THE NORTH AMERICAN MENOPAUSE SOCIETY
Hello from Dr. Cynthia StuenkelHello, my name is Dr. Cynthia Stuenkel and I am an Endocrinologist and...
Hello, my name is Dr. Cynthia Stuenkel and I am an Endocrinologist and menopause expert involved for over 20 years in the care and education of women and their healthcare providers. I am also involved in research into the prevention of heart disease and osteoporosis. Menopause is a fascinating field. There's always something new to talk about, and often more questions than answers! I look forward to our exchanges.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Response to "recently had a hysterectomy"When we talk about menopause resulting from surgery, it is important...
When we talk about menopause resulting from surgery, it is important to get a few things straight. You can have a hysterectomy (surgical removal of your uterus) and you won't have any more vaginal bleeding or menstrual periods. But your ovaries will continue to secrete the hormones estrogen and progesterone in a cyclical fashion, usually until close to the time of expected natural menopause. More and more frequently, clinicians are advising women who require a hysterectomy for benign conditions to keep their ovaries because of long-term health benefits.
It is only when your ovaries are surgically removed along with your uterus that you experience induced menopause and hormonal changes including a drop in estrogen, progesterone, and testosterone.
Surgical menopause (with removal of the ovaries) is very different than natural menopause. The transition to natural menopause takes many years; surgical menopause occurs in a matter of minutes. Natural menopause results in a loss of estrogen and progesterone, but in most women, testosterone levels remain stable. With surgical menopause, testosterone levels also fall. Natural menopause occurs during midlife; surgical menopause can occur at any age, often years younger. Surgical menopause is usually recommended because of a health condition such as excessive bleeding and anemia, uterine cancer, or endometriosis, which can compromise your well-being before surgery. And surgical menopause abruptly ends your fertility, a significant loss for some women, but a relief for others.
If you have your ovaries removed, common symptoms of menopause, especially vasomotor symptoms or hot flashes, can occur while you are still in the recovery room. Depending upon the reason for the surgery and your personal risks and medical history, some clinicians recommend starting hormone therapy immediately after surgery. Estrogen alone seems to have fewer associated risks, such as less breast cancer, than combined therapy.
But if estrogen therapy is not advised for you, there are other options for relief of severe hot flashes. Beyond dietary and lifestyle changes, antidepressants, and prescription drugs such as gabapentin can help. If you have been prone to depression, you might experience symptoms after the surgery. Sexual function might improve, stay the same, or worsen. Vaginal dryness can be treated with hormonal or nonhormonal vaginal preparations.
The bottom line is that it is very important to understand before you go into surgery what the extent of the operation will be and what your options are for symptom relief. Will you have your uterus removed or both ovaries as well? Is estrogen safe for you, or should you explore other options? If you have already had your surgery, be assured that symptom relief is available. Don't be shy in asking your clinician about which options make sense for you!
Always check back with NAMS for more information about menopause and beyond.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
To the man in desperate need of helpHats off to you for seeking a way to help your girlfriend navigate a...
Hats off to you for seeking a way to help your girlfriend navigate a difficult time. Wise men reach out for understanding and advice as their partners move through the menopause transition. Your patience and support are so important.
In spite of all the literature, all the Web sites, and all the talk shows, the symptoms of menopause can sneak up on an unsuspecting woman and she might not fully grasp how extensively she is being affected. For some women, transitioning to menopause may not yet be on their radar. Hot flashes are certainly a major symptom, and hot flashes can interrupt sleep. Sleep deprivation and fluctuating hormones can take their toll on mood. And so the spiral begins.
A woman should confirm with her healthcare provider that her symptoms are being caused by the menopause transition. Other medical conditions can cause "spells," which can be confused with hot flashes; and there are other possible causes for emotional symptoms and mood swings. If a woman needs a referral to a healthcare provider specializing in menopause, visit The North American Menopause Society (NAMS) Web site to find a NAMS Certified Menopause Practitioner in your area.
Getting the correct information from the beginning is critical. Beware that Internet surfing for advice yields the good, the bad, and the ugly. Free, trusted information can always be found, however, on our NAMS Web site including books (Menopause Guidebook), an online magazine (Menopause Flashes), and a Menopause Glossary. There are also discussions of the many avenues available for symptom relief so women and their loved ones can be more comfortable during this transition and beyond. Check it out.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Response to 51 and still on the pillWe are from the generation of women who grew up in the early wave of...
We are from the generation of women who grew up in the early wave of oral contraceptive (OC) use, so I suspect your question is relevant to many. One of the ways OCs work is by suppressing or shutting down the signals from the pituitary gland to the ovaries, so monthly ovulation usually does not occur. OCs provide plenty of hormones, so there is no shortage of estrogen and some form of synthetic progestogen to make up for the lack of hormone production by the ovary.
The question is what's happening to the eggs within the ovary during those years on OCs? Is the ovary somehow "hibernating"? Do 30 years of OCs mean that menopause occurs 30 years later? It appears that aging of the eggs within the ovary continues to occur despite the absence of pituitary hormone stimulation. So, the best evidence we have right now is that menopause probably occurs close to the normal anticipated age even in women taking OCs (age 51).
While you're taking them, however, contraceptives mask the symptoms of menopause. The hormone content of even low-dose OCs is about 4 to 8 times stronger than the doses of postmenopausal hormone therapy (HT) that we now recommend. That's more than enough estrogen to prevent hot flashes and vaginal dryness, the common symptoms of menopause. And you still have monthly bleeding on the pill. That's why you only experience menopause symptoms during the week you are off the pill.
Postmenopausal HT, with few exceptions, uses different types of hormones than those included in OCs. Most clinicians initiate the conversation about switching off OCs around age 50. Again, women differ in their risk profiles, so the decision to stop or switch is an individual one. In healthy, nonsmoking women, some clinicians will continue low-dose OCs until age 55. If you elect to continue, you should talk with your clinician about a plan to relieve your symptoms during the week off—either supplemental low-dose estrogen or change to a continuous schedule of the pills. Given that risks of any hormone treatment (including the pill) increase with age, it's probably a good idea to at least review your personal risks, which might change during midlife, and discuss the pros and cons of switching from the pill to lower-dose postmenopausal HT or some other option for symptom relief.
Remember to use barrier contraception until you're certain you're fully postmenopausal (usually a year without periods or consistent elevations of the pituitary hormone, FSH, on blood tests). Postmenopausal HT is not potent enough to suppress pituitary hormones and prevent ovluation like the pill does; thus, HT does not provide contraception.
Good luck!View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Concerns about prolonged HT useThe main concern with prolonged HT is an increased risk of breast...
The main concern with prolonged HT is an increased risk of breast cancer. The risk seems to be greater in women taking combined therapy (estrogen plus a progestogen) than in women taking estrogen alone. And, it may be that starting HT right away after menopause is also associated with greater risk. The good news is that the risk returns to baseline within several years after stopping HT. You should also be aware that combined HT can make it more difficult to read your mammogram (both while you're taking hormones and in the first years after stopping). As a result, you might be called back for additional views or biopsy of suspicious areas.
Right now most experts recommend limiting HT to several years. The NAMS 2010 HT position statement (www.menopause.org/PSht10.pdf ) suggests that longer use is acceptable for a woman if she believes that the benefits outweigh the risks (especially if she's had trouble stopping therapy). The other condition includes women with low bone mass or osteoporosis who cannot tolerate osteoporosis drugs.
The one exception to limiting HT to a few years is the woman who has had premature menopause, either because of natural failure of her ovaries or surgical removal. In that case, most experts are comfortable advising you to continue HT at least until the age of natural menopause, about age 50, at which time you can reassess.
If you've been taking hormones for a very long time, you might want to start by discussing a lower dose. Many clinicians now prescribe half the dose we used to use.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Response about mom’s depressionWhat a lucky mom to have a child who cares so much about her. While I...
What a lucky mom to have a child who cares so much about her. While I cannot respond specifically to your mother's situation because I have not seen her as a patient, I can discuss how other women and their clinicians approach such issues.
First of all, many women have a tough time during the menopause transition. If a woman isn't sleeping well for some time, the sleep deprivation alone can make a person more vulnerable to life's ups and downs. So it would probably be helpful to ask a healthcare provider about options to relieve hot flashes (with or without hormone therapy) and allow the woman to catch up on her rest.
But more urgent is severe depression during the midlife years. Depression is a dark cloud that casts a shadow on every aspect of life. People lose interest in daily activities they once enjoyed, feel sad most of the time, can't sleep or sleep all the time, can't eat or eat all the time, lose energy, can't think clearly or concentrate anymore, and can compromise their self-care and hygiene.
We don't think menopause causes depression, although it's common for some women to have the blues at this time of life. A woman who has already experienced an episode of depression, who has a long and difficult menopause transition, or who suffered from severe premenstrual syndrome can be more susceptible to full-blown depression later on. There is no question that the loss of a parent can be a devastating experience. Adding this loss to the depression and menopausal symptoms, a woman would benefit from the counseling of a healthcare professional or a mental health practitioner, and her family, to get back to her old self.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Final installment about stopping HTThis is the last aspect in our discussion about stopping HT: once you...
This is the last aspect in our discussion about stopping HT: once you and your clinician have decided that it's time to stop, what's the best approach? The simple answer is that we don't know. Formal studies to evaluate this question have failed to show that either going cold turkey or tapering off is better. So the choice is really yours. The important thing is to know that women in general have about a 50/50 chance of experiencing hot flashes again (although maybe not as severe as initially) after stopping. Some studies suggest that symptoms peak within 3 months after stopping hormones. After you stop, take some time to evaluate how you feel before beginning any new medication so you don't get the two effects confused.
There are a couple of other things to keep an eye on once you've stopped HT. If you develop vaginal dryness or recurrent urinary tract infections, ask your clinician about vaginal estrogens. Nonhormonal lubricants and moisturizers can also help with dryness. And, you might want to ask about a bone density test. We know that women who stop HT often lose bone. Depending on your bone density score and risk profile, you might be a candidate for an osteoporosis drug (bone-sparing). At any rate, discuss calcium and vitamin D supplements, weight-bearing exercise, and fall prevention with your clinician.
Another good idea is to have your cholesterol rechecked in about 3 months after stopping HT because hormones can affect "lipid levels" (both good and bad). And if you're taking a thyroid medication for an underactive thyroid, your dose might need to be adjusted.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
Fact or fiction? Estrogen therapy is an option for... Fiction: Only women who no longer have a uterus should consider...
Fiction: Only women who no longer have a uterus should consider using esdtrogen-alone therapy (ET). For women with a uterus, the option they might consider is estrogen plus progestogen therapy (EPT). Progestogen is needed to protect the uterus and balance the effects of estrogen. Using ET alone for 5 or more years can more than triple the risk of developing cancer of the uterus, but adding progestogen prevents the uterine lining (endometrium) from thickening and greatly reduces the cancer risk. Then, of course, each woman must determine (with her healthcare provider) if EPT is right for her. See the NAMS Web site for more information.View Thread
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THE NORTH AMERICAN MENOPAUSE SOCIETY
When & how to stop hormone therapyWhile we spend an awful lot of time discussing whether or not an...
While we spend an awful lot of time discussing whether or not an individual woman should go on hormone therapy (HT), an equally challenging question for many women is when (and how) to stop. This issue deserves a conversation with your clinician to look at your specific situation and weigh the pros and cons for you. In general, The North American Menopause Society (NAMS) (www.menopause.org ) and most other medical groups advise women to take systemic HT at the lowest dose that relieves your symptoms (hot flashes and vaginal dryness) for the shortest amount of time. That "shortest amount of time" phrase, however, is somewhat vague and open to discussion. There are several important considerations about stopping therapy, such as prolonged use, lower doses, ways to stop, and follow-up tests, which I will post in the coming days.View Thread
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