use hormones and then other women just don't want hormones. So then, there are a variety of non-hormonal prescription treatments out there.

There's a brand new one, which looks to be quite promising. And some of the early studies suggest it might be as effective as estrogen in treating hot flashes. We're getting excited about that. And really for any of the prescription or hormonal treatments, a woman just needs to her physician and discuss this. The Women's Health Initiative study that came out in the early 2000s really put a lot of fear out there surrounding hormone replacement therapy. And I would say that most OB-GYNs understand who is an appropriate candidate and who is not an appropriate candidate for hormones. And most women can safely use hormone replacement therapy for the treatment of hot flashes.

Host: Yeah. So, not necessarily one-size-fits-all. Some things women can do, like my wife, turn the fan on, use less covers, and then, obviously, hormone therapy and some newer treatment options as well. So, good to know that there are some things that can be done, some options available. Are there any signs and symptoms specifically of menopause? You said earlier that it's. Five to 10 years is perimenopause, before menopause. And then, there's menopause that's diagnosed after 12 months. So during those 12 months, what might women experience? Was it just the hot flashes or some other things as well?

Dr. Rachel Beck: Yeah. Still the main thing are the hot flashes, but insomnia and sometimes the difficulty sleeping, insomnia is related to the night sweats. Night sweats wake the women up, and then they can't fall back asleep. And then, weight gain can sometimes occur. And this is also related to hormones and the changing in the hormones.

One thing that we have found is that women through menopause, they start to lose muscle mass. And that's again, there's a hormonal change. And as we lose muscle mass, our metabolism decreases because muscles have a higher metabolic rate than other tissues. And so, strength training is really important for women in that menopausal transition to keep their muscle mass increased and try and help decrease some of those symptoms.

Host: Yeah. So, you're talking about muscles there. Let's talk about bones. I know that osteoporosis is a big concern for women. Is there a direct connection between menopause and bone health or menopause and osteoporosis? Are those things connected?

Dr. Rachel Beck: Well, There definitely is a connection between estrogen and bone health. So as we age, as we go through menopause, our estrogen levels decrease. And with the decrease in estrogen, there is an increase in bone resorption, a decrease in new bone formation, and that can increase the risk of osteopenia and osteoporosis.

So, you know, best thing we can do is get our bones as strong as possible prior to menopause through a healthy diet, exercise. But most of us realize in our 50s, "Oh gosh, all those things I should have done in my 20s and 30s and I didn't." So now, here we are in our 50s and we are where we are. So absolutely, there's an association with decreased estrogen and decreased bone health. But the things we can do are things to keep our bones healthy and strong, weight-bearing exercise, so walking, hiking. When we talk about weight-bearing exercise, we're talking about exercise that puts weight on our joints. Swimming is an amazing exercise and it's great, but it's not great for our bones. We really want like hiking, walking, running for exercise. And decreasing alcohol intake. Actually, alcohol has been shown to decrease our bone health. We want you to moderate alcohol. And then, making sure that we're getting enough calcium in our diet and taking vitamin D. A lot of women don't have enough vitamin D in their system, so having adequate vitamin D as well.

Host: So, let's talk about women as they go down the path of life, if you will. They may experience sexual problems related to menopause. Maybe you can talk a little bit about that.

Dr. Rachel Beck: Yeah. So, the most common, well, there's probably two most common complaints that I hear in the office. One is decreased libido, so decreased sex drive, and then the other is painful intercourse. And definitely with menopause and with the decrease in estrogen levels, there is an increase in vaginal dryness and there's a decrease in the normal elasticity of the vaginal tissue, which can make intercourse painful. And so, there are definitely treatments for that. And I know a lot of women are hesitant to bring this up in the doctor's office because they feel embarrassed or they just don't feel comfortable talking about this. But it's really important for women to talk about these issues with their physicians.

Because first, we would just recommend lubricants, vaginal lubricants, but we can also sometimes use vaginal estrogen to help with the sexual pain. And the vaginal estrogens do not have any of the risks that the systemic estrogens will have. So, we can sometimes even use vaginal estrogen in patients who have had breast cancer or who may have other contraindications to systemic hormone replacement therapy, but we can actually still use vaginal estrogen for them.

Host: Yeah. It's always good to know that, we as humans, men, women, all of us in this together, always good to know that there are treatments available, there are options, there are things that we can do for behavior, lifestyle, and so forth. it's always encouraging to me to know that, all right, we don't have to just get older and live with these things. There are things that we can do. There's treatment options. There's experts that we can lean on like yourself. I just want to give you a chance here at the end, just final thoughts, takeaways about Perimenopause, menopause, how you can help women and so on.

Dr. Rachel Beck: The most important takeaway would be to be honest with your physician, to talk to your doctor and to tell him or her what is going on with you so that they can personalize the treatment and help you get through this in the healthiest possible way.

Host: Yeah, for sure. See their providers, be open and honest as much as they can be open to the different treatment options, behavior, lifestyle changes, things like that as well. So, thank you so much for your time today. You stay well.

Dr. Rachel Beck: Thanks. You too.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.