Amanda Wilde (Host): Menopause. What is it? When is it? Does it require treatment? What should I be prepared for? What is normal? What is abnormal? It can be confusing. UK Health has opened a Menopause Clinic dedicated to helping women enjoy a healthy midlife. Up next, we'll demystify menopause with an expert, UK Health's Medical Director of the Women's Health Clinic and Certified Menopause Practitioner, Dr. Deidra Beshear. Welcome to UK Healthcast, a podcast presented by UK HealthCare. I'm Amanda Wilde and welcome, Dr. Beshear.

Deidra Beshear, MD, MSCP: Thank you. Thanks for having me.

Host: Well, first, let me ask you about this clinic that is dedicated to menopause. What led to the creation of the UK Midlife Health and Menopause Clinic?

Deidra Beshear, MD, MSCP: Well, several years ago, Dr. Kathy Dillon, she was one of my mentors and she started a Midlife Health and Menopause Clinic, until she retired and around that time COVID hit. And so we really have not offered this clinic for patients in some time. Over the past few years, my colleagues and I have noticed that a lot of women are coming in with concerns about the menopausal transition. A lot of questions about what is perimenopause, how do we help to manage these symptoms as we enter into menopause and I think there's also been a lot of discussion and attention in the news about more studies showing the safety in using hormone therapy to treat these bothersome symptoms. So that led us to restart this clinic here at UK.

In addition to women coming in with many concerns about the menopausal transition and how to treat menopause, in 2020, the American Heart Association actually released a scientific statement highlighting that the menopausal transition is a period of increased cardiovascular risk factors for women. So it's really important to try to address these factors early on before patients go through the menopause transition. So that's why we really wanted to be able to offer patients an in-person visit designated to discuss midlife health concerns and menopause symptoms and treatment, and allow patients an affordable option as we do take all insurance plans UK healthcare accepts.

Host: So, a clinic dedicated to menopause, to midlife, and with more studies coming in, you're getting more information, and now you're also offering services to a broader population of people.

Deidra Beshear, MD, MSCP: Right.

Host: But it can be confusing with all the different terms used to describe menopause, like perimenopause. Can you clarify the terms that we use?

Deidra Beshear, MD, MSCP: Yes, it can be confusing. There are so many different terms and a lot of them are more clinically relevant, I would say. I think the best way to start in this discussion is to define what is menopause. So menopause is the end of a woman's reproductive years. So she's no longer able to ovulate, or that means she can no longer get pregnant, and her menstrual cycles will stop.

Because of these changes, there's significant shift in a patient's estrogen and progesterone levels. And once a woman has gone a full year without having a menstrual cycle, she is now menopausal. That period though, leading up to that last menstrual cycle, is what is referred to as the menopausal transition or perimenopause.

 And women can start experiencing symptoms of perimenopause as early as two to eight years before that last menstrual period. So the average age of menopause in the United States for women, is between the ages of 51 and 52, but what is considered normal is anywhere between the age of 45 and 55 years of age.

So as you can see from these numbers, it is possible that a woman in her late 30s can start experiencing symptoms of perimenopause. And that fluctuation in the hormone levels, the estrogen, progesterone, is what is responsible for most of the symptoms that we are experiencing.

Host: WAnd Dr. Beshear, what are those symptoms? What are the symptoms of perimenopause and what are the symptoms where we know we're fully in menopause?

Deidra Beshear, MD, MSCP: The most common symptom, the one that I think most of us would associate with menopause, is the hot flash. That's what we're most aware of, that comes with menopause. And it is, the majority of women going through menopause, up to 80%, are going to experience hot flashes. And out of that 80%, up to 30 percent of those women can have significant hot flashes that affect their daily living.

They can have multiple hot flashes during the day. And also, as we continue to lose estrogen, in addition to the hot flashes, we can start losing bone. And that can lead to osteoporosis. In addition to the bone loss and the hot flashes, we can start having symptoms such as brain fog, insomnia, weight changes, mood changes.

We can become more anxious, more depressed, more irritable. Also can experience symptoms of joint and muscle complaints. Vaginal dryness, pain with intercourse, dry eye, headaches, you name it, we can blame it on perimenopause. So, we really do have a much better understanding over the past decade of how many symptoms we can attribute to these hormonal fluctuations that are occurring in this menopausal transition.

I actually, heard a great analogy about caring for the menopausal patient and how we used to think of menopause care as we would focus really just on that year right around that last menstrual cycle and those few years following that. Because we do know that is when women are most symptomatic. But when we think about that, these women can be experiencing symptoms a good 10 years prior to that last menstrual cycle; referring back to that analogy that I heard a few days ago, thinking of it like pregnancy and that delivery. So the goal of the pregnancy is to have that the date of delivery, the birth, right? The day of delivery. And so if we can think of menopause in that way, but a lot happens in those nine months leading up to that delivery of the baby.

So if we think of menopause, is, okay, yes, the defining event of menopause is that last menstrual cycle. But there's a lot going on in those 8 to 10 years prior to that last menstrual cycle. And I think that's really what we are focusing on and reframing how we look at patients going through this menopausal transition.

Host: So these hormone changes can start early and they can affect our daily living and you've described some really lovely symptoms that we might be able to look forward to. I'm curious, is that all part of the transition or do those symptoms continue post menopause?

Deidra Beshear, MD, MSCP: So yes, these symptoms can begin in that transition and they absolutely can continue post menopause. Most women five years out from their last menstrual cycle, we know that many women do start to have less and less symptoms and symptoms may go away completely, but for up to 10 to 15 percent of women, they can still have menopausal symptoms even into their seventies and eighties.

Host: So to continue your pregnancy analogy, you know, more and more obstetricians are talking about the fourth trimester. And so this is sort of like that. You've been through the changes, but you're still experiencing symptoms. Now, what are the treatment options? I've heard of hormone therapy. Is that something patients should consider?

Deidra Beshear, MD, MSCP: So, hormone therapy is the main treatment, the best treatment for menopausal symptoms. And when we're referring to hormone treatment, hormone therapy is really talking about estrogen and progesterone and possibly testosterone replacement. Most of the symptoms, as we said, about causing the menopausal symptoms are from that loss of estrogen.

And so those forms of hormone therapy can come in many different ways. We can administer pills, we can look at transdermal options, such as a patch or a gel. And also we can consider vaginal options, such as vaginal suppositories and creams. Not every woman is a candidate for hormone therapy. But many are and that's why it is so important to have that discussion with your physician to talk about your individual risk and benefit of such treatment.

Host: So when we talk about these treatments, do they stop the symptoms we were talking about earlier, the brain fog or insomnia or losing bone mass?

Deidra Beshear, MD, MSCP: So, for the majority of women, if we decide to treat with hormone therapy, you will start to notice an improvement in symptoms as early as, two to four weeks of treatment. Usually by six to eight weeks of being on medication, we will know if it's working for you. And there are other labs, other possibilities for symptoms that we want to also check and make sure are not occurring.

Thyroid disease is one of them that's very common in midlife and can present with very similar symptoms to perimenopause. So there are other things we want to assess for in that initial evaluation to make sure that there aren't other issues that we need to also address.

Host: And for women who are not good candidates for hormone therapy, which you mentioned was the best treatment, are there non-hormonal treatment options?

Deidra Beshear, MD, MSCP: Yes, we're very fortunate that over the past few years, there have been several more non-hormonal options to treat menopausal symptoms, especially for those women who are too high risk to be on hormone therapy or if they choose not to be on hormones. There is a new medication that I'm sure most people have seen ads for on TV called fezolinetant, which is known as VEOZAH, which is one of those medicines I'm speaking of.

And this medicine actually targets the thermoregulatory center in the brain help to decrease the severity and frequency of hot flashes. And it's actually been shown to be quite effective. So a nice new option that we have. Women may be familiar with the use of medications called SSRIs, which are used for anxiety and depression.

We know that those can also help with the symptoms of menopause. In addition to those non-hormonal options, there are a lot of lifestyle changes that we can address during that menopausal transition that may help patients to better function with all of these changes. So things such as dietary changes, exercise is a really important aspect of helping to manage this menopausal transition and lower our cardiovascular risk, especially with an emphasis on resistance training during this time and also focusing on sleep hygiene. As we know that sleep can definitely be affected through this transition.

Host: It sounds like menopause is something we're learning more and more about, and you've mentioned there was a demand for the kind of clinic that you have, but I just want to end so that people know who would benefit from a consultation at UK Midlife Health and Menopause Clinic.

Deidra Beshear, MD, MSCP: So any patient, of course, who is struggling with menopausal symptoms, as well as patients who just have concerns as they are starting to enter that menopausal transition and perimenopause, and would like some advice on how to best enter this new phase of life. And we also want to include those women who have already gone through menopause, who may still have symptoms or just questions about how to better their health as they enter into their 60s and 70s.

Our goal is to have a holistic approach to treatment options for these patients and to come up with an individualized plan that best fits them.

Host: That sounds fantastic. Thank you so much for providing clear answers about menopause today. And also thank you for this clinic that models offering focused, menopausal services for all women.

Deidra Beshear, MD, MSCP: Well, thank you so much for allowing me the time to discuss our new clinic. Really appreciate it. Thank you.

Host: That was Dr. Deidra Beshear. For more information, visit ukhealthcare.uky.edu. Thanks for listening to UK Healthcast, a podcast from UK Healthcare.