All of a sudden, you’re in a hormonal minefield, dealing with a host of menopausal symptoms you never had before. Whether you’re 40 or 50, these signs of perimenopause can be uncomfortable, to say the least. Judith Reichman, M.D., a respected Beverly Hills ob-gyn and author of several women’s health handbooks, shares what you can do to get through the change…
Insomnia, night sweats, agitation and hot flashes: Classic menopausal symptoms can actually start long before the big change – and when you least expect them.
Besides the annoying signs of perimenopause, or the stage before your last period, women can look forward to these other conditions: Low or no sex drive, incontinence, overactive bladder and hormone imbalance – just to name a few.
With all the information out there, it’s hard to know how to navigate your health vs. comfort.
What can you treat and what should you suffer through?
Can you safely use hormone replacement therapy to lessen menopausal symptoms?How do you sift through the volumes of explanations, home remedies and medical advice to find exactly what to do?
Beverly Hills ob-gyn, Judith Reichman, M.D., author of Not in the Mood: What Every Woman Should Know About Improving Her Libido (Harper Paperbacks), answers our questions and offers the facts, warning signs and available treatments.
Do hot flashes last forever?
Most women stop having hot flashes within 2-5 years [after going through menopause]. Fifteen percent of women will have them for the rest of their lives.
I start a patient on hormone replacement therapy and when she says, “How long should I take it? Should I stop?” I say, “You can stop and there are studies that show stopping cold turkey or stopping with diminished doses doesn’t really make a difference [how the hormone leaves your body]. But we’ll see what happens to your menopausal symptoms.”
What are some signs of perimenopause?
The patient will say, “One day, I’m having hot flashes, the next day, my breasts hurt.”
Or “I had a period, then I didn’t have it for two months,” as well as, “I just feel like someone took over my body and I’m not in control anymore. What are you going to do?”
I call it a dress rehearsal for menopause.
Do menopausal symptoms change?
If my patient is very symptomatic, she’ll have hot flashes, night sweats, can’t sleep, mood changes, and some patients even say their cognition changes.
They also complain that it hurts when they have sex and they have no sex drive.
Every symptom that occurs to a woman over the age of 50 is attributed to hormones, whether that’s true or not.
So, a hormone discussion is extremely important for the post-menopausal woman.
Having said that, that’s not her only health issue.
Which tests should women with menopausal symptoms get?
Women over 50 should be having mammograms – and yearly.
They should definitely be having their cholesterol checked and pelvic exams too.
I check something called hemoglobin A1C. That’s the tattletale blood test to see if blood sugars have been elevated in the last three months.
If patients are at a high risk to develop diabetes, I look at their weight. We discuss diet and exercise.
There’s something called “successful survival.” It means you’ve reached 70 and you don’t have any major diseases. The best way to get there is exercise. We go over that.
Also, if women aren’t going on hormones or if they’re at risk for osteoporosis, I want them to get a bone density scan – and I yell at them if they haven’t gotten a colonoscopy.
I tell patients it’s more important to get a colonoscopy than to see me. I also check to see if they have elevated inflammatory levels.
When should a woman consider hormone replacement therapy?
Anyone who goes through a very early menopause should go on hormones – unless she has some major contraindication.
With very early menopause, before 40 or some say 45, if she doesn’t take hormone replacement therapy, she’s at higher risk for coronary vascular disease, osteoporosis and earlier dementia.
Whether the early menopause is natural or because she had surgery or radiation, there’s no question a young woman should be treated.
When is hormone replacement therapy risky?
The real issues come when you’re 51, the average age of menopause.
Your periods stop and then I ask, “Are you having menopausal symptoms or not?”
For a woman who is significantly symptomatic – she’s shvitzing, can’t concentrate or sleep – the general consensus is if she doesn’t have a history of breast cancer, clotting problems or a cancer that had anything to do with estrogen, the pros of taking hormone replacement therapy in the first few years outweigh the cons.
What problems can arise from extended hormone replacement therapy?
Continuing it long term increases your risk for breast cancer, especially if [the patient is] taking estrogen and progesterone, because she still has a uterus.
If she’s on estrogen only because she’s had a hysterectomy – and they do 600,000 of these every year – then she only needs estrogen. Then the risk for breast cancer isn’t quite as high.
Hormone replacement therapy scares a lot of women. Why?
The Women’s Health Initiative (WHI) study that came out a number of years ago really scared a lot of women.
The study was on Prempro. They had about 25,000 women, half on and half off, and they found an increased risk in breast cancer.
Actually, the study was meant to see if it diminished coronary vascular disease.
It didn’t, but it did decrease fracture rates and reduced colon cancer.
Was it a realistic study?
The problem with that study is they wanted women who didn’t have menopausal symptoms. If you’re doing a double-blind study, then you can’t have the patient or the doctor know if you’re on a placebo or the tested medication.But if you have a woman with terrible hot flashes, night sweats and sleep disorders, she’s going to know whether you’re giving her estrogen or not.
She’s either going to feel better or not.
That meant that they were taking mostly women who were older, who had gone through menopause who were 10-15 years post-menopausal.
The average age [of the women] they checked was early 60s.
How would that influence the data?
The question becomes – is what they found in these older women applicable to a woman who’s 51?
The last few years has been devoted to arguing over that – and it’s not.
The thought is today that in the early years of menopause, hormones can be very efficacious. But, we don’t want to take a woman without menopausal symptoms in her 60s and give her hormones.
Statistically, how do patients do when they quit hormones?
For a woman who had serious menopausal symptoms before she started, chances are they’ll recur when she stops.
If she says, “What should I do?” I say, “Always go to the lowest dose that helps you and know that, at some point, if you continue taking hormones, you are making a quality-of-life decision vs. risk.”
We make that quality-of-life decision every time we go on the freeway, every time we don’t exercise, every time we have that extra sundae.
Life is full of quality-of-life vs.-risk decisions. This is one of them.
Sounds like we should be paying attention to our insides much more as we age?
You need to get your skin checked once or twice a year for pre-cancer and cancer.
You also need to get your eyes checked and teeth cleaned. And all that’s aside from getting your roots done.
Thanks for stopping by our post about Curbing Menopausal Symptoms, please come back as we update daily with new articles, videos, and blog listings.
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