Whoa, It is HOT today!

I am hot and sticky today because it is 98 degrees outside. Many of you feel like this all year round because the thermostat both outside and inside can be boiling without notice. Reminds me of one of my patients, Sue. Could you be Sue too?

One afternoon Sue trudged into my office, slumped down in a chair and weakly exclaimed, “I think that I need my hormones checked.” When I asked her why, she replied,  “I am just such a mess. I never know when my period is going to come. Sometimes it’s every two weeks, and sometimes I skip months.  At times I will find myself wide-awake in the middle of the night for no reason at all.  And I’m always hotter than everyone around me. I feel like someone has selectively turned up the thermostat in my world.  In addition, sex has become a much less comfortable experience.  I don’t create any natural moisture, which makes sex much less pleasurable.  On top of that, I really have no sexual desire at all.  In short, I’m hot, dry and neutered!  What is happening to me?

Well Sue, welcome to the wonderful world of menopause and perimenopause.

The most challenging part of the process is not knowing:  not knowing if its normal, not knowing how long it will last, not knowing what system will go haywire next, and not knowing what to do about it.  Well, we certainly don’t have all the answers about menopause, and each woman’s journey can be very different.  However, here are a few things we do know.

Menopause, by definition, is when you’ve stopped having your period for twelve consecutive months.  Unfortunately, by the time a woman’s periods have ceased, she has already been through the hell of perimenopause that Sue described.  Perimenopause is often far more difficult than menopause itself. The books will tell you that perimenopause starts for most women 2-5 years before menopause.  Since the average age of menopause is 51 years of age, that would be in the late 40’s. However, I have found that the majority of my patients in their early 40’s are experiencing symptoms of perimenopause and some may start in their late 30s.

Perimenopause may begin as what appears to be increasing moodiness and irritability or our faithful friend PMS seems to hang around a lot longer. Perimenopause is also accompanied by erratic periods, some of which can be quite heavy. Never knowing when, where or how much you will bleed can be exasperating and certainly decrease desire. The ovaries also start to wind down in a sporadic manner producing normal estrogen one month and low levels the next. Low levels of estrogen account for most of the symptoms of menopause. These symptoms include hot flashes, night sweats, insomnia, vaginal dryness, decrease in the blood supply to the vagina and thinning of the vaginal mucosa or tissue. Lovely. Isn’t it great to be a woman?  You don’t even want to be in your body, let alone have sex with it.

First, Is this normal??..YES! So many women are still not getting the message that all of these changes can be a part of the normal transition. You are not crazy and this is not all in your head.

What can I do about it? A lot actually.

The first remedy is lifestyle changes. Your body is telling you, “If you keep putting crap in, you’ll get crap out.”

Quitting smoking, decreasing alcohol consumption and increasing exercise are keys to health. Vitamins, good nutrition and limiting caffeine are critical and really can make a huge difference.

Chart your bleeding pattern and discuss it with your doctor. Some women who are in perimenopause greatly benefit from a low dose oral contraceptive. Yes, you can take oral contraceptives over age 35, up to about age 55, if you don’t smoke. That is a good thing because you can still get pregnant in your 40s. There are plenty of women who thought they were going through the change only to find the BIG CHANGE of pregnancy. Even if you know that you can’t get pregnant, the pill can help regulate the bleeding and hot flashes. (Warning, in addition to causing bloodclots and certain cancers, contraception may decrease sex drive..for others it increases it, so talk to your doctor.)

Pelvic floor exercises like Kegels are essential.  Many women groan when I tell them to do them but they are actually more important now than ever.  Urinary incontinence is a growing problem with age and many women are sexually inhibited because they are afraid that they will be incontinent during intercourse. Those squeezing exercises will not only prevent urinary leakage but also intensify orgasm.

Speaking of orgasm, don’t be embarrassed, use a lubricant. They make a world of difference. Astroglide is one of my favs. Watch out for any lubricant that contains menthol or any warmth or tingle. They can really cause a burning ring of fire especially if you have low estrogen to begin with.

Supplements can help some women but often are not enough.

Soy is one supplement that some women do have success with. Mild hot flashes can be alleviated with 40g/day. That’s a lot more soy than is in the American diet. Roughly it translates into ½ cup soy nuts, ½ cup edamame, 2 glasses soy milk, 1/3 brick of tofu but check labels to be sure.

Flax, 1-2 T ground seeds have Phytoestrogens called lignans, have helped some women. Keep them in the fridge. You also have to be careful because they do have about 200 calories per serving.

Vitamin E 800 IU helps with hot flashes and breast tenderness for some women

Black Cohosh, 20 mg, 2xs/day for hot flashes can also be of benefit.

Many swear by Red Clover but it is NOT shown to help hot flashes.

The most controversial treatment for menopause is hormone therapy (HT). HT can be a combination of estrogen alone, estrogen with progesterone or progesterone alone. Within each group there are a variety of types of estrogens and progesterones.  There are a multitude of delivery systems for HT, including pills, patches, creams and vaginal rings. It can be given to the whole body or just to the vaginal area. All of these possibilities can be very confusing and it can be difficult to determine which regiment is right for each woman. I will discuss in future posts which women may benefit from which regiment.  There are numerous misconceptions and fears about HT and I will review some of the key studies that have shaped our opinions about it. Many women are interested in” natural hormones” thinking that they are safer but I will also discuss what we know and don’t know about them.

That is the quick and dirty on Menopause. I’ll be talking a lot more about it so don’t hesitate to ask me a question.

Dr Deb