What You Need to Know About Menopause

Today we have a post from our guest blogger, Courtney A. Seacat, M.D., who is an OB/GYN physician. She practices at INTEGRIS Women's Health Edmond. Dr. Seacat received her medical degree from the University of Kansas School of Medicine in Kansas City and completed her residency at the University of Oklahoma. Her special interests include prenatal care, birth plans, preventive health care, general gynecology, teen health and contraception counseling. She can be reached at 405-657-3825.

Hi everyone. I’m Dr. Seacat. I’m here to talk about “the change” – something that half the world’s population will experience at some point. Yes, I’d like to discuss the sometimes-dreaded menopause with all of you. It’s that time in all women’s lives when their menstrual periods stop permanently and they stop being able to have children.

On average women hit menopause at 51, but it can actually happen to women any time, from their 30s to their mid-50s or later. Women who smoke and are underweight tend to experience an earlier menopause, while women who are overweight often experience a later menopause. Generally, a woman tends to experience menopause at about the same age as her mother did. Here I will try to answer some of your most common questions.

Is it hot in here or is it me?

Many women dread menopause because of the pesky symptoms coming with it that can cause significant disruptions in day-to-day life. Some of the most frequent and stressful ones include hot flashes and night sweats, pain during intercourse, vaginal dryness, heart palpitations, urinary incontinence, irritability, increase in facial hair growth and thinning hair on the scalp.

Not every woman feels the bothersome effects of menopause. Studies report that 30 percent of women don’t report significant symptoms, but that means 70 percent do, and if you are in that 70 percent you probably have questions about how to curb those symptoms if possible.

So, what is menopause all about?

Basically, menopause means your ovaries stop producing estrogen (the girly hormone). This leads to the end of your periods (yay!) and the beginning of the aforementioned hot flashes, irritability and vaginal dryness (boo!). Besides these symptoms, menopause leads to an increase in bone loss, which can lead to osteoporosis (osteoporosis means the bones get thinner and can break easier).

What can I do to help symptoms?

In a nutshell, here are your options:

1. Do nothing and tough it out.
2. Try lifestyle changes to help with hot flashes. These include avoiding things that can worsen hot flashes (such as alcohol, hot beverages, caffeine and hot/spicy foods) and dressing in layers that you can you remove when a hot flash begins.
3. Start taking herbal supplements such as ginseng and black cohosh. These have not been 100 percent proven to help and are not FDA regulated, but some women do feel the benefits. If you have any medical problems, make sure to ask your doctor before taking these.
4. Start taking an antidepressant (aka an SSRI) such as Paxil (Paroxetine), which has been FDA approved to help with hot flashes. There is another medication called Brisdelle that is basically the same as Paroxetine, but made just for hot flashes instead of depression symptoms.
5. Try an over-the-counter lubricant like K-Y Jelly that can help with vaginal dryness during intercourse.
6. Topical estrogen cream can help immensely with vaginal dryness and may have decreased risks compared to oral estrogen (see number 7) because it is more localized to just the vaginal area.
7. Start taking estrogen, aka hormone replacement therapy. Out of all the options I’ve listed, this is the most likely to help with menopause symptoms, but it is also controversial because it has the most possible risks.

What are the risks and benefits of hormone replacement therapy?

To learn more about women’s health, the National Institutes of Health did a study called the Women’s Health Initiative, beginning in 1991, that involved more than 160,000 postmenopausal women. This study is where we in the medical community get most of our information about the risks and benefits of hormone therapy.

Here are the findings: if you have a uterus (meaning you haven’t undergone a hysterectomy) your hormone replacement therapy (estrogen) will need to include a hormone called progesterone as well as estrogen to help protect your uterus. If we just give you estrogen, it can cause abnormal cells to develop in the uterus and lead to uterine cancer.

More results from the study:

1. Estrogen-plus-progestin (progestin is a synthetic version of progesterone) combination therapy can increase the risk of breast cancer and heart disease (blood clots, strokes and heart attacks).
2. Estrogen-plus-progestin therapy can decrease the risk of colon cancer and osteoporosis.
3. However, hormone therapy should not be used solely to prevent osteoporosis. The risks outweigh the benefits.
4. Estrogen alone does not seem to increase risks of breast cancer, but may increase risk of heart disease.

So, what’s your final recommendation?

Hormone replacement therapy should be used at the lowest doses tolerated, for the shortest period of time needed, to achieve treatment goals. Postmenopausal women who are considering the therapy need to talk about the risks and benefits with their doctor. Every woman is different, and this is an individual decision you need to make in consultation with your physician.