Mid-Life and Menopause


Mid-Life and Menopause

Menopause is a very normal part of a woman’s life, even though at times, it can seem anything but normal! Symptoms typically begin to show up in your mid-40s. Menopausal symptoms are unique to each woman and because we’re in tune with your needs, we can help you manage the symptoms you’re experiencing.

What is Menopause?

It marks the end of menstruation, when the ovaries stop releasing eggs, whether it happens naturally or because of a hysterectomy or other medical treatment. Natural menopause is gradual and generally happens in three stages:

  • Perimenopause. This starts a few years before menopause. Your ovaries gradually produce less estrogen and in the last 1-2 years, the decrease speeds up. This is when you may have symptoms of menopause. 
  • Menopause. You have your last period at menopause. At this time, your ovaries stop releasing eggs and producing most of their estrogen. Menopause is diagnosed when a woman has gone without a period for 12 consecutive months. This is important because it’s still possible to become pregnant until then. 
  • Post-menopause. During this stage, symptoms like hot flashes ease-up for most women. However, health risks related to the loss of estrogen increase as a woman ages.

Symptoms of Menopause

Most women going through menopause have hot flashes. A hot flash is a sudden feeling of warmth that spreads over the upper body and is often accompanied by blushing and some sweating. They vary in frequency and intensity from mild to severe. Not all women experience all menopausal symptoms. Most women have a combination of symptoms, some of them mild, some more intense. Fewer than 2% of women get symptoms severe enough to interfere with daily activities. Don’t hesitate to talk with us about yours. We can find ways to alleviate them if they become too much of a nuisance or too hard to bear. Common symptoms of menopause include:

  • Hot flashes
  • Irregular or skipped periods
  • Insomnia
  • Mood swings
  • Fatigue
  • Depression
  • Irritability
  • Racing heart
  • Headaches
  • Joint and muscle aches and pains
  • Changes in libido (sex drive)
  • Vaginal dryness
  • Bladder control problems

Premature Menopause

Premature menopause can be the result of genetics, autoimmune disorders, or medical procedures. Other conditions that may cause early menopause:

  • Premature ovarian failure. When the ovaries, for unknown reasons, stop producing eggs, the hormone levels produced by the ovaries drop. When this happens before age 40, it’s considered premature ovarian failure. Premature ovarian failure is not always permanent.
  •  Induced menopause. This happens when the ovaries are surgically removed for medical reasons, such as uterine cancer or endometriosis. It can also happen as a result of damage to the ovaries caused by radiation or chemotherapy. Premature menopause is permanent.

Management and Treatment of Menopause

Sometimes simple steps can alleviate certain symptoms, or at least make you feel more comfortable when they do happen. For example, if you’re prone to hot flashes, try wearing lighter weight clothes or layering your clothes. It’s not always that simple though. Talk with us about your symptoms and how well you’re able to tolerate them. The loss of estrogen associated with menopause has also been linked to a number of health risks that become more common as women age. It’s possible that you might benefit from hormone replacement therapy.

Bio-equivalent Hormone Therapy

We have a safe alternative to synthetic hormones. Bio-equivalent hormone therapy (also known as bio-identical or BHRT) is a natural option that poses decreased risk for drug interactions because it’s not processed through the liver. The dose you receive is created just for you by a compounding pharmacy. The pharmacy forms your special hormone combination into small pellets then sends them to us. We insert your dose through a very small puncture in the fatty part of the hip. The pellets slowly dissolve, steadily and continuously releasing hormones. Results typically last 3-6 months before you need another treatment. If you’re having problems managing the effects of menopause, please be sure to ask us about bio-equivalent hormone therapy.

Hormone Replacement Therapy

Hormone replacement therapy can help relieve the symptoms of perimenopause and menopause. It usually involves taking estrogen, and sometimes progestin as well, to replace the fluctuating levels or lost production of your body’s hormones.

  • Estrogen is a hormone produced in the ovaries. If you don’t have a uterus, you may be prescribed estrogen-only therapy. Estrogen-only increases the risk of endometrial cancer.
  • Progesterone is a hormone produced in the ovaries that prepares the lining of the uterus for pregnancy.
  • Progestin is a synthetic form of progesterone. Estrogen plus progestin is sometimes called “combined hormone therapy.”
  • Testosterone is called the “male” hormone. Women’s ovaries and adrenal glands produce small amounts of testosterone but production peaks in women at about age 20 then slowly declines. Testosterone isn’t approved by the FDA for women but can be prescribed in a compounded formula in the form of methylestosterone, a product that’s sometimes prescribed to improve sex drive and energy levels, and reduce fatigue in menopausal women.

The hormones used in replacement therapy can be released in your body in several forms, including pills, skin patches, gels and sprays, and vaginal rings and intrauterine devices (IUDs). Other options provide symptom relief and include products such as lubricants and moisturizers. Please feel free to talk with us about these options.

Benefits vs Risks

Hormone therapy has benefits and risks. Since hormones impact other aspects of your health, we must weigh the benefits and risks each form of therapy poses for you. What works for your best friend, might not work for you. How much you take and for how long depends on many factors. Usually, you start with the lowest dose for the shortest amount of time. Your treatment must be monitored carefully so be prepared to discuss it during your annual visit. And, please keep us informed at all times of any changes in your health that might require a change in therapy.

Over-the-Counter Products

A number of products are sold over the counter that claim to treat menopause symptoms. Usually these are herbal supplements, teas, creams, and oils. Please talk with us before trying them. They can pose risks to your health and cause drug interactions and side effects. Vaginal moisturizers and lubricants can be purchased without a prescription and are highly effective in alleviating dryness and pain. Many types are available and safe to use. We’re happy to make recommendations. Note, these products are not contraceptive; and oil-based lubricants should not be used with condoms, they can dissolve the latex and cause breakage.

Prescription Therapy and Medication

Low-dose birth control pills may be prescribed to help relieve symptoms during perimenopause. Prescription hormone therapy might be another option for you. It comes in the form of pills, skin patches, and other methods such as an IUD. Patches work by releasing hormones through the skin. You place a small patch on the skin near the ovaries and change it weekly. An anti-depressant or anti-anxiety medication may be considered to help mood-related problems. There are also prescription creams available to help with vaginal dryness. Talk with us and together we’ll decide what’s safest and right for you.

Long-Term Health Risks Associated With Menopause

The loss of estrogen associated with menopause has been linked to a number of health problems. Osteoporosis is a very common risk because bone loses density naturally as we age; the loss of beneficial hormones during menopause hastens it. You’ll need periodic bone density exams and may need medication. In addition to osteoporosis, post-menopausal women are more prone to:

  • Heart disease.
  • Bladder and bowel problems.
  • Decreased brain function (increased risk of Alzheimer’s disease).
  • Loss of skin elasticity (increased wrinkling).
  • Decline in muscle power and tone.
  • Some deterioration in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration (breakdown of the tiny spot in the center of the retina that’s the center of vision).

Pelvic Organ or Bladder Prolapse

After menopause, it’s not unusual for a woman to experience prolapse of the pelvic organs or bladder. Prolapse is when the organ drops from its usual place. Symptoms can be mild or severe and cause a number of problems, including bladder and bowel problems. If prolapse is mild, it might not require treatment. If you have problems, there are non-surgical and surgical treatments available. Non-surgical options include the pessary, a device that’s inserted vaginally to support the pelvic organs. Kegel exercises may be recommended to strengthen surrounding muscles. Surgical options include attaching a mesh holder, or stitching to put organs in place.

Urinary Incontinence

Often called overactive bladder, urinary incontinence often occurs in menopause. Women experience a small amount of urine leakage, often when you sneeze or laugh. Frequent urination is also a symptom of an overactive bladder. If leakage is infrequent, the use of panty liners may be sufficient. There are treatment options available including physical therapy, & in office procedures that might be right for you. Talk with your doctor or nurse practitioner about the options available to you. Surgery may be option if you are unhappy with other options. Be assured, it’s a common problem and one you don’t have to live with. Talk with us about it.

Mid-Life Health

Many women enjoy a sense of freedom after menopause. Embrace ageing! Stay healthy and “up your game” with these healthy habits:

  • Enjoy a balanced diet but be sure to eat more foods rich in calcium and vitamin D such as milk, salmon, and dark leafy green vegetables.
  • Eliminate or limit salt and processed sugar intake.
  • Exercise regularly. Walking is a great activity that’s also good for bone health. Water aerobics and swimming are good options for women with arthritis.
  • Stay socially active to fend off depression.
  • Keep your mind active–read, do puzzles, draw, paint, try a new craft.
  • If you drink alcohol, limit the amount you drink. If you don’t drink, don’t start.
  • Don’t smoke. If you smoke, stop.
  • Get your regular medical, vision, and dental exams, and if you see a specialist, don’t skip those appointments.
  • Take medications as prescribed, don’t cut pills or stop taking medications without talking to your physician. Be sure to keep your health records current.