Menopause is a time of change that may not be simple, but doesn’t have to be hard! Whether you are trying to make sense of your symptoms or you want to learn what may lie ahead, we can help.
Listen in as Laura Flanagan, MD discusses strategies to help you manage the symptoms of menopause and to share tips to make this exciting change more bearable.
Menopause: No Need To Sweat it!
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 9/4/17
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Menopause is a time of change that may not be simple, but doesn’t have to be hard. Whether you are trying to make sense of your symptoms or you want to learn what may lie ahead; we can help. My guest today is, Dr. Laura Flanagan. She is a Board-Certified Family Physician at Stoughton Hospital. Welcome to the show Dr. Flanagan. So, give us a working definition of perimenopause and then into full blown menopause. How do we know when it’s happening?
Dr. Laura Flanagan, MD (Guest): Yeah, so menopause is actually defined as cessation of menses for 12 months. So, if you haven’t had a period or any bleeding for a full 12 months; you are considered menopausal. Perimenopause is any symptoms, cluster of symptoms prior to menopause. I have been in preparing for discussions about menopause and seeing multiple patients that are in the throes of menopause; I have kind of looked for less classic definitions and the research that I found, I like this quote and this is from a book called “Shmirshky: The Pursuit of Hormone Happiness” and she describes menopause as this. “It’s your brain, your body and your life transforming into something you are totally unfamiliar with. You begin to question your sanity, relationships, hormones, genetics, sex drive, age, food, clothes, underwear, everything.”
Melanie: Wow. I mean, really and that is absolutely perfect and as someone who is in this right now, I hear all of those things you just described Dr. Flanagan and completely agree with all of them. So, is this something that a woman should visit her physician about to start discussing what to expect or whether or not they need hormone replacement or some of the symptoms?
Dr. Flanagan: Yeah, I think so. I mean, each woman, she talks to I’m sure her family members, female family members that have already gone through this or are struggling with the same symptoms as her as far as perimenopausal symptoms, or she has probably been talking to some friends, right, because misery likes company a little bit so I think it is important to kind of get some family history, seeing what others have experienced, important to get some input from your friends to kind of know what to expect, but to also get a medical provider’s take on it; I think is really smart. I find that some of my patients have like no symptoms at all, God bless them. But the majority of women will have at least one or two symptoms. So, I do think that it makes sense to discuss it with your doctor.
Melanie: So, let’s talk about the symptoms for a minute because we hear so many in the media, on TV, but some of these happen to women anyway. So, what are some symptoms that could kind of give us a parameter and say, you know what, this is what is starting?
Dr. Flanagan: Yeah, so, I would say the most common symptom is probably the hot flash. And we find that in the US, about 75 percent of females have experienced a hot flash and if you have experienced it, then you probably know what it is, but for those of us who are not yet that age or maybe we’re male and our female counterparts are going through it, just so we can relate. It is kind of these recurrent transient episodes of flushing or perspiration. Interestingly, we found that in some countries in Asia, for example in Hong Kong, it is estimated that only about 10 percent of women have hot flashes and only about 20 percent in Japan. So, some stuff may be environmental or diet related as well. So, that is probably the most common but gosh, the symptoms can be many. Some other hot flashes/night sweats, those are kind of in the same bundle, vaginal dryness, sometimes vaginal odor, vaginal itching, some psychological symptoms. A lot of women have mood swings, irritability, depression, panic attacks, memory lapses, crying spells, also some GI symptoms like indigestion, bloating, more gas, sometimes hair growth on your face, losing hair of the scalp. Sometimes UTIs, painful intercourse, also some trouble sleeping, maybe excessive dreaming, snoring, and sometimes just some aching joints. That one is pretty common that I hear about is just my muscles feel sore or my joints hurt and I’m not sure why. So, yeah, the list is extensive.
Melanie: Well, it certainly is. So, as we understand the cause is a woman is going through these changes and she is losing estrogen; now we look into some of these treatments, Dr. Flanagan and some women don’t want to go on hormone replacement and replace that estrogen. What do you say to them about some of the questions of treatment and we will also get into a little bit later, some of the home remedies that we might try. But let’s talk about the physician recommended ones like hormone replacement. What do you do for us and what do they do for us?
Dr. Flanagan: So, you’re right. I mean menopause that is kind of the definition is that estrogen levels start to decline. Our oocytes or eggs are declining as soon as we are born. I mean we have lots and lots and then through puberty and in our twenties and thirties, I mean those eggs are getting less and less, but when we hit forties, fifties, sixties; those estrogen levels start to decline. So, what hormone replacement does is it gives you a little bit of estrogen and some other hormones to kind of bring those up to a reasonable level where maybe you won’t have so many side effects or symptoms from a low estrogen level like those that I discussed. My kind of rule for hormone replacement therapy is if you feel like your symptoms are drastically interfering with multiple avenues of life. Hormone replacement therapy kind of got a little bit of a bad rap during the Women’s Health Initiative study. That was back in the early 2000’s where they showed that gosh there may be side effects of certain types of cancer and heart disease, etc., etc., and certainly there are those risk factors and so it’s a discussion with your doctor about do I want to take those risks for potential benefits of what this can offer me. Hormone replacement therapy, it is meant to be of a short duration, so maybe one to three years to really get you through the worst of it, in a sense. But, gosh, if it can improve quality of life drastically, then I do have that serious conversation with my patients. Hormone replacement therapy is available in various quantities and routes so you can get it in a pill form, a patch form, there is vaginal gel form that a lot of patients are familiar with.
Melanie: So, does the vaginal gel or vaginal estrogen, does that help with maybe vaginal dryness or is it really just a topical? Is that what it helps with or can it get systemic?
Dr. Flanagan: It’s pretty localized, so it is a pretty safe form and it does help with vaginal dryness in most patients. Initially, we dose it so that you are getting your body used to it, you are really building up that vaginal mucosa because it can really break down and be dry and sex can be painful and it can make you higher risk for UTIs just with all that dryness and more room for bacteria which we don’t like. So, yeah, we dose it so that it would be daily for maybe one to two weeks and then people can scale back so they are only using it once to twice per week because sometimes it can be pretty costly too, depending on your medication plan. But I do find that a lot of patients have relief with that.
Melanie: So, what about some home remedies, things we can do for these hot flashes or mood swings that we might be experiencing. People have heard about fish oil, they have heard about black cohosh, they have heard about all of these different things. Do any of these hold merit?
Dr. Flanagan: Yeah. I think everything is trial and error. I tell people that our hormonal blueprint is kind of as different as our thumb prints, I mean everyone is just so different in their experiences and if they are going to find success in these remedies. Probably the most common one I would say is the black cohosh. That comes in a kind of over the counter supplement also known Remifemin. That is probably the most common one that I hear people talk about and that’s about 20 milligrams of black cohosh twice a day. Some other home remedies have been soy, soy protein that’s in food 20-60 grams a day, soy extract, that’s another thing that you can get over the counter. That theory is maybe why some of our Asian countries, why their women don’t experience the symptoms as frequently is because they have just naturally more soy in their diet. Another dietary agent that I have had some patients do and there has been some scientific evidence on, is some flax seed. So, about 2-4 tablespoons of ground flax seed can be helpful and then also there is some newer data showing that vitamin E can be helpful and the dosing that I have had people try is about 800 international units per day. So, those are all things that would be available over the counter and then there is also some prescription medications, like especially for the psychological symptoms; panic attacks, depression, irritability. Sometimes we do put people on a medication that kind of helps to balance out the serotonin system in their brain like Paxil, Celexa, Prozac; those are all common ones that we can use.
Melanie: So, these are all great suggestions and sleep disturbances is another one that women experience. You mentioned anxiety, and we talked about hot flashes and all but also insomnia seems to go along with it and sleep disorders then can also be associated with obesity, and more anxiety and depression. So, what do you tell women about sleep disturbances and then wrap it all up in nice neat little ball for us Dr. Flanagan, with your best advice about menopause and getting through it on to the other side.
Dr. Flanagan: Yeah, so insomnia in menopause is a real thing. Data shows that the time required to fall asleep increases and you are probably saying yeah, I know. And then the actual sleep period shortens during menopause so how frustrating; it is taking forever to fall asleep and then the duration is less. So, as far as for the time required to fall asleep, sometimes prescription sleep aids can go a long way in those one to two years a nice over the counter supplement would be something like melatonin, also magnesium supplements so like 250-500 milligrams nightly, that is a nice kind of anti-tension that can sometimes be helpful for both insomnia and headaches. The melatonin dose if people are interested. I start with 3 milligrams and if you are really not seeing improvements within a couple of weeks, you could increase it to 5 or 10 milligrams safely.
So, gosh to wrap it all up. Like your introduction said, this can be a really challenging time but it doesn’t have to be hard. I mean you have so many female counterparts in your life who are probably experiencing the same thing. I think one of the most powerful things for success and getting through menopause is just talking about it. I think that is so therapeutic for one of the most transitional times of your life is to just gosh, talk about it and experience it with others. Because they might have some ideas or something that worked for them or gosh maybe for someone else like the sleep thing only lasted like eight months and then it was better. So, that has been really powerful in my experience with my patients is when I get them together and I get women in their forties and fifties all together in one room and maybe having a couple women in their sixties and seventies who can retrospectively look upon their experience; that I think is what has been the most powerful. And people love to hear other’s experiences. So, I think going forward, everything that we talked about today, good options; but I think one of the most valuable things is learning from your friends and family.
Melanie: Thank you so much, what great information Dr. Flanagan. You’re listening to Stoughton Hospital Health Talk and for more information you can go to www.stoughtonhospital.com . That’s www.stoughtonhospital.com . This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Menopause is a time of change that may not be simple, but doesn’t have to be hard. Whether you are trying to make sense of your symptoms or you want to learn what may lie ahead; we can help. My guest today is, Dr. Laura Flanagan. She is a Board-Certified Family Physician at Stoughton Hospital. Welcome to the show Dr. Flanagan. So, give us a working definition of perimenopause and then into full blown menopause. How do we know when it’s happening?
Dr. Laura Flanagan, MD (Guest): Yeah, so menopause is actually defined as cessation of menses for 12 months. So, if you haven’t had a period or any bleeding for a full 12 months; you are considered menopausal. Perimenopause is any symptoms, cluster of symptoms prior to menopause. I have been in preparing for discussions about menopause and seeing multiple patients that are in the throes of menopause; I have kind of looked for less classic definitions and the research that I found, I like this quote and this is from a book called “Shmirshky: The Pursuit of Hormone Happiness” and she describes menopause as this. “It’s your brain, your body and your life transforming into something you are totally unfamiliar with. You begin to question your sanity, relationships, hormones, genetics, sex drive, age, food, clothes, underwear, everything.”
Melanie: Wow. I mean, really and that is absolutely perfect and as someone who is in this right now, I hear all of those things you just described Dr. Flanagan and completely agree with all of them. So, is this something that a woman should visit her physician about to start discussing what to expect or whether or not they need hormone replacement or some of the symptoms?
Dr. Flanagan: Yeah, I think so. I mean, each woman, she talks to I’m sure her family members, female family members that have already gone through this or are struggling with the same symptoms as her as far as perimenopausal symptoms, or she has probably been talking to some friends, right, because misery likes company a little bit so I think it is important to kind of get some family history, seeing what others have experienced, important to get some input from your friends to kind of know what to expect, but to also get a medical provider’s take on it; I think is really smart. I find that some of my patients have like no symptoms at all, God bless them. But the majority of women will have at least one or two symptoms. So, I do think that it makes sense to discuss it with your doctor.
Melanie: So, let’s talk about the symptoms for a minute because we hear so many in the media, on TV, but some of these happen to women anyway. So, what are some symptoms that could kind of give us a parameter and say, you know what, this is what is starting?
Dr. Flanagan: Yeah, so, I would say the most common symptom is probably the hot flash. And we find that in the US, about 75 percent of females have experienced a hot flash and if you have experienced it, then you probably know what it is, but for those of us who are not yet that age or maybe we’re male and our female counterparts are going through it, just so we can relate. It is kind of these recurrent transient episodes of flushing or perspiration. Interestingly, we found that in some countries in Asia, for example in Hong Kong, it is estimated that only about 10 percent of women have hot flashes and only about 20 percent in Japan. So, some stuff may be environmental or diet related as well. So, that is probably the most common but gosh, the symptoms can be many. Some other hot flashes/night sweats, those are kind of in the same bundle, vaginal dryness, sometimes vaginal odor, vaginal itching, some psychological symptoms. A lot of women have mood swings, irritability, depression, panic attacks, memory lapses, crying spells, also some GI symptoms like indigestion, bloating, more gas, sometimes hair growth on your face, losing hair of the scalp. Sometimes UTIs, painful intercourse, also some trouble sleeping, maybe excessive dreaming, snoring, and sometimes just some aching joints. That one is pretty common that I hear about is just my muscles feel sore or my joints hurt and I’m not sure why. So, yeah, the list is extensive.
Melanie: Well, it certainly is. So, as we understand the cause is a woman is going through these changes and she is losing estrogen; now we look into some of these treatments, Dr. Flanagan and some women don’t want to go on hormone replacement and replace that estrogen. What do you say to them about some of the questions of treatment and we will also get into a little bit later, some of the home remedies that we might try. But let’s talk about the physician recommended ones like hormone replacement. What do you do for us and what do they do for us?
Dr. Flanagan: So, you’re right. I mean menopause that is kind of the definition is that estrogen levels start to decline. Our oocytes or eggs are declining as soon as we are born. I mean we have lots and lots and then through puberty and in our twenties and thirties, I mean those eggs are getting less and less, but when we hit forties, fifties, sixties; those estrogen levels start to decline. So, what hormone replacement does is it gives you a little bit of estrogen and some other hormones to kind of bring those up to a reasonable level where maybe you won’t have so many side effects or symptoms from a low estrogen level like those that I discussed. My kind of rule for hormone replacement therapy is if you feel like your symptoms are drastically interfering with multiple avenues of life. Hormone replacement therapy kind of got a little bit of a bad rap during the Women’s Health Initiative study. That was back in the early 2000’s where they showed that gosh there may be side effects of certain types of cancer and heart disease, etc., etc., and certainly there are those risk factors and so it’s a discussion with your doctor about do I want to take those risks for potential benefits of what this can offer me. Hormone replacement therapy, it is meant to be of a short duration, so maybe one to three years to really get you through the worst of it, in a sense. But, gosh, if it can improve quality of life drastically, then I do have that serious conversation with my patients. Hormone replacement therapy is available in various quantities and routes so you can get it in a pill form, a patch form, there is vaginal gel form that a lot of patients are familiar with.
Melanie: So, does the vaginal gel or vaginal estrogen, does that help with maybe vaginal dryness or is it really just a topical? Is that what it helps with or can it get systemic?
Dr. Flanagan: It’s pretty localized, so it is a pretty safe form and it does help with vaginal dryness in most patients. Initially, we dose it so that you are getting your body used to it, you are really building up that vaginal mucosa because it can really break down and be dry and sex can be painful and it can make you higher risk for UTIs just with all that dryness and more room for bacteria which we don’t like. So, yeah, we dose it so that it would be daily for maybe one to two weeks and then people can scale back so they are only using it once to twice per week because sometimes it can be pretty costly too, depending on your medication plan. But I do find that a lot of patients have relief with that.
Melanie: So, what about some home remedies, things we can do for these hot flashes or mood swings that we might be experiencing. People have heard about fish oil, they have heard about black cohosh, they have heard about all of these different things. Do any of these hold merit?
Dr. Flanagan: Yeah. I think everything is trial and error. I tell people that our hormonal blueprint is kind of as different as our thumb prints, I mean everyone is just so different in their experiences and if they are going to find success in these remedies. Probably the most common one I would say is the black cohosh. That comes in a kind of over the counter supplement also known Remifemin. That is probably the most common one that I hear people talk about and that’s about 20 milligrams of black cohosh twice a day. Some other home remedies have been soy, soy protein that’s in food 20-60 grams a day, soy extract, that’s another thing that you can get over the counter. That theory is maybe why some of our Asian countries, why their women don’t experience the symptoms as frequently is because they have just naturally more soy in their diet. Another dietary agent that I have had some patients do and there has been some scientific evidence on, is some flax seed. So, about 2-4 tablespoons of ground flax seed can be helpful and then also there is some newer data showing that vitamin E can be helpful and the dosing that I have had people try is about 800 international units per day. So, those are all things that would be available over the counter and then there is also some prescription medications, like especially for the psychological symptoms; panic attacks, depression, irritability. Sometimes we do put people on a medication that kind of helps to balance out the serotonin system in their brain like Paxil, Celexa, Prozac; those are all common ones that we can use.
Melanie: So, these are all great suggestions and sleep disturbances is another one that women experience. You mentioned anxiety, and we talked about hot flashes and all but also insomnia seems to go along with it and sleep disorders then can also be associated with obesity, and more anxiety and depression. So, what do you tell women about sleep disturbances and then wrap it all up in nice neat little ball for us Dr. Flanagan, with your best advice about menopause and getting through it on to the other side.
Dr. Flanagan: Yeah, so insomnia in menopause is a real thing. Data shows that the time required to fall asleep increases and you are probably saying yeah, I know. And then the actual sleep period shortens during menopause so how frustrating; it is taking forever to fall asleep and then the duration is less. So, as far as for the time required to fall asleep, sometimes prescription sleep aids can go a long way in those one to two years a nice over the counter supplement would be something like melatonin, also magnesium supplements so like 250-500 milligrams nightly, that is a nice kind of anti-tension that can sometimes be helpful for both insomnia and headaches. The melatonin dose if people are interested. I start with 3 milligrams and if you are really not seeing improvements within a couple of weeks, you could increase it to 5 or 10 milligrams safely.
So, gosh to wrap it all up. Like your introduction said, this can be a really challenging time but it doesn’t have to be hard. I mean you have so many female counterparts in your life who are probably experiencing the same thing. I think one of the most powerful things for success and getting through menopause is just talking about it. I think that is so therapeutic for one of the most transitional times of your life is to just gosh, talk about it and experience it with others. Because they might have some ideas or something that worked for them or gosh maybe for someone else like the sleep thing only lasted like eight months and then it was better. So, that has been really powerful in my experience with my patients is when I get them together and I get women in their forties and fifties all together in one room and maybe having a couple women in their sixties and seventies who can retrospectively look upon their experience; that I think is what has been the most powerful. And people love to hear other’s experiences. So, I think going forward, everything that we talked about today, good options; but I think one of the most valuable things is learning from your friends and family.
Melanie: Thank you so much, what great information Dr. Flanagan. You’re listening to Stoughton Hospital Health Talk and for more information you can go to www.stoughtonhospital.com . That’s www.stoughtonhospital.com . This is Melanie Cole. Thanks so much for listening.
