The June 5 edition of the seminar series, Dining with Docs, focused on a subject near, but not dear, to females of a certain age range; menopause.
Dr. Kim C. Brooks, a board certified OB/GYN physician with Women’s Healthcare of Morristown, dispelled myths and shared the facts about menopause while attendees dined on a buffet prepared by Chef Lawrence Phillips at his downtown Morristown venue, Little City Catering.
“Menopause is the permanent end of menstrual cycles and is associated with the natural decline in your female reproductive organs,” Brooks said. “It’s also the end of your fertility. It doesn’t mean the end of your life; it’s just the end of your fertility and your periods. From my experience taking care of my patients, most are happy to see their periods go away. They may not be so happy about some of the things that come when their periods go.”
A woman is considered menopausal when she has not had a period for 12 consecutive months. Transition or perimenopause is usually a three to five year process. The average age of menopause is 51. “Anything less than age 40 is considered premature, is abnormal and needs to be evaluated,” Brooks said.
Family history can predict a woman’s age at menopause, according to Brooks. When a woman begins menopause is closely related to how old a woman’s mother or older sister was when she went through it. The age of a woman’s first period does not affect age of menopause. “It’s not usual for me to see nine-year-olds who have started their periods,” Brooks said. The startled reaction from her audience led the doctor to offer suggestions as to why young girls are maturing in this way.
“Some of why girls are starting earlier can be attributed to the fact that we are a well-fed society; how much you weigh determines when you start,” Brooks said. “And it can also be attributed to some of the things they are giving to animals we use for food. We’re getting those things too.”
“Women who smoke or who take chemo start menopause earlier, as do those who have had multiple ovarian surgeries. Pregnancy and breast-feeding or use of hormonal birth control methods do not affect the age of menopause,” Brooks said. Symptoms to watch for are irregular menstrual cycles, hot flashes, mood swings, difficulty sleeping, difficulty concentrating, changes in skin (discolorations similar to pregnancy spots on the face, for example), decreased sex drive, genital atrophy, urinary incontinence, bone loss and alterations in cholesterol levels.
Hot flashes are due to changes in reproductive hormones. “We think that includes the hypothalamus, the part of the brain that controls your body temperature,” Brooks said. In menopause, even slight changes in body temperatures can cause hot flashes. Smoking and obesity will increase the likelihood of hot flashes.
The good news is there are a variety of options for treating symptoms, according to Brooks, including hormone replacement therapy and a variety of anti-depressants and other medications like some seizure medications, blood pressure medication, herbal and dietary supplements and lifestyle changes.
Cooling the menopause fire maytake some trial and error. And, just to take the fun out of things, ingesting hot or spicy food, caffeine and alcohol increases hot flashes. Hormone replacement therapy (estrogen and progesterone) is probably one of the more effective in relieving symptoms, Brooks said. The recommendation by doctors is the lowest effective dose for the shortest period of time.
Estrogen alone should not be used by women with a uterus; there is a risk of cancer in the lining of the uterus. Woman who have had a hysterectomy can be prescribed estrogen alone for symptoms. Hormone replacement therapy does have risks (blood clots in legs or lungs, stroke, heart disease) but if started in early menopause, there is a lower risk for heart disease.
“If you had your last menstrual period at 50, then asked for HRT at 60, I would say no because it would increase the risk for heart disease,” Brooks said. She added there is an increased risk of dementia for women who are taking both estrogen and progesterone. “When I first completed residency, a hysterectomy would mean prescribing hormones for the rest of the patient’s life,” Brooks said. “But we don’t say that anymore. We are just trying to get you through this period in your life.”
There are some women who have been on a type of HRT for decades and are doing fine, according to Brooks; most are women who still have their uterus – “We still address it every year, during their physical exams,” she said. Brooks emphasized that HRT should not be stopped during stressful times in a woman’s life. “Quality of life is a reason to stay on hormone replacement therapy, especially if they have had a hysterectomy,” Brooks said. Vaginal estrogen helps dryness and pain and is available in pill form, creams and a ring.
“I felt like we had to talk about bio-identical hormones: man-made hormones (estrogen, progesterone and testosterone),” Brooks said. Claims that these forms are safer are not really true. There is not any scientific evidence that shows that bio-identical hormones are any safer than traditional hormones.” The ingredients are essentially the same in both traditional and bio-identical hormones, according to Brooks. “Bio-identical hormones are compounded, so the formulations could vary,” she said.
Some medications used for treating depression and seizures may help to relieve hot flashes. Medications that have been scientifically proven to be effective for treating hot flashes in Effexor (venlafaxine), Paxil (paroxetine), Celexa (citalopram) Lyrica (pregabalin), Pirstiq (desvenlafaxine), Prozac (fluoxetine) and Neurontin (gabapentin). Herbal and dietary supplements are not necessarily safe just because they are labeled “natural,” according to Brooks.
They can have side effects and may interact with medications. For example, black cohosh should not be used if a woman has liver problems, although flaxseed or flaxseed oil may help with mild symptoms. Calcium is needed to prevent bone loss, but is best absorbed and most effective when obtained through food sources, not supplements. Vitamin D is needed to absorb calcium. Wild yam and ginseng are not known to be effective and DHEA carries a possible increased risk of breast cancer with long term use. Dong Quai should not be taken with blood thinners because it slows blood clotting. Soy foods have been found to be modestly effective in relieving mild hot flashes.
Brooks had one last warning for her dining companions. “Fertility in menopause is unpredictable,” she said “If you have not gone at least 12 months without a menstrual cycle, you may still be fertile and need some kind of contraception to prevent pregnancy.” She added that rates of spontaneous twins and triplets are higher in premenopausal women. Until a woman is menopausal contraception is still needed. Bleeding after a woman is menopausal is abnormal and requires investigation.
The Dining with Docs seminars are presented by Morristown-Hamblen Healthcare System and Covenant Health. To learn more about Dr. Kim Brooks or to schedule an appointment visit www.womenshealthcaremorristown.com.
Article courtesy of Citizen Tribune, published Sunday, June 10, 2018.
By Glenna Howington, Tribune Staff Writer