Frequently Asked Questions about Menopause

Here are the top 10 questions (well, actually 13) I am asked about menopause when discussing it with new patients.  For more information on the specific ways we treat menopause at Optimal Wellness MD, please click here.

What is menopause? 

Menopause is the time in a womans life, on average 50 years of age, when she ceases having menstrual cycles.  Typically menopause is diagnosed when no period has occurred for 12 months.  Menopause happens because the ovaries have stopped ovulating and the amount of estrogen, progesterone, and testosterone produced is drastically reduced.  The lack of these important hormones causes the typical menopausal symptoms.  Common symptoms are hot flashes, night sweats, fatigue, hair loss, skin ageing, memory loss, anxiety, insomnia, depression, weight gain, low libido, vaginal dryness, breast drooping.


What is perimenopause?

Perimenopause is the time just before menopause, when certain hormonal symptoms may occur even though a woman is still having menstrual cycles.  Common symptoms are insomnia, anxiety, PMS, heavy periods, breast tenderness, breast lumps, weight gain, migraine headaches.


What is postmenopausal?

Post menopausal refers to the time after a woman stops having periods permanently, from menopause through the rest of her life.  Menopausal symptoms often persist to some degree during this time.


Do I need treatment for menopause?

Whether to treat menopausal symptoms is always an individual choice; however, it is important to understand that these symptoms are due to the lack of important hormones.  The lack of these hormones may lead to adverse health results over the long term such as osteopenia (bone loss), increased cardiovascular disease, memory impairment and a higher risk of dementia, fatigue, and depression.  While drugs are available to help manage each of these conditions, many women elect to simply replace the missing hormones and thus not only relieve menopausal symptoms, but also reduce the risk of diseases developing as they age.


Do hormones increase my risk of developing cancer?  Some types of hormone replacement such as the synthetic progestin hormones and conjugated horse estrogen pills have been linked to a small increased risk of breast cancer; other types of natural bioidentical estrogens and natural progesterone do not appear to have the same risk.  It is important to understand that hormones must be prescribed in a balanced manner at the proper dose to avoid health risks; even natural bioidentical hormones must be balanced to avoid increased risk and annual mammograms or thermograms must be done to screen for breast cancer.  However, recent studies indicate no increased risk over usual background risk for women choosing natural bioidentical hormones when prescribed correctly.


Are there certain conditions where hormones are risky to use?  As with any medicine, some people have higher risks of adverse effects.  For example, women with a history of being overweight, smokers, history of blood clots, heavy alcohol use, have never been pregnant, had previous breast cancer are potentially at higher risk.  However, there are no absolute contraindications to the use of bioidentical hormones.  Each case is individualized and the risks and benefits must be explored by the patient and her doctor.  There are many ways to replace hormones and certain types of hormones may have more or less of a risk than others.  For example, estrogen-containing pills may increase the risk of blood clots, where creams and pellets do not.  In general, we avoid prescribing estrogen to women with a history of estrogen-responsive breast cancer, but she may be able to use testosterone and progesterone with no increased risk.


Is there a certain age I should consider hormone replacement?  Some studies suggest that the earlier a woman starts hormone replacement, the better off she is with less risk of adverse cardiovascular disease developing later if hormone replacement is started early.  I suggest starting HRT as soon as menopausal symptoms begin to develop or when menses become irregular or perimenopausal symptoms begin.


Are there natural treatments for menopause?  Certainly eating a healthy diet, exercise, maintaining a healthy weight can make the menopausal years healthier, but nothing is a substitute for those missing hormones.  There are herbs that may reduce the symptoms of night sweats and hot flashes, but they are not an exact match for your missing hormones and do not reduce the risks of disease due to menopause.


Why is sex painful after menopause?  The lack of estrogen due to menopause causes the vaginal lining to atrophy, leading to dryness and pain during sex.  This can be easily reversed with vaginal hormone treatments such as vaginal estriol cream or suppositories or by replacing the missing hormones throughout your entire body with creams, pellets, or other methods.


Why do I have a low libido after menopause?  This is due to the loss of estrogen and testosterone after menopause, poor sleep and fatigue due to menopause, vaginal atrophy which causes pain during sex, and the changes in the brain after menopause.  Replacing the missing estrogen, progesterone and testosterone hormones can restore a normal libido.


Why am I fatigued after menopause?  Fatigue has many causes, but if due only to menopause, it is likely due to a lack of testosterone and estrogen which both boost energy and mood and a lack of progesterone, which is needed for deep sleep and feeling rested.  When hormones are in balance, sleep is restful and deep, and women have plenty of energy.


I am losing hair after menopause.  What can I do about it?  Hair loss is very common due to menopause and can be stopped and often reversed with hormonal replacement.  In addition, in our practice, treatments such PRP scalp treatments with micro needling and medications such as minoxidil and finasteride have shown great results in growing back lost scalp hair.


Why am I gaining weight since menopause?  This is due to several reasons.  First, many women have an imbalance between estrogen and progesterone and become “estrogen dominant” during perimenopause and even after menopause.  This excess of estrogen causes fat storage.  Next, due to feeling depressed or anxious, many women tend to overeat or eat sweets or carbohydrates to excess, leading to weight gain. Third, the stress of not sleeping, and the anxiety associated with menopause raises cortisol levels, tending to cause fat to grow on the belly area.  Hormone replacement alleviates all of these causes and can help a woman lose weight with a proper diet plan and exercise.


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