Women’s Health and Menopause

Feel comfortable talking to your doctors.

Although most women experience perimenopause in their mid-40s and find themselves transitioning to menopause by their early 50s, it's not a topic everyone is comfortable discussing.

A woman has reached menopause after her menstrual periods have stopped for 12 consecutive months. The average age of women in the United States reaching menopause is 51.

"During perimenopause, some women will find themselves facing various symptoms such as irregular cycles, heavier cycles, hot flashes, night sweats, vaginal dryness, painful intercourse, and changing moods and sleep patterns," said Juliana Verticchio, MD, OB/GYN, on staff at Missouri Baptist Medical Center.

"The most common symptoms of hot flashes and night sweats, also referred to as vasomotor symptoms, are experienced by 50 to 80 percent of women, but only 20 to 30 percent seek medical treatments," she said. "We still find a lot of women don't talk about menstrual-related symptoms, but they may find some relief by talking to a physician about the many treatment options available."

Looking for help.

When Rhonda White sought a new OB/GYN, she was desperate to find relief. The 50-year-old wife and mother had been living with menopausal symptoms that were making her miserable, and she couldn't do it any longer.

"In the last year, I was having hot flash after hot flash every hour. I'd wake up soaking wet during the night and sometimes get up two to three times a night," she said. "I was extremely moody and crabby, and the stress was too much. It was just terrible, and I needed help."

White would often discuss her symptoms with friends, and they'd share their similar experiences and the ways they were managing their own menopause.

"I tried dressing in layers and eliminating alcohol and caffeine, but nothing worked," said White, who in 2009 had an endometrial ablation to help reduce heavy bleeding and continuous discomfort.

White contacted the office where partners Laura Donnelly Mueller, MD, and Erin DuMontier, MD, are both OB/GYNs, and on staff at Missouri Baptist.

"I went to Dr. Donnelly, and we discussed several options," White said. "I was aware of the hormone therapy patch and how it helped others I knew, so I was willing to give it a try."

Dr. Donnelly said White was just about the average age for menopause and had stopped having periods for more than a year.

"She had menopausal symptoms that were interfering with her life, and given her duration of symptoms and worsening of symptoms, I felt treatment was indicated," Dr. Donnelly said. "She was interested in relieving her most bothersome symptom, hot flashes."

Although there are alternative options other than hormones, Dr. Donnelly said none are as effective at relieving hot flashes than hormone replacement. After discussion with White about the risks and benefits, she prescribed a lower-dose hormone replacement patch.

"The patch has made a world of difference and been life-changing for me," White said. "Dr. Donnelly explained everything to me, and I understood there might be risks such as spotting. But my symptoms aren't there any longer, no hot flashes, and I'm able to sleep through the night."

White said Dr. Donnelly checked in with her to follow her progress with the patch and ensure that it was the right solution.

"I felt really good about my decision," said White, who works from home and also has been caring for elderly parents. "Being able to eliminate symptoms has helped to alleviate a lot of stress in my life. I can go to bed and have a full night of sleep, feeling rested."

Finding what's best for you.

Patients seeking relief from menopausal symptoms can take several paths to find what works best for them.

Drs. Donnelly, DuMontier and Verticchio all agree that, for some patients, there are behavior modifications that can provide relief for many symptoms and help with the stress many women experience at this time. These can include:

• Dressing in layers, both day and night
• Sleeping in light pajamas
• Having a fan at your desk at work or overhead while sleeping
• Avoiding hot, spicy foods and drinks
• Drinking cool beverages
• Limiting caffeine and alcohol intake
• Eating a balanced diet
• Incorporating weight-bearing exercise to build muscle mass

Although hormone therapy is a standard treatment, particularly for patients experiencing hot flashes, night sweats and vaginal dryness, it is not for everyone. It would not be recommended for patients who have estrogen-dependent cancers such as breast or uterine, unexplained vaginal bleeding, a history of blood clots, uncontrolled high blood pressure, or a history of heart attack or stroke.

For women who are not candidates for hormone therapy, or those who desire to avoid hormones, there are non-hormonal options.

"Although estrogen remains the gold standard to relieve symptoms, women should be aware of alternative treatment options and ask their physicians about them," said Dr. Verticchio.

"For younger patients particularly, if symptoms are interfering with their quality of life, hormone therapy at the lowest effective dose for the shortest amount of time can be very beneficial," Dr. Donnelly said.

"Every patient is different, and, therefore, no one patient experiences the symptoms of menopause in the same way," said Dr. DuMontier, adding that each patient's care should be personalized to meet their needs and lifestyle.

Taking steps to remain healthy.

When women reach menopause, they are also at an age when many women are at an increased risk for heart disease, stroke, diabetes and other related concerns.

According to the American Heart Association, menopause does not cause cardiovascular disease. However, certain risk factors for heart disease increase around the time of menopause, and a high-fat diet, smoking or other unhealthy habits that began earlier in life can be harmful.

"In the past, physicians recommended hormone therapy for primary and secondary cardiovascular disease, but subsequent studies have been either inconclusive or even shown an increased risk for patients on hormone therapy, so it is no longer prescribed for that reason," Dr. Verticchio said.

In addition, women are encouraged to follow the guidelines for annual mammograms recommended for age 40 by the American College of Obstetricians and Gynecologists and colonoscopy at age 50 for average-risk individuals.

Beyond menopause.

Once a woman reaches postmenopause, she may still experience symptoms.

"Even after age 65, or many years after menopause, women have symptoms including hot flashes, night sweats or difficulty sleeping," Dr. DuMontier said. "It's important that patients continue seeing their doctor and are re-evaluated when they are postmenopausal, especially when they are taking hormone therapy. They should be monitored for any new medical problems that may occur."

For example, if a woman who has gone 12 months without a period experiences unexpected bleeding, that is abnormal and she should call her physician's office immediately, Dr. Donnelly said.

"We would want to see a patient as soon as possible to determine the cause of bleeding," she added. This would include a physical exam and possible tests such as a transvaginal ultrasound or endometrial biopsy. These tests are conducted to determine if a patient might have endometrial hyperplasia that could lead to endometrial cancer.

Most of the time, bleeding is due to atrophy of the vagina when the endometrium, or tissue that lines the uterus, has become very thin, leading to unexpected bleeding.

"Patients should feel comfortable bringing up any subject with their OB/GYN," Dr. DuMontier said. "We are here to help with any symptoms you may be experiencing."

Laura Donnelly, MD, is an OB/GYN on staff at Missouri Baptist Medical Center. She received her medical degree from the University of Kansas Medical School. She completed a combined internship/residency at St. Louis University Hospital.

Erin DuMontier, MD, is an OB/GYN on staff at Missouri Baptist Medical Center. She received her medical degree from Southern Illinois University School of Medicine in Springfield. She completed her combined internship/residency at George Washington University.

Julianna Verticchio, MD, is an OB/GYN on staff at Missouri Baptist Medical Center. She received her medical degree from Loyola University Stritch School of Medicine in Chicago. She completed her residency at Washington University School of Medicine.