Transcription:
How to Deal with Menopause Symptoms

Melanie Cole (Host):  Well, it’s not a disease, but it is certainly a condition that every woman is going to go through at some point in her life but what are some of the most common symptoms of menopause?  How do you know that that’s the time that you’re in and what are some potential options for dealing with them?  My guest today is Dr. Joann Pinkerton. She’s board certified in obstetrics and gynecology and she’s the division director of UVA Health Systems Mid-life Health Center and the executive director of the North American Menopause Society. Welcome to the show, Dr. Pinkerton. When do menopause symptoms typically start?  How does a woman know that we’re starting perimenopause and heading towards that change?

Dr. Joann Pinkerton (Guest):  Well, first of all, thank you so much for giving me a chance to talk about something I’m so passionate about which is about menopause and the decisions women get to make as they move through it. Most women start to know that something has changed, their cycles are not coming as regular as they normally do. They might come a little bit closer; they might start to skip; they might be heavy one cycle, light one cycle; or they might start to notice that they’re having a few hot flashes a week before their period, more migraines, more PMS, even to where they start to feel a little road rage or even fatigue a week before their period. But, they will start to notice changes and they may start to have hot flashes or night sweats that occur at night. All of those lead up to an average age of menopause at about 52. So, any time around that sort of 45-55 can be the perimenopause. Menopause is when you’ve had a year without periods which means you can only determine it when you look backwards.

Melanie:  Is there a genetic component to when you’re going to start?  Do you look at your sisters and your mother?

Dr. Pinkerton:  It has been shown that family occurrences of menopause run together. So, if your mother and your sister had an early menopause, you want to be prepared that you might have an early menopause. If they had a late menopause, you might also have a later menopause. There are other things that might affect it. Like, if you smoke, you might have an earlier menopause. Or, if you’ve had an ovary removed or a hysterectomy, you might have an earlier menopause but, in general, you can look to your mother or your sister for a guideline for when you might go through it.  

Melanie:  All of these things you mention Dr. Pinkerton, heavy periods, irregular, maybe road rage or insomnia, hot flashes, any of these things, do women want to do something to alter these or deal with these symptoms or is it something we’re just supposed to settle for and let happen to us?

Dr. Pinkerton:  So, for 75% of women, the hot flashes and night sweats occur, they’re bothersome, they last 30 seconds or maybe their mild. They’re not a major issue. For 25 % of women, they are pretty bad. They might be happening for lasting 10 minutes, eight times a day. They might have soaking sweats where they have to change their sheets or their beds. They might have flooding periods. If you have anything than is more than a minor nuisance, you want to talk about what are your options. For the bleeding, we might use birth control pills around the time of menopause. For somebody with hot flashes, we are going to be thinking about either hormones or non-hormonal options.

Melanie:  Okay. So, the hormonal options:   some women are, you know, for a lot of years now we’ve heard various controversies such as “you’re trading one problem for another,” “you’re increasing your risk of breast cancer but yet helping your bone density,” and “your risk of heart disease goes down.” So, what do you tell women when they ask all these questions about hormone treatment?

Dr. Pinkerton:  Well, what’s really exciting is we are working on our 2016 NAMS Position Statement, so I’ve looked at all the data that’s out there including the study that came out in 2012 that scared us so much. That’s the study that said that hormones cause breast cancer and heart disease and dementia and stroke and blood clots and everybody went off of them.  We’ve learned a lot since then. Now, we know if you’re under 60 or within 10 years of menopause and you’re having moderate to severe bothersome symptoms, that estrogen not only can help your symptoms but it’s probably good for you. It may actually help your heart. It may help your brain and you will have fewer sleep disturbances, your dreaming will come back. So, we can not only improve your hot flashes but we can help your health risks if you’re young and you’re under 60. We also have low doses. We have different ways of giving it. So, if a women has a lot of symptoms, she just needs to sit down with her provider and say, “Here’s my health risks; what can I do?  What’s the safest thing for me?”  But, the mantra that you shouldn’t use hormones is gone and even low dose for only a couple of years might be wrong.  It might be what’s the right dose for you and how long should we be using it for you?  Even women who want to stay on it longer because they keep having hot flashes when they go out or when they try to stop, we may talk about using the hormones even longer for those women.

Melanie:  What are bio-identical hormones?  That’s been thrown around a lot lately, too.

Dr. Pinkerton:  Well, a bio-identical hormone is a marketing term. It really means the hormones that you used to make before menopause. Primarily estradiol and progesterone. What happened when that scary study came out was that everybody said, “Well, FDA approved hormones must be bad so we’ll go get something compounded and that will be safe.”  But, if you remember the 64 deaths from the contaminated intrathecal steroids, compounding is not always safe. There’s a MORE magazine article that showed that compounding had underdosing and overdosing risks. We have many FDA Approved bio-identical hormones which means that they are hormones that are the same that you used to make before menopause and we can give them as a pill, as a patch, a gel, a lotion, lots of creative ways to give you hormones that match what you used to give.

Melanie:  So, speaking about gels and things, women hear about hormones and they mostly think of estrogen and estrogen replacement but there are some other hormones that you’re replacing for us and some of them help with various dry…They have intercourse that could be painful, so what do you do for those and are there certain creams that you can use as opposed to taking an oral steroid, or an oral hormone?

Dr. Pinkerton:   Yes, so we divide the hormone therapy into systemic, which could be oral patch or gel but it’s giving you a systemic level. So, we have to look at risk for your heart and your brain as well as the benefits of helping your hot flashes. For women who have dryness, though,  we have estrogen cream, tablets, and ring that are low dose, go in the vagina, prevent the vaginal dryness, prevent the pain with intercourse without giving you the same systemic risks. In fact, we just went to the FDA, came from UVA and from NAMS to ask them to remove the box warning from these very low dose vaginal products because so little gets into your system that your blood levels are the same as in a normal post-menopausal woman so that you can safely use these products and treat that painful sex. There’s also a new oral, what we call a designer estrogen, it’s called ospemifene or sold as Osphena. It’s an oral tablet that is a combination estrogen/anti-estrogen that actually treats pain with intercourse. So if women are having pain with intercourse please, please come see us. Talk to your doctor, find out what you can do. If the over-the-counter lubricants and moisturizers don’t work, we can use these creams. For women who haven’t had sex for a long time, we can use dilators with the estrogen creams so that for many, many women we can restore a part of their life that they’ve lost.

Melanie:  Okay. So, when we talk about sexual intercourse and things women think, “Oh, I’m in perimenopause. I’m in menopause. I can have sex now I don’t have to worry about finally getting pregnant.”  Is that a myth?

Dr. Pinkerton:  If you are a year without a period and you’re around your 50’s, you don’t have to worry about pregnancy. But, the second highest unintended pregnancy rate is women in their 40’s because you’re cycles are irregular, then you might ovulate when you’re bleeding, you might ovulate early or late, so we actually worry more about pregnancy prevention in the 40’s and for women who are having a late menopause into the 50’s. The oldest spontaneous conceived delivered baby was in Ireland in at age 57. So, if you have a late menopause you might be able to have a late child. So, we have to think about pregnancy.

Melanie:  Wow. So many good things for us to think about. What else do you tell women every day, Dr. Pinkerton about menopause, about this change of life that we’re all going to go through and give us some of your best advice.

Dr. Pinkerton:  Everyone goes through this. This is something that we’re all going through and everybody goes through it a little different and everybody has different health risks. We want to sit down and figure out, what’s your breast cancer risk?  Have you had a mammogram?  Did your mother have breast cancer?  How bad are your symptoms?  We need to think about your bones. Are you taking calcium?  Do you get it in your diet?  Do you drink milk?  Are you taking a calcium supplement that’s got some Vitamin D?  What about avoiding that weight gain?  Menopausal women can gain 12-15 pounds and we don’t want that. We don’t want that extra belly fat. They’ve shown that if you exercise, if you avoid being sedentary, that you can actually make going through menopause better. Your hot flashes will be less intense and your mood will be better. Now we’re looking at are you sleeping?  Do we need treatment for hot flashes?  Are we preventing bone loss?  What about your heart?  How are you doing with your cholesterol?  Are you getting enough aerobic exercise for your cholesterol?  And then, sleep. Women need 7 hours of sleep a night. I don’t know very many women who are getting that much sleep. They’re worried about their kids. They’re worried about their parents. They’re worried about their jobs. It’s hard to fit it all in. There is a lot of evidence that we can help our brains as we age if we not only exercise and eat right, but if we also sleep. I look at menopause as a time to say, “Okay, here are your health risks. Here’s where you’ve gotten off track. What can we do to get you back on track?”  Someone says, “Well, I can’t do an hour of exercise three times a week.”  But, you could do ten minutes three times a day and you could take that extra set of stairs; you could eat a more Mediterranean diet, a more healthy diet; you could work on getting to sleep earlier. If you have significant symptoms, if you’re having really bothersome hot flashes, we can talk about hormone therapy but we’ve also got non-hormonal therapy that can work. We can use cognitive behavioral therapy – things like dream therapy or hypnosis has shown to help hot flashes. Acupuncture helps some women. All of the anti-depressants – a medicine called Gabapentin can help hot flashes. We have so many choices for hormone therapy if people need it that going through menopause ought to be something that you do with your doctor so that you can make the decisions as you go along. You know, you make a birth plan but you know that real life sometimes gets in the way of your birth plan. Same thing for menopause. You can decide how you’re going to handle it and then, you have to wait and see what nature throws at you.

Melanie:  In just the last minute here, why should women come to UVA’s Mid-Life Health Center for their care?

Dr. Pinkerton:  The beauty of our physicians here is that we’re specialists. We’re actually credentialed menopause specialists. We’re very active in our organization called the North American Menopause Society and we believe in looking at women as an individual, looking at health risks, getting tests that we need to do and in helping women navigate this process. If someone wants to navigate it without any medications, we will do our best to help them do that. If people want to navigate with medications, we’ll try to pick and choose the best medicines and also continue following them, help them go off and then watch them as they age. We want those vibrant 90-year-old women who are still serving on boards, who are still active, who are still in great health. Our goal is you go through menopause is to get you set so that’s who you become.

Melanie:  Wow. So beautifully put. Great information, Dr. Pinkerton. Thank you so much clearing so much of that up for us and being with us today. You’re listening to UVA Health Systems Radio. For more information you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.