Transcription:
Menopause

Melanie Cole (Host):  Menopause affects every woman differently and I know it certainly affects me differently than it affects my friends. My guest today is Dr. Gloria Richard-Davis. She’s the Director of Reproductive Endocrinology and Infertility at the University of Arkansas for Medical Sciences. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Melanie Cole. Dr. Richard-Davis, such a pleasure to have you on. I’m in menopause. My friends are in menopause. We all have questions. What exactly is happening with our bodies during menopause?

Gloria Richard-Davis, MD (Guest):  When we talk about menopause, it is a natural phase that every woman goes through. Although I do have to kind of back up and explain that we talk about natural menopause versus surgical versus premature menopause. So, most of the time, when we refer to menopause; it is the natural menopause. Surgical means her ovaries have been removed for other reasons and for women who are less that 40 who enter menopause; then that’s considered premature menopause.

But in general, it occurs around 51 for most women. And it’s when the ovary has exhausted its supplies of eggs and it’s no longer making estrogen which is a critical hormone for our bodies. It affects all of our systems.

Host:  So, tell us about the indicators of perimenopause, when we think we are starting to get into there, how do we know that this is what’s going on?

Dr. Richard-Davis: It’s quite interesting because the symptoms of perimenopause really are the same as when you have gone through menopause. The typical ones that most women experience is hot flushes, night sweats, sleep disturbances, as I say to most of our students; if you’ve been sleep deprived, you’ve been on call; you are not usually in the best of moods. So, mood disturbances kind of comes along with the territory, vaginal dryness, and if not addressed; vaginal dryness will lead to pain with intercourse. So, those are typically the most common early to mid-signs that can occur with perimenopause and menopause.

Host:  So, if we’re told by our doctor that yes, you are entering menopause, this lovely phase of life and we experience bleeding during or after; is this something we should be concerned about and let our providers know?

Dr. Richard-Davis:  If a woman has truly gone through menopause where she’s not had a period, no bleeding for at least a year; and she experiences bleeding; then the first thing that we are concerned about is does she have any sort of endometrial precancerous or cancerous changes. So, it is important to get evaluated if you have postmenopausal bleeding. In the perimenopause; the bleeding is very erratic, right. It may be where you have short cycles or long cycles where you will go two, three, four, six months without a cycle but until you completely stop, you are not menopausal.

Host:  Well thank you for that explanation. It’s so confusing for some women. So, now symptoms. Because that’s – as you said this is a natural course, we all are going to go through it. But there are symptoms that some women experience more than others and they have questions about hormone replacement therapy. Tell us a little bit about that bioidentical hormones. What is it intended to do?

Dr. Richard-Davis:  When we talk about hormone therapy; we used to say hormone replacement therapy but subsequently we now refer to it as hormone therapy. And really, what we are trying to do is to give that woman back some estrogen that she’s lost. Now if she has a uterus in place, then we have to give her both estrogen and progesterone because we have to protect her endometrium from endometrial cancer. So, there are lots of options on the market when we talk about estrogen or estrogen and progesterone therapy.

It could be everything from systemic treatment and when you talk about bioidentical; it really refers to hormones that are plant derived and there are certainly many hormones that are plant derived. We also have a new FDA approved preparation which is estrogen and progesterone both of which are considered to be natural or bioidentical. So, lots of options. It just depends on the conversation between the woman and her physician identifying what’s going to be the best fit for her, whether it’s hormonal or nonhormonal.

Host:  So, before we get into symptom management; we are now at risk for everything. I mean it seems like after you go through menopause now you are at risk for heart disease, and bone loss and osteoporosis and all of these things. Where does that discussion fit into the picture with a woman when you are discussing hormone therapy, when you are discussing symptom management; where do you discuss the risks that we now have to be concerned with?

Dr. Richard-Davis:  I generally do a fairly thorough questionnaire for patients who come in with menopause, really any woman who comes in that’s at least around perimenopausal age. And in that questionnaire is embedded questions to make sure that we’re not overlooking any sort of chronic disease, anything that might be a contraindication to even starting a discussion with her about hormone therapy. And those would be breast cancer, anything estrogen dependent malignancies, liver disease, anything that would affect her body’s ability to basically metabolize the estrogens. And cardiovascular disease if there is clear cardiovascular disease would be considered a contraindication.

Host:  Now on to the symptoms. Women experience these to different degrees. And they are everything from anxiety and mood swings and night sweats. We hear so much about those and hot flashes, those as well. You mentioned vaginal dryness. Of course, we are looking at weight gain and there’s so many things on the market besides our hormone therapy, black cohosh, soy. What do we think of these Doctor and what should we take away from this about them?

Dr. Richard-Davis:  There’s lots and lots of things on the alternative market and it’s several billions of dollars a year women spend on preparations trying to go the natural route. The reality is, we don’t have a lot of anything that’s evidence-based about how much you need, how long it’s going to take, but in general; it requires a fairly significant amount if you are doing black cohosh, ginseng, that type of preparation; before you will even begin to see any sort of improvement. So, it’s not something that we in menopausal realm usually recommend to patients when we have so many other things that have been clinically researched and that we know are safe.

Host:  Well then give us some healthy tips to get through menopause. Are there certain things that we can do lifestyle behaviors that might help with some of these things?

Dr. Richard-Davis:  The best thing is what you would do at any age and that’s healthy eating, healthy choices, there are certainly foods that have more estrogenic activity than others like tofu soy, yams, which might be helpful. But again, just as we said with the natural products you probably can’t eat your way through hot flushes, okay. So, eating healthy, exercising and trying to maintain a good balance because when we look at some of the long-term ramifications of menopause; you mentioned cardiovascular disease. What we know is postmenopause women are at greater risk for cardiovascular disease because estrogen is protective. It’s protective on our lipid profiles. So, we have higher high density lipids, so the good lipids are higher when you are premenopausal or when you are on hormone therapy versus not.

So, with your primary care physician, making sure that your lipids are checked and that you are replacing calcium. You need a least 1200 milligrams of calcium, vitamin D at least 800 milligrams because that’s going to help to protect against bone loss. When we enter menopause, we lose about 2% of bone per year if we do nothing.

Host:  Wow, that’s so important for us to hear and before we wrap up Dr. Richard-Davis, one of the things I hear from many of my friends is the anxiety and even depression. What about the mental psychosocial issues that we go through, the anxiety seems pervasive and maybe we blame it on menopause, maybe it’s not menopause. But what can we do about those things because hormone replacement does that help with that, hormone therapy? Would that help with those kinds of symptoms?

Dr. Richard-Davis:  Well I think it’s important to differentiate between women who have had those types of symptoms premenopausal. Somebody who has premature menstrual disorder who might be depressed or someone who just has an underlying anxiety disorder then menopause does not – is not the cause of that. But it might exacerbate it. It might make it a little worse simply because when we talk about the sleep disturbances that occurs with menopause; if you are not rested, if you are not getting good REM sleep, you’re going to have worsening of your depression, your mood irritability and anxiety. It just goes along with that with sleep deprivation and not being able to compensate as well as you can. But it is important to differentiate between those two.

Host:  Well we are all experiencing it to a degree. So, wrap it up for us, best advice. Women, going through menopause and what you’d really like us to know.

Dr. Richard-Davis:  It’s important to embrace the change. It can be very exciting because for some women, they feel it’s liberating. You no longer have to worry about sanitary protection, right. It’s a normal phase of life and as long as we enter it with the right attitude, where we are eating healthy, we’re living healthy, we’re staying active; women are living a third of their lives postmenopausal. So, it’s certainly not the end and that you can have a healthy normal sex life postmenopause which I hear a lot of women come in and they don’t really want to talk about it. some of them don’t want to talk about it because they don’t feel like there’s some help. There’s plenty of help out there. So, talk to your physicians. If you are not getting the answer that you seek; then I would suggest looking at menopause.org which is the North American Menopause Society’s webpage and you can find a menopause certified practitioner from that website who is very knowledgeable about menopause.

Host:  Absolutely great information. Thank you so much Doctor, for joining us. That wraps up this episode of UAMS Health Talk from the University of Arkansas for Medical Sciences. You can head on over to our website at www.uamshealth.com for more information and to get connected with one of our providers. If you found this podcast as informative and helpful as I did; please share with other women, you know. Share on your social media and that way we can learn from the experts together. And be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.