Maggie McKay (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm your host, Maggie McKay. Joining us today is Dr. Erica Contreras, OBGYN of University of Maryland, Charles Regional Medical Group Women's Health in La Plata.

Thank you so much for being here today.

Erica C. Contreras, MD, FACOG: Thank you for having me.

Host: Absolutely. Let's start with the basics. What is surgically induced menopause and how is it different from natural menopause?

Erica C. Contreras, MD, FACOG: So menopause is the normal cessation or end of ovarian function that occurs for all women, and naturally it occurs over time. So this could be over years. Where surgically induced is where it occurs at a specific time point as a result of the removal of a patient's ovaries.

Host: What are some common reasons a woman might have surgery that leads to menopause?

Erica C. Contreras, MD, FACOG: So often if women have cancer, whether it be endometrial, ovarian, that could be a reason their ovaries might be removed. For some women who have endometriosis, removal of the ovaries can also be part of that treatment, or if they have other ovarian problems such as a dermoid cyst, or ovarian torsion where the ovary can twist on itself, compromising the blood supply, that could result in the loss of a ovary or both depending on the patient's status prior to surgery.

Host: So if you have a hysterectomy, can that cause early menopause?

Erica C. Contreras, MD, FACOG: So a hysterectomy is just the removal of the uterus and often the cervix. So generally it will not, it has to be associated with the removal of the ovaries because those are the organs that are producing the hormones that lead to these changes.

Host: How does sudden loss of estrogen and related hormones affect the body and mind?

Erica C. Contreras, MD, FACOG: So with menopause, with this gradual process, women will have often things such as decreased libido, hot flashes, vaginal dryness. They can also have cardiovascular effects and increased risk for osteoporosis. So instead of this being a gradual process, once you remove those ovaries, those risks present immediately.

So often women who maybe had this occur naturally might have had a slow progression of hot flashes, they might occur overnight after surgery, and that can be really distressing.

Host: How quickly do symptoms appear after surgery and what are the most common ones patients notice first.

Erica C. Contreras, MD, FACOG: So they can appear as soon as the next day or maybe a few weeks after surgery. The most common generally are hot flashes, and then often vaginal dryness.

Host: Dr. Contreras, what treatment options are available to manage these symptoms from hormone replacement therapy to lifestyle approaches?

Erica C. Contreras, MD, FACOG: There's a variety of options that can be used to help address these symptoms that women have. As you mentioned, this can include hormonal medications, which typically would include an estrogen or progesterone, depending or not if the uterus is present. And that can be delivered a lot of different ways.

It could be a pill, a patch, cream, local therapy to the vagina, can also be a pellet, which is a compounded product that's injected in the buttocks. Usually lasts for about three months. And then there are non-hormonal options and these can include medications that traditionally have been used to help for things like depression, but have shown to have benefit with treatment for hot flashes.

There's also a company called Bonafide that has a series of products to help address a lot of these symptoms for women. And these are all non-hormonal options. There's also herbal products which patients can get at, you know, their local Target, Walmart, their Buy the House, or other general health stores that are generally going to be in the women's health section.

And then of course, lifestyle modifications, avoidance of caffeine, working out, having a fan available, personal lubricants, are some examples as well.

Host: Are there special considerations for women who can't or shouldn't take hormone therapy?

Erica C. Contreras, MD, FACOG: Correct. So although hormone therapy works very well, every patient is not a candidate, and that could be because they have a hormone sensitive cancer, such as breast cancer or other cancers. And so you want to avoid these hormones because that could worsen some problems with their preexisting cancer. Also, women who have liver disease, because a lot of these medications are metabolized through the liver.

So we don't want to add any extra stress if there's already a preexisting condition. And then also for women who have a strong history, either family or personal of DVT or pulmonary embolism, because estrogen can increase that risk. So we want to always, you know, risk reduction, do no harm for patients if possible.

Host: Dr. Contreras, if someone is facing surgery that will cause menopause, what should they know ahead of time to prepare physically and mentally for what comes next?

Erica C. Contreras, MD, FACOG: So it's important for that patient to have a open and honest conversation with their provider, to set these expectations. Now, depending on where someone is in their lifecycle, their symptoms might be mild to nothing or they could be more severe. So obviously asking what to expect and your provider should say, you know, potential for hot flashes, vaginal dryness, and often we start patients on therapy shortly after surgery to help mitigate for some of those problems that can occur as a result of menopause.

But the biggest thing is to understand this is a trial process, so there are lots of options. So just because one thing doesn't work, doesn't mean that we can't help to manage those symptoms overall.

Host: What's one piece of advice you would give women to help them feel empowered through this transition?

Erica C. Contreras, MD, FACOG: This is, you know, a new phase of life just like it was for puberty when you were in middle school or high school. It's not the end of the world. It's something that's easily manageable and we can help improve your quality of life.

Host: Very encouraging, good outlook because you can't stop it. Right?

Erica C. Contreras, MD, FACOG: Correct.

Host: Well, thank you so much. This has been really informative. And is there anything else you'd like to add?

Erica C. Contreras, MD, FACOG: Obviously again, if you have questions, talk with your physician. They'll be more than happy to provide you with resources and explanations and other alternatives for treatment so that you can find something that works best for you. Because this is individualized medicine and that's important to understand.

Host: Thank you so much for sharing your expertise.

Erica C. Contreras, MD, FACOG: Thank you for having me.

Host: Again, that's Dr. Erica Contreras. This episode is part of a mini series focused on empowering and educating women about menopause. Listen to more at umms.org/podcast, YouTube or your favorite podcast platform. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.