The Menopausal Transition

By admin
March 07, 2016

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Probably more than any other time of life, menopause is like an impending mystery many women look toward with a looming sense of doom. And no wonder – who looks forward to the thought of hot flashes, night sweats, irregular periods, difficulty sleeping, mood changes, anxiety or depression, and that’s just a few of the most common symptoms. Menopause also symbolizes the end of a woman’s reproductive years. Even as we breathe a sigh of relief that our children are growing into adulthood, we still can have the nagging desire to bring another new life into the world and regret that our time in that realm is over. (It’s times like these we really need to remember that’s why God makes grandchildren.)

Maybe it’s because our mothers didn’t talk about it. Maybe it’s because we don’t want to think about it until we have to, but few of us are really prepared for or adequately educated about this physical transition that signals a change in the way our bodies function for the rest of our lives. It is for this reason Well-Being reached out to two healthcare providers who counsel women and treat the symptoms of menopause along with its subsequent physical changes as a regular part of their healthcare practices. We spoke to Ms. Michie Autry, Menopause & Sexual Wellness Nurse Practitioner of Ovation Woman’s Wellness and Dr. Kristi Trimm, Family Medicine, of Merit Health Medical Group.

Perimenopause is the span of time between the start of symptoms and 1 year after the final menstrual period.

“What many women don’t realize is that the menopause transition or perimenopause can start as early as a woman’s late thirties and can take as long as 15 years (although the average is about four years prior to the final menstrual period),” notes Ms. Autry. “Women who have had hysterectomies with one or both ovaries removed usually experience immediate surgical menopause.

“Symptoms vary widely between women and can be as unspecific as trouble sleeping, variation in the length and cycle time of periods, feelings of exhaustion, irritability, vaginal dryness, lack of interest in sex, and depression – all easily justified by a stressed, over-committed, multi-tasking woman juggling many roles,” adds Autry.

The first step for getting help with menopausal symptoms is to be aware of what to look for so you can have an open discussion with your healthcare provider about what you are going through. Besides the symptoms already mentioned, a woman may also experience heart palpitations, dry skin, hair loss, incontinence, joint pain, bone loss (osteoporosis), weight gain, and problems with memory and concentration.

The second step is finding out where you are in the perimenopausal transition by analyzing your natural hormone levels at different times of your cycle. This can be done with a blood test called a follicle stimulating hormone (FSH) test. Even after periods have become very light or almost nonexistent, a woman can still become pregnant, so it is advisable to keep track of where you are in the transition process before discontinuing birth control measures if you do not plan to conceive. A woman is generally considered to be in menopause 1 year after her final period.

“Since 2002, when the Women’s Health Initiative warned of increased risks of breast cancer, blood clots and stroke for women undergoing hormone replacement therapy, a lot of women have been concerned about whether or not to take hormones,” adds Autry. “However these studies were conducted using two specific products, Premarin and Prempro which use conjugated estrogens isolated from the urine of pregnant mares. Compounded and synthetic bioidentical hormones (believed to more closely mimic natural hormones produced naturally in a woman’s body) were not included in WHI trial. That said, experts still agree hormone therapy should use the lowest possible dose for the shortest period of time, based on a woman’s age, height and weight.”

“I see a lot of women who are not aware of the wide variety of hormone therapies now available,” Autry continues. “There is so much we can do to help reduce and alleviate unpleasant and disruptive menopausal symptoms. I believe in practicing good, safe medicine, to improve a woman’s quality of life. With the benefits of hormone replacement therapy comes the responsibility of keeping a close check on overall health, regular breast exams and mammograms, pap smears, monitoring of blood pressure, cholesterol and other measures to watch for any warning signs.”

Smiling grandmother piggyback ride with baby“Before prescribing hormone replacement therapy (HRT) we look at a woman’s medical history, current state of health and family history,” notes Dr. Trimm. “Women with moderate to severe symptoms are the best candidates for short-term hormone therapy,” notes Dr. Trimm. The exception would be patients with a history of breast cancer, coronary artery disease, previous blood clots, stroke or liver disease. For most of our patients, we start by prescribing a transdermal estradiol (estrogen patch). This formulation is associated with lower risk of blood clot and stroke. If the patient still has a uterus, she must also be on micronized progesterone to prevent endometrial hyperplasia (abnormal cells in the lining of the uterus).”

There are two basic types of hormone therapy. Systemic products circulate throughout the bloodstream and to all parts of the body. They are available as an oral tablet, patch, gel, emulsion, spray, implants or injection and can be used for hot flashes and night sweats, vaginal symptoms, and osteoporosis. Local (nonsystemic) products affect only a specific or localized area of the body. They are available as a cream, ring, or tablet and can be used for vaginal dryness and painful intercourse.

“Sexual dysfunction among women became an even worse problem with the availability of Viagra and other products to treat ED,” explains Autry. “Many postmenopausal women suffering from vaginal dryness and thinning of the vaginal lining were suddenly dealing with painful intercourse as their partner’s sexual function improved. Locally applied hormones can be effective in treating these painful symptoms and help both partners enjoy a more satisfying physical relationship.”

Your healthcare provider should recommend an individualized plan specifically for you. There is no “one size fits all” hormone replacement therapy.

“Hormone therapy is not the only way to counter menopausal symptoms,” adds Autry. I recommend trying non-hormonal measures first.”

Trimm agrees. “It’s never too late to make lifestyle changes that may reduce your uncomfortable symptoms and improve your overall health and wellbeing. Avoiding high-fat foods, limiting intake of sodium, alcohol and caffeine, eating a healthy diet rich in whole grains, low-fat dairy, fresh fruits and veggies and getting regular exercise to boost mood, improve sleep and keep weight gain at bay, are all positive steps that may also reduce your menopausal symptoms. Don’t be discouraged, there are a number of treatment options, hormonal, non-hormonal and alternative, that can make this transition more bearable. Team up with your provider to develop the best plan of care for you.”

“I remind my patients that their quality of life is an important part of keeping them healthy. Body, mind and spirit are interrelated. The symptoms of menopause can affect every aspect of your life from your ability to concentrate on the job, to your interpersonal relationships and your self-image. Have an honest discussion with your healthcare provider about exactly what you are experiencing and carefully weigh the risks and rewards of treatment. Menopause doesn’t have to signal the beginning of old age. With lifespans increasing all the time, your postmenopausal years can last for decades. Make the most of it,” concludes Autry.

Ms. Michie Griffith-Autry, PhD, NP-C, earned her Bachelor of Science degree in nursing from Jacksonville State University, her Masters of Science degree in nursing from the University of Alabama Huntsville, and her PhD from Walden University. Her research dissertation was entitled Pelvic muscle strengthening: Impact on sexual functioning in the menopausal woman. Ms. Autry sees patients at Ovation Women’s Wellness at 4814 Lakeland Drive in Flowood.

Dr. Kristi Trimm attended the Kansas City University of Medicine & Biosciences-Osteopathic Medicine College in Kansas City, MO and completed her residency in family medicine at University of Missouri in Kansas City, MO. Her prior professional experience includes treating patients at Lee’s Summit Hospital in Lee’s Summit, MO. Dr. Trimm currently sees patients in Madison, Miss. at her Merit Health Medical Group clinic, located at 7732 Old Canton Road.

 

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