I had a great time launching our House Call with Dr. Lady Doctor web series* at BlogHer18 a few weeks ago. A particular highlight was hearing from women across the country about what topics in women's health they wanted me to tackle next. Without a doubt, the most popular answer was MENOPAUSE! So, to get us started, here are 5 common questions and answers about menopause.
1) What is menopause? The medical definition of menopause is 12 months without a period. This is caused by the ovaries no longer producing an egg each month (which is the trigger for a regular menstrual cycle - check out my previous post on this if you need a refresher!). The problem with this definition is you don't know if you're in menopause until a full year has gone by! Testing for menopause is challenging because of fluctuations of hormones during this time but your doctor can check your hormone levels including FSH and LH which are produced in your brain and regulate ovulation. A single test doesn't unfortunately guarantee you are definitely in menopause but can be a clue to the diagnosis.
2) When do most women experience menopause? The average age of menopause is 52. But that is just an average. Some women experience menopause as early as 40 or as late as 56 or even older. "Menopause" before age 40 is a different condition called Premature Ovarian Insufficiency (POI) or Premature Ovarian Failure and is a cause of infertility.
3) Could XX be a sign of menopause? But I'm too young!! Peri-menopause is the period of time before menopause when women have symptoms including hot flashes, night sweats, irregular periods/bleeding including possibly heavier/longer periods, mood changes, vaginal dryness, decreased metabolism/weight gain (especially around the belly). These symptoms can start up to 10 years before menopause!
4) What can I do to treat these symptoms/feel better? Treatment for peri-menopausal symptoms depend on the symptoms themselves. Traditional treatments have included supplemental estrogen and/or progesterone - usually referred to as Hormone Therapy or HT. Other drug treatment options include certain anti-depressant medications (SSRIs) which have been shown to improve hot flashes, even if depression is not present though they will help with this as well). Behavioral therapies such as improved sleep hygiene for insomnia, avoidance of triggers and utilizing cooling measures (such as cold packs/fans) for hot flashes and even hypnosis can also provide benefit. It is estimated that 50-75% of peri- or post-menopausal women use alternative and complementary therapies such as herbal remedies to treat menopausal symptoms. Most alternative therapies unfortunately do not have a lot of evidence to support them but I personally know women who have benefited from some of them such as Black Cohosh, Evening Primrose Oil, soy or acupuncture. You should definitely let your doctor know if you are using any alternative or over the counter products in case they might interfere with any medications you are taking or complicate any existing medical problems.
5) Do I still need to use birth control - even if I'm not having regular periods? Though there aren't data on unintended pregnancy in women over 45, of the pregnancies among women aged 40-44 in the US, 48% are unintended. Contraception remains important for women who do not want to become pregnant in their 40s or 50s as although fertility declines significantly during this time period, the risks of pregnancy increase when a woman does become pregnant. Most contraceptive methods can be used safely by women in their 40s and 50s as long as they don't have medical conditions and don't smoke. It is important to note that the doses of HT used to treat menopausal symptoms are MUCH lower than those used for contraception and HT is not effective as birth control.
*Web series to be distributed online soon! Stay tuned!!