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     What is menopause?

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    Menopause means that you have not had a period for 12 months and you are now incapable of having a baby. You are now “post-menopausal” and will be for the rest of your life. This is a time of joy for some women as they do not have to worry about pregnancy any longer. Many post-menopausal women report that these years are filled with personal fulfillment. It’s a time to focus on their hobbies, interests, personal health, and relationships.

    On the other hand, it can be a time of great sadness for some women. Some women report that it is hard to lose their menstrual period, the one thing that may have made them feel “womanly.” If she never had children, a woman may grieve the fact that her chance of pregnancy is gone.

    Accurate information about the emotional changes of menopause and effective symptom management can make all the difference in the world. Imagine going through puberty and not know what is happening. There’s no reason women should go through this life event without understanding it either. The Memorial Center for Menopausal Medicine will help you transition through this major life event with good health and support.

     

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     What is perimenopause (the menopause transition)?

    Content:

    Perimenopause refers to the period of time when menstrual cycle and hormone changes occur in a woman who still has her ovaries. As the level of estrogen released from the ovaries varies, the length of the menstrual cycle changes. The temperature regulation system in our bodies is somehow tied to this and women may start to experience hot flashes or night flushes. Pamela Gaudry, M.D., refers to this time as “puberty in reverse.” When girls go through puberty, the hormonal changes start around age 8. The child doesn’t look any different, but the hormones are increasing constantly. It takes many years of hormonal stimulation to change the way the girl looks. These physical changes may not appear until age 11 or 12, and menses typically begins at age 13 or 14. The hormonal changes continue until age 18 or 20. At that point, the hormones begin to stabilize and the acne changes and mood swings of puberty normalize. We then have about 15 years of relative hormonal stability.

    Then, around age 35 to 40, the hormones begin to change again and the ovaries start to fail.  A woman may not realize it at the time, but changes are occurring as they did in puberty. Acne may return with a vengeance. Emotions fluctuate dramatically. Menstrual cycles may become irregular and heavy. Cramps and PMS may worsen. The perimenopause or menopausal transition is over when you have not had a menstrual period for 12 months.

     

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     What does post-menopausal mean?

    Content:

    Post menopause refers to the years in a woman’s life after her final menstrual period. The average age of natural menopause in the Western world is age 51. It is normal to go through menopause anywhere from 40 to 60 years of age. Most women can expect to live up to one-third of their lives as a post-menopausal woman.

     

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     What is induced menopause?

    Content:

    Surgical or induced menopause occurs when the ovaries are removed by a surgeon. This is the most common cause of “induced menopause.” Menopause can be induced by chemotherapy or radiation therapy given to a pre-menopausal woman for treatment of cancer. After chemotherapy, the ovaries in women under the age of 30 may recover and start functioning again. For a woman over the age of 40, they are unlikely to recover.

    Radiation therapy anywhere in the body may affect ovarian function. Radiation of the pelvis is likely to cause induced menopause.

     

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     What kind of bleeding abnormalities might I expect in perimenopause?

    Content:

    Abnormal bleeding is usual from age 40 until menopause. Studies involving many perimenopausal women found that 12 percent of women have an abrupt stop to their menstrual periods. The other 88 percent go through a wide variety of bleeding patterns.

    Sometimes, the bleeding will be infrequent (every three to four months) but when it comes, it is unusually heavy and painful. Some women bleed frequently and lightly and may have only a little spotting every two weeks or so. Other women have heavy, painful bleeding more than once a month and may pass large clots. If bleeding is so severe that it disrupts your quality of life, talk to your doctor for assistance.

     

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     What is a hot flash?

    Content:

    Hot flashes are episodes of flushing accompanied by a sensation of warmth or intense heat on the upper body and face. There are many names for the same phenomenon: hot flashes, hot flushes, night flashes, night flushes, vasomotor symptoms, or thermoregulatory dysfunctions. They usually start at night and may cause you to wake up soaked and hot. Then you may promptly become freezing cold.

    During the day, hot flashes may cause your scalp and head to drip sweat. The hot flash is the second most frequently reported perimenopausal symptom (the first is irregular bleeding). As many as 75 percent of perimenopausal and post-menopausal women in the U.S. report having hot flashes. The frequency of hot flashes is usually highest during the first two post-menopausal years. Some women have them for 10 years or longer experience a recurrence of hot flashes more than 10 years after menopause.

     

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     How do you treat hot flashes?

    Content:

    Actually, there is no reason to “treat” hot flashes unless they are affecting your quality of life. Systemic estrogen therapy is the standard treatment for moderate to severe menopause-related hot flashes. If you have a uterus, you should use a combination of estrogen and progesterone. We increase the dose of estrogen until the hot flashes and night flushes are tolerable or gone.

    As with any prescription drug, there are risks associated with taking estrogen therapy. For women who can’t or won’t take estrogen, some anti-depressants have been used very successfully to treat hot flashes. In 2014, the anti-depressant paroxetine was approved by the FDA for hot flashes. It is given in a low dose and seems to be just enough to help women tolerate hot flashes. The non-FDA-approved use of gabapentin (also known as Neurontin), pregabalin (Lyrica), clonidine, Bellergal, and methyldopa (Aldomet) have been used alone or in combination to treat hot flashes. They have been successful in many patients. Over time, most doctors will temporarily stop the treatment to see if the hot flashes have gone away. You shouldn’t think that you will need treatment forever, as the hot flashes tend to go away over time.

     

    Tab header and content

    Tab Heading:

     Is there a libido pill for women?

    Content:

    Flibanserin is a new drug just recently approved for the treatment of hypoactive sexual desire disorder (HSDD) in woman. HSDD means a woman who is otherwise healthy has a lacking libido, or a lack of sexual desire. Studies show that about 10 to 20 percent of women face this problem and some say HSDD outnumbers men with sexual problems. Flibanserin is not a hormone. It increases dopamine and noradrenalin within the brain and decreases serotonin. This has a positive effect on a woman’s sexual craving. This is the first drug ever approved by the FDA for women with decreased libido. Some women have biologic issues (as opposed to emotional issues) that cause low libido. Flibanserin or Addyi® works by rebalancing key brain chemicals.

    Before starting any medication, you should understand the benefits, side effects, and risks of the drug. This drug will not make you hypersexual. This drug will not make sex “better.” It will not make you a better lover. However, if you feel better and less distressed about your sexual experiences, your relationship with your intimate partner may improve significantly.

     

    Tab header and content

    Tab Heading:

     What if I cannot achieve an orgasm?

    Content:

    Many women of all ages come into the office and want to ask questions about orgasms. They think that they are not normal because they can only have an orgasm with clitoral stimulation. Pamela Gaudry, M.D., has this response, “I tell them that not only is it normal, but as you get older, and especially after menopause, it may be the only way. And, it takes longer to even achieve orgasm that way. After they get comfortable with the conversation, many admit that they have never really had an orgasm without clitoral stimulation. This is normal. It is just something that we find hard to admit. In our society, entertainment outlets, cable television, the Internet, and movies today, we are subjected to watching people having intercourse whether we want to or not. I suspect that watching women have these orgasms every time they have intercourse makes us feel inadequate if we don’t respond the same way. The fact of the matter is, what happens in your own bedroom is probably a much more the normal response than what we see actors portraying. There are many women who come in and admit that they are not sure that they have ever even had an orgasm. There is no OB/GYN out there that will make you feel uncomfortable about this. If they do, then find someone else Working with a sex therapist would be the next step.”

     

    Tab header and content

    Tab Heading:

     What is the treatment for vaginal dryness?

    Content:

    The best thing to prevent vaginal atrophy is vaginal estrogen placement. There are three ways to give local estrogen to all of the estrogen receptors in and around your vagina and bladder: a vaginal estrogen cream, a vaginal estrogen pill, or a vaginal estrogen ring. There are two FDA-approved vaginal creams to help build up the vaginal skin (mucosa): Estrace® and Premarin®. Estrace® contains one estrogen called estradiol. Premarin® has several estrogens combined: estradiol, estriol, and estrone.

    The Estring® vaginal ring is approved for vaginal dryness. The estrogen is delivered right to the vagina from the ring and lasts for three months. At the end of three months, you take the ring out and put in another. You can take it out every day if you want to wash it off and you can take it out for intercourse. It is a silastic ring impregnated with estradiol. It is worn similar to a diaphragm.

    There is a new medication for vaginal dryness called Osphena®. The generic name is ospemifene. Per the package insert, it is the first and only FDA-approved non-estrogen oral treatment that reverses certain physical changes of the vagina and significantly relieves moderate to severe painful intercourse due to menopause.

     

     

    Menopause means that you have not had a period for 12 months and you are now incapable of having a baby. You are now “post-menopausal” and will be for the rest of your life. This is a time of joy for some women as they do not have to worry about pregnancy any longer. Many post-menopausal women report that these years are filled with personal fulfillment. It’s a time to focus on their hobbies, interests, personal health, and relationships.

    On the other hand, it can be a time of great sadness for some women. Some women report that it is hard to lose their menstrual period, the one thing that may have made them feel “womanly.” If she never had children, a woman may grieve the fact that her chance of pregnancy is gone.

    Accurate information about the emotional changes of menopause and effective symptom management can make all the difference in the world. Imagine going through puberty and not know what is happening. There’s no reason women should go through this life event without understanding it either. The Memorial Center for Menopausal Medicine will help you transition through this major life event with good health and support.

    Perimenopause refers to the period of time when menstrual cycle and hormone changes occur in a woman who still has her ovaries. As the level of estrogen released from the ovaries varies, the length of the menstrual cycle changes. The temperature regulation system in our bodies is somehow tied to this and women may start to experience hot flashes or night flushes. Pamela Gaudry, M.D., refers to this time as “puberty in reverse.” When girls go through puberty, the hormonal changes start around age 8. The child doesn’t look any different, but the hormones are increasing constantly. It takes many years of hormonal stimulation to change the way the girl looks. These physical changes may not appear until age 11 or 12, and menses typically begins at age 13 or 14. The hormonal changes continue until age 18 or 20. At that point, the hormones begin to stabilize and the acne changes and mood swings of puberty normalize. We then have about 15 years of relative hormonal stability.

    Then, around age 35 to 40, the hormones begin to change again and the ovaries start to fail.  A woman may not realize it at the time, but changes are occurring as they did in puberty. Acne may return with a vengeance. Emotions fluctuate dramatically. Menstrual cycles may become irregular and heavy. Cramps and PMS may worsen. The perimenopause or menopausal transition is over when you have not had a menstrual period for 12 months.

    Post menopause refers to the years in a woman’s life after her final menstrual period. The average age of natural menopause in the Western world is age 51. It is normal to go through menopause anywhere from 40 to 60 years of age. Most women can expect to live up to one-third of their lives as a post-menopausal woman.

    Surgical or induced menopause occurs when the ovaries are removed by a surgeon. This is the most common cause of “induced menopause.” Menopause can be induced by chemotherapy or radiation therapy given to a pre-menopausal woman for treatment of cancer. After chemotherapy, the ovaries in women under the age of 30 may recover and start functioning again. For a woman over the age of 40, they are unlikely to recover.

    Radiation therapy anywhere in the body may affect ovarian function. Radiation of the pelvis is likely to cause induced menopause.

    Abnormal bleeding is usual from age 40 until menopause. Studies involving many perimenopausal women found that 12 percent of women have an abrupt stop to their menstrual periods. The other 88 percent go through a wide variety of bleeding patterns.

    Sometimes, the bleeding will be infrequent (every three to four months) but when it comes, it is unusually heavy and painful. Some women bleed frequently and lightly and may have only a little spotting every two weeks or so. Other women have heavy, painful bleeding more than once a month and may pass large clots. If bleeding is so severe that it disrupts your quality of life, talk to your doctor for assistance.

    Hot flashes are episodes of flushing accompanied by a sensation of warmth or intense heat on the upper body and face. There are many names for the same phenomenon: hot flashes, hot flushes, night flashes, night flushes, vasomotor symptoms, or thermoregulatory dysfunctions. They usually start at night and may cause you to wake up soaked and hot. Then you may promptly become freezing cold.

    During the day, hot flashes may cause your scalp and head to drip sweat. The hot flash is the second most frequently reported perimenopausal symptom (the first is irregular bleeding). As many as 75 percent of perimenopausal and post-menopausal women in the U.S. report having hot flashes. The frequency of hot flashes is usually highest during the first two post-menopausal years. Some women have them for 10 years or longer experience a recurrence of hot flashes more than 10 years after menopause.

    Actually, there is no reason to “treat” hot flashes unless they are affecting your quality of life. Systemic estrogen therapy is the standard treatment for moderate to severe menopause-related hot flashes. If you have a uterus, you should use a combination of estrogen and progesterone. We increase the dose of estrogen until the hot flashes and night flushes are tolerable or gone.

    As with any prescription drug, there are risks associated with taking estrogen therapy. For women who can’t or won’t take estrogen, some anti-depressants have been used very successfully to treat hot flashes. In 2014, the anti-depressant paroxetine was approved by the FDA for hot flashes. It is given in a low dose and seems to be just enough to help women tolerate hot flashes. The non-FDA-approved use of gabapentin (also known as Neurontin), pregabalin (Lyrica), clonidine, Bellergal, and methyldopa (Aldomet) have been used alone or in combination to treat hot flashes. They have been successful in many patients. Over time, most doctors will temporarily stop the treatment to see if the hot flashes have gone away. You shouldn’t think that you will need treatment forever, as the hot flashes tend to go away over time.

    Flibanserin is a new drug just recently approved for the treatment of hypoactive sexual desire disorder (HSDD) in woman. HSDD means a woman who is otherwise healthy has a lacking libido, or a lack of sexual desire. Studies show that about 10 to 20 percent of women face this problem and some say HSDD outnumbers men with sexual problems. Flibanserin is not a hormone. It increases dopamine and noradrenalin within the brain and decreases serotonin. This has a positive effect on a woman’s sexual craving. This is the first drug ever approved by the FDA for women with decreased libido. Some women have biologic issues (as opposed to emotional issues) that cause low libido. Flibanserin or Addyi® works by rebalancing key brain chemicals.

    Before starting any medication, you should understand the benefits, side effects, and risks of the drug. This drug will not make you hypersexual. This drug will not make sex “better.” It will not make you a better lover. However, if you feel better and less distressed about your sexual experiences, your relationship with your intimate partner may improve significantly.

    Many women of all ages come into the office and want to ask questions about orgasms. They think that they are not normal because they can only have an orgasm with clitoral stimulation. Pamela Gaudry, M.D., has this response, “I tell them that not only is it normal, but as you get older, and especially after menopause, it may be the only way. And, it takes longer to even achieve orgasm that way. After they get comfortable with the conversation, many admit that they have never really had an orgasm without clitoral stimulation. This is normal. It is just something that we find hard to admit. In our society, entertainment outlets, cable television, the Internet, and movies today, we are subjected to watching people having intercourse whether we want to or not. I suspect that watching women have these orgasms every time they have intercourse makes us feel inadequate if we don’t respond the same way. The fact of the matter is, what happens in your own bedroom is probably a much more the normal response than what we see actors portraying. There are many women who come in and admit that they are not sure that they have ever even had an orgasm. There is no OB/GYN out there that will make you feel uncomfortable about this. If they do, then find someone else Working with a sex therapist would be the next step.”

    The best thing to prevent vaginal atrophy is vaginal estrogen placement. There are three ways to give local estrogen to all of the estrogen receptors in and around your vagina and bladder: a vaginal estrogen cream, a vaginal estrogen pill, or a vaginal estrogen ring. There are two FDA-approved vaginal creams to help build up the vaginal skin (mucosa): Estrace® and Premarin®. Estrace® contains one estrogen called estradiol. Premarin® has several estrogens combined: estradiol, estriol, and estrone.

    The Estring® vaginal ring is approved for vaginal dryness. The estrogen is delivered right to the vagina from the ring and lasts for three months. At the end of three months, you take the ring out and put in another. You can take it out every day if you want to wash it off and you can take it out for intercourse. It is a silastic ring impregnated with estradiol. It is worn similar to a diaphragm.

    There is a new medication for vaginal dryness called Osphena®. The generic name is ospemifene. Per the package insert, it is the first and only FDA-approved non-estrogen oral treatment that reverses certain physical changes of the vagina and significantly relieves moderate to severe painful intercourse due to menopause.