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Menopause Management

Menopause Is A Treatable Condition!

The definition: “Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period.”

Menopause is a natural biological process, not a medical illness. Unfortunately, there are many physical and emotional symptoms of menopause such as sleep disruption, low energy, irritability and feelings of sadness or loss during this time of hormonal change.

Even though menopause is not a disease, you should never hesitate to seek treatment for mild or severe symptoms. After a thorough evaluation and history, Dr. Ramirez will tailor a treatment protocol specifically to your needs. Many effective treatments are available, from lifestyle adjustments to hormone therapy. With proper care and diagnosis, you will feel MUCH better about yourself and get back to living life with more energy and enthusiasm than before!

Listed below are different ways menopause can manifest itself in a woman’s body.

Total Hysterectomy

A hysterectomy that removes only the uterus but not the ovaries, usually doesn’t cause menopause. But a total hysterectomy which includes removal of both ovaries (bilateral oophorectomy) does cause menopause. The woman’s periods stop immediately and she is likely to have hot flashes. The physician should discuss hormone replacement therapy with you as part of your post-operative care.

Chemotherapy and Radiation Therapy

Unfortunately, certain cancer therapies can induce menopause, causing symptoms such as hot flashes while the patient is being treated or within three to six months. During chemotherapy, women may have irregular menstrual cycles or amenorrhea (disappearance of menstrual periods). Some medications used in chemotherapy may also cause damage to the ovaries, resulting in menopausal symptoms or menopause.  When this occurs, a treatment plan worked out between the gynecologist and the oncologist is highly recommended.

Premature Ovarian Failure

Premature Ovarian Failure (POF) is a loss of ovarian function before the age of 40.  Approximately 1% of the female population is affected by POF at various ages from teenage years to thirties. These women are at a greater risk for osteoporosis, estrogen deficiency (hot flushes, vaginal dryness, etc.) and heart diseases. These issues can usually be managed well with hormone replacement therapy.

Although it is sometimes called early menopause, POF is different from menopause because it is not a result of the natural aging process of a woman. These women may continue to have menstrual cycles, though their cycles will be irregular. In fact, a small percentage of women with POF can conceive naturally.

Perimenopause And Naturally Occuring Menopause

Perimenopause is technically the period immediately preceding menopause. This period of time could be months or years. Some of the symptoms are:

  • Decreased fertility
  • Irregular periods
  • Vaginal dryness
  • Hot Flashes
  • Inability to sleep
  • Weight gain
  • Thinning hair

It is important to keep seeing your doctor for your annual exams at this time. If you are approaching your late 40’s and have concerns please write them down before seeing Dr. Ramirez. You may want to include any of the above symptoms as well as other issues such as abnormal bleeding or pain with intercourse.

Tests and Diagnosis

When a woman comes to Dr. Ramirez complaining of menopausal symptoms, he may check her level of follicle-stimulating hormone (FSH) and estrogen (estradiol) with a blood test. As menopause occurs, FSH levels increase and estradiol levels decrease. He may also recommend a blood test to determine her level of thyroid-stimulating hormone, because hypothyroidism can cause symptoms similar to those of menopause. After taking into account all factors, Dr. Ramirez will tailor a specific plan to not only help alleviate the symptoms of menopause but to also help extend her productive years by improving her overall hormonal health. He will also strongly recommend a good exercise program to help keep weight down and bone density strong.

When patients present in their 40’s with peri-menopausal symptoms of irregular or abnormal periods, insomnia, difficulty concentrating or remembering, mood swings, lack of energy or general lack of well-being, Dr. Ramirez will suggest HRT. Usually, the patient is prescribed a low-dose birth control pill because it has sufficient estrogen and is easy to take. In women who don’t have a uterus (due to hysterectomy) a higher dose estrogen without progesterone is prescribed.

  • Hormone Therapy

Estrogen therapy is by far the most efffective treatment option for relieving menopausal symptoms. Depending on her personal and familuy medical history, estrogen in the lowest dose may be recommended  to provide symptom relief for the patient. Recent research has indicated that it can be very beneficial if taken in the short term at the onset of menopause. Remember, the most healthy, happy and vigorous parts of a women’s life is the pre-menopausal days when estrogen was abundant. When women become menopausal, their health, body and mind begin to deteriorate, as a result of the lack of estrogen. In fact, estrogen is the youth hormone and should be continued for as long as is feasible.

  • Selective Estrogen Receptor Modulators (SERMs)

SERMs are a group of drugs that includes raloxifne (Evista). Evista mimics estrogen’s beneficial effects on bone density in postmenopausal women, without some of the risks associated with estrogen.

  • Vaginal Estrogen

Vaginal dryness is a common perimenopausal and menopausal symptom and can be relieved with the help of estrogen tablets, rings or creams. This treatment releases a small amount of estrogen which is then absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary tract problems.

My Personal Opinion As A Gynecologist Regarding The Women’s Health Initiative (WHI) Study

In 2002, the NIH stunned the country by publishing a study regarding hormone replacement therapy (HRT). This study refuted ALL the previous studies heralding the benefits of HRT, by claiming that it increased the incidents of heart disease and breast cancer. This sensationalized conclusion led millions of women to abandon their HRT, leading to mass suffering among women. The Women’s Health Initiative or WHI of 2002 has since been refuted many, many times and shown to have been flawed in part by focusing on women in their 60’s and 70’s, long after menopause has ceased to be an issue. The beneficial aspects of  hormone replacement therapy or HRT for women in their 50’s were not considered as part of the study.

According to ASRM, the American Society of Reproductive Medicine, when the study was released in 2002,”The public comments were wide ranging, leveling both praise and criticism of the WHI. Most of the critical comments centered on the age of the participants.  Given that the mean age at enrollment was 63, and given that most of the women were not newly menopausal, the value of the study as a primary prevention trial was repeatedly questioned. The second and perhaps harshest criticism centered on the manner in which the initial results were announced and the media coverage that followed.” It was this media coverage that created the most amount of disinformation among women who were approaching their late 40’s and becoming perimenopausal.

The 2012 medical conference of ASRM headlined Dr. Roger Lobo, M.D. as keynote speaker for “Menopause Day”. Research done by Dr. Lobo of New York’s Columbia University has helped to revise the WHI findings and update the guidelines for use of hormone replacement therapy in women 50-59 years of age. In a recent article on MSN Healthy Living, Dr. Lobo explained that there was clear evidence showing that  “…short-term hormone replacement therapy (HRT) can be very beneficial to women who are 50-59 years old.  He concluded HRT is generally safe for most women at the time of menopause. Also, by relieving bothersome menopausal symptoms such as hot flashes and vaginal dryness, Lobo said HRT may improve quality of life and sexuality. It may also help prevent osteoporosis and colon cancer. In women under 60, there is early evidence there is benefit for heart health as well.”

The current thinking is that for healthy women in their 50s — women who have not had breast cancer or a history of blood clots — and have been experiencing the symptoms of menopause for less than 10 years, hormone therapy can be very effective for symptom relief and overall is quite safe. Other recent studies have in fact shown beneficial effects to heart disease and other long term problems, mentioned above, if the replacement starts within 5 years of the onset of menopausal symptoms.  Patients not requiring the progesterone component, because they don’t have a uterus, and who take only estrogen, have been shown to have a decrease in breast cancer incidence.  The media still seems to focus on an anti-HRT program when in fact, medically, the many benefits HRT provides continues to be proven with newer and newer studies.

Internet resources for more information on Menopause:

American Society for Reproductive Medicine topic pages http://www.asrm.org/Topic_Index_Menopause/

Reproductive Facts.Org

The Endocrine Society’s very helpful “Menopause Map” http://www.hormone.org/MenopauseMap/

North American Menopause Society