Maggie McKay (Host): Women's bodies go through a lot of changes in their lifetime, and menopause is just one of them. But these days it's not your mother's menopause, as our guest today, Dr. Oscarina Contin-Mendoza, Gynecologist at Valley Health System will discuss. Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey.

Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay. Thank you so much for making the time to be with us today, Dr. Contin-Mendoza. Let's start at the beginning. At what age does menopause occur?

Oscarina Contin-Mendoza, MD: Thank you for inviting me. It is my pleasure to answer any questions that you have. Usually menopause starts around 51 years old. It can start few years before or few years after.

Host: And can someone get pregnant once they're in menopause?

Oscarina Contin-Mendoza, MD: No. Once menopause has ocurred, the ovarian function decreases, hormone imbalance happens, so it's very, very unlikely that you will get pregnant after menopause.

Host: And what about hot flashes, the dreaded hot flashes? What can we do about them?

Oscarina Contin-Mendoza, MD: Interesting question. So for hot flashes, we have couple of options. Option number one will be environmental changes and behavioral changes including light clothes, opening the windows, using air conditioner, cold drinks. If this doesn't work, then we can jump to medical management and that we have couple of options as well.

Host: Are there natural or herbal therapies maybe for hot flashes and menopause symptoms in general?

Oscarina Contin-Mendoza, MD: The most effective treatment for menopause is actually hormonal therapy, so it is the most effective. That would include estrogen if no contraindications is fine, and progesterone. And also other medical management that are not hormones. In terms of herbal remedies, there are a couple of options that include soy, black cohosh, red clover, acupuncture. However, data has not been shown benefits when compared with placebo.

Host: And how can one decipher gimmicks versus true symptom relievers?

Oscarina Contin-Mendoza, MD: Sure. We counsel, the patients first of all, what is the goal of the patient? We have to be realistic. Most of the treatment, including medical management or herbal remedies, are not going to make all the symptoms disappear, but will improve it and decrease.

So even if the patient is taking a placebo, if the patient has the perception that she feels better and has less frequent of the hot flashes, then that is okay. So all this is based on the patient's feeling a perception of improvement.

Host: And how important is diet? Does it make a difference when it comes to menopause?

Oscarina Contin-Mendoza, MD: Well, diet directly does not interfere with menopause itself. However, body weight may interfere with the age that you may reach menopause and menopausal symptoms. So patients that are more on the overweight or patients that have obesity, sometimes may develop menopause later on in their lifetime.

Host: And what are the most common symptoms of menopause?

Oscarina Contin-Mendoza, MD: The most common symptoms is vasomotor symptoms, which are actually the hot flashes that we were discussing before. And the second most common is genitourinary symptoms of menopause and previously called vaginal dryness or vaginal atrophy.

Host: And Dr. Contin-Mendoza, what are some of the less common symptoms of menopause that people may not know are part of menopause?

Oscarina Contin-Mendoza, MD: Some symptoms could include mood swings, painful intercourse or what we call dyspareunia, and also decreased libido, which is directly related to the painful during intercourse.

Host: What about irregular periods and excessive bleeding? Is that worrisome or normal?

Oscarina Contin-Mendoza, MD: No. It's usual, however, we want to make sure when the patient is already postmenopausal, they shouldn't develop any postmenopausal bleeding. So first, let me clarify something. Menopause is when the patient has 12 months completed with amenorrhea. So not seeing her cycle for a year completed. After that, we don't expect to see any bleeding. In that case, we need to rule out immediately any malignancy.

Host: And if you're having sex and it's uncomfortable, is that because of menopause and why?

Oscarina Contin-Mendoza, MD: There are multiple reasons why sex can be painful. One of the things that we want to rule out is an infection, which also could happen in postmenopausal patients or any other kind of vaginitis. However, painful intercourse or dyspareunia, it is common postmenopausal, not because of menopause itself, but because some patients may develop vaginal dryness, so after intercourse, that area may become irritated and sore.

Host: And what's the best natural remedy for vaginal dryness? You were talking about that a little bit, but what if someone wanted to take a natural remedy?

Oscarina Contin-Mendoza, MD: So that's the first line treatment. Actually, I wouldn't call it natural remedies, but non- hormonal remedies. So the first line is actually water-based lubricants. It could be silicone-based lubricants. Sometimes we can use coconut oil and as well we can use other lubrications in the area that may help the patient for smoother intercourse.

Host: Are gynecology visits necessary after menopause?

Oscarina Contin-Mendoza, MD: Yes, it's actually very important. Routine GYN visits are recommended every year, so even if the patients is not seeing her cycle at this point, it's important that we screen for postmenopausal bleeding. We do the pelvic exam, we assess the adnexa next of the patient. Still the patient will need their breast examination every year, and this is a great opportunity to reassess any concerns or any possible management that the patient will need based on the symptoms.

Host: And let's say your symptoms have subsided a little bit, does that mean menopause is over?

Oscarina Contin-Mendoza, MD: No. So once menopause is a shift, no, it is not reversible. You cannot go back to premenopausal state. Symptoms may improve five to 10 years after menopause. However, that doesn't mean that menopause has passed or had succeeded at that point.

Host: So once you're in menopause, that's it for life.

Oscarina Contin-Mendoza, MD: That's it. Menopause is not seeing the cycle after 12 months, so there is no such a thing of seeing the cycle after that. So by definition, this is irreversible, and if you have any bleeding, then that's abnormal. Then we would like to see you.

Host: And what are the updated recommendations about hormone replacement therapy? Do they cause cancer? Are they dangerous to one's health?

Oscarina Contin-Mendoza, MD: Very important question. So, hormone replacement therapy, it is a great option. It's the option number one in patients that have postmenopausal symptoms. However, like any other medical management, we need to rule out contraindications. So few of the contraindications will be does the patient has history of myocardial infarction, does the patient had a stroke, liver disease, breast cancer.

So we take all these in consideration before starting hormone replacement therapy. However, does that directly cause cancer? There is a link out there, especially when this is provided with progesterone as well, which we have to sometimes in patients that have a uterus, but the fact that you take estrogen itself doesn't mean that you are going to develop cancer if you don't have any risk factors. And we discuss this with the patient. We do encourage the patient to start with hormone replacement therapy.

Host: And Dr. Contin-Mendoza, does menopause make a difference for hormones or health risks in women who have not had children versus women who have had kids?

Oscarina Contin-Mendoza, MD: Well, parity is not taken into consideration when we are electing good candidates for hormonal replacement therapy. However, patients that don't have kids itself being menopause or not menopause, it does increase the risk of other cancer like ovarian cancer. So we have to take that in consideration. However, there is no contraindication for hormone replacement therapy, depending on the parity of the patient at all.

Host: And if someone takes birth control for other reasons like migraines or cysts or whatever it is, what happens during menopause?

Oscarina Contin-Mendoza, MD: Actually, it may improve symptoms of menopause. You may see less postmenopausal symptoms that we described before. Less hot flashes, less vaginal dryness because oral contraceptive pills have hormones. They are different doses though. The doses are very different, but pills have estrogen and progesterone, which are the medications that we use to treat postmenopausal symptoms. So that may help during menopause.

Host: That's good news, right? We got to get some good news out of this. What is perimenopause and how long does that last?

Oscarina Contin-Mendoza, MD: So perimenopause is the period before menopause. So once the patient, the ovarian function starts declining and your cycle start getting lighter or escaping some months of cycle means that you are getting into menopause. It may vary, but the median time is around five years. Varies in length of the cycle. The patient may notice skipping cycles and longer interval until the patient developed an amenorrhea, which is competed a year without cycle then, now the patient passed from perimenopause to postmenopause or menopause.

Host: And so is it possible to get pregnant during perimenopause?

Oscarina Contin-Mendoza, MD: Yes, it is possible because at this point you are inconsistently having unscheduled ovulation, so you need to ovulate here and there to get pregnant. It won't be consistent every month, like a patient 25 years old, but it will happen every so often, and that's what causes the periods to be irregular because you have irregular ovulation. So yes, it could happen during perimenopause.

Host: Is discharge after menopause normal.

Oscarina Contin-Mendoza, MD: Some vaginal discharge, postmenopausal patient yellowish. It is expected to be seen. However, if this discharge is causing any other symptoms, irritation, some abnormal odor, some itching in the area, then this is not a physiologic discharge. But in patients that have vaginal atrophy, this happens very, very common.

Host: How does menopause affect someone's mood or mental health? Does it make you cranky?

Oscarina Contin-Mendoza, MD: It does, it does. So mood changes may appear in menopause. Increase the risk of depression during menopausal transition, especially in patients that have already a background history of depression or other mood disorders.

Host: What other systems in the body does menopause affect, like cardiac, neurology, et cetera?

Oscarina Contin-Mendoza, MD: There are symptoms that it may affect your joints. It may cause a sleep disturbance, it may cause breast pain. And all this is usually happen early in the menopause due to that decrease of estrogen. Also a sleep disturbance. It's not directly menopause itself, but related with the symptoms surrounding the menopause, like hot flashes.

So a lot of patients having hot flashes, sweats during the nighttime have to wake up multiple times a day due to the hot flashes. Then all this interfere. Also that are cardiovascular disease out there. Increase the risk of hyperlipidemia, osteoporosis. Skin changes, maybe more related with age, but of course plus menopause more than 51 years old, so less collagen. You can see some skin changes as well.

Host: Is there anything else you'd like to add in closing?

Oscarina Contin-Mendoza, MD: So uh, menopause itself, the diagnosis has been the same. There is no changes. However, we want to encourage patients that have any post menopausal symptoms, you don't have to wait it out. You don't have to suffer. You can reach us and we will guide you through the process. We will like to start maybe with some behavioral modification, maybe the patient don't need medical management, and then we will guide the process through the patient.

We will screen who is a better candidate for hormones, so maybe not a good candidate and we can help the patient to feel better and pass through all these difficult times. But there is hope. There is treatment and there are multiple options, so we are happy to help any patients that is going through this.

Host: That's all good news. Thank you so much for sharing your expertise on menopause with us. It was really educational and informative. I learned a lot, and I'm sure our listeners did as well.

Oscarina Contin-Mendoza, MD: It is my pleasure to share any information with you. Thank you for inviting me.

Host: Absolutely. Again, that was Dr. Oscarina Contin-Mendoza. For more information about obstetrics and gynecology at Valley, please visit valleyhealth.com/obgyn or call 1-800Valley1, 1-800-825-5391 to schedule an appointment. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. Thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. You can also find more information on today's topic or be connected with today's guest by calling 201-291-6090 or you can email Valley podcast at valleyhealth.com.