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Ask the Expert: Menopause Ready or Not

Online Health Chat with Holly Thacker, MD

November 13, 2009 | Reviewed on January 20, 2014 by Holly Thacker, MD

Introduction

Cleveland_Clinic_Host: Are you confused about hormone replacement therapy? Do you wonder if you really need a yearly mammogram? Do you want to check which foods affect PMS?

Many women have questions about their health care. Dr. Holly Thacker, the author of The Cleveland Clinic Guide to Menopause, has written a compassionate, practical guide that gently reminds women that midlife is not only a time of change but also a time of great freedom. Now is the time to ask questions about hot flashes and how to get a good night's sleep; the facts about vitamins, supplements, and antidepressants; using diet and exercise to boost energy; the basics of good bone health; preventing cancer and heart disease; and how to recharge your sex life.

Dr. Holly Thacker is the founder of the interdisciplinary Cleveland Clinic Center for Specialized Women's Health and is a trailblazer in women’s health. The executive director of Speaking of Women’s Health and author of several books on women’s health, Dr. Thacker is recognized as a national leader in women’s health issues.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Holly Thacker. We are thrilled to have Dr. Thacker here today for this chat. Let’s begin with the questions.


Overview of Menopause

linda33469: I am a 57 yr old woman who has no perimenopausal symptoms with regular periods. My periods follow regular 30 day cycles with rare exception. (Yes, I am over all of this). I am scheduled for a TVH next month. How will I know when I go thru menopause? I have had no hot flashes, minimal vaginal dryness, etc. I have requested that I keep my ovaries as they continue to secrete hormones. How will I know?

Speaker_-_Dr__Holly_Thacker: You can request to have hormone blood tests done after your hysterectomy to find out when you go into menopause.

Linda33469_2: Thank you Dr. Thacker. Is there any value to doing hormone levels pre hysterectomy?

Speaker_-_Dr__Holly_Thacker: Only if there is a concern about menopausal status. If you are clearly premenopausal prior to hysterectomy, that information does not help.

g: My mother experienced alternating unilateral edema of face and hand despite she has no chronic illness except hypertension. Can this be considered menopausal symptoms?

Speaker_-_Dr__Holly_Thacker: No. Your mother should be seen by a doctor for evaluation.

nystrom: Does menopause differ for women that have never been pregnant or given birth?

Speaker_-_Dr__Holly_Thacker: No, other than if women have been on birth control pills and/or have been pregnant and not experienced a blood clot, we are less likely to be worried that they will have a blot clot while on menopausal therapy. The greatest risk of hormone therapy is the rare risk of blood clot.

velph26: What effect does taking fertility meds have on the course of menopause?

Speaker_-_Dr__Holly_Thacker: None. Menopause is primarily determined by how many eggs you are born with.

maria: I am 35 years old and haven't had a period in over a year. My Dr. told me that I am going through menopause. Are symptoms worse or less when you go through menopause early compared to in your 50's?

Speaker_-_Dr__Holly_Thacker: It is abnormal to go through menopause under the age of 40. Not all women who stop their period are having menopause. Women who go through early menopause are at higher risk for osteoporosis and possibly heart disease.

Pauls: I am taking flax seed and fish oil to help lower my cholesterol and I was concerned if this would affect anything with menopause.

Speaker_-_Dr__Holly_Thacker: No. However some women taking daily omega 3 may have a higher risk of breast tenderness.

larrysgirl: When taking calcium with vitamin D in it, do I need to take extra vitamin D? And how much calcium is the right amount?

Speaker_-_Dr__Holly_Thacker: Most calcium supplements only have 200-400 IU (international units) of Vitamin D and most folks in Northern climates need 1,000 to even 2,000 IU of Vitamin D3 daily. The maximum dose of Vitamin D is 10,000 IU daily. You can ask your doctor to measure your 25-OH Vitamin D level if you are unsure of how much Vitamin D you should take.

raleigh: What does it mean if you have high testosterone levels? What are the risks?

Speaker_-_Dr__Holly_Thacker: High testosterone levels can happen with polycystic ovarian syndrome (PCOS) and some rare ovarian and/or adrenal tumors. High levels can also occur if women take high doses of compounded testosterone products, over the counter DHEA and/or if they get exposed to testosterone products from the skin of their male partners who are on testosterone gels. High testosterone can lead to acne, oily skin, hair loss, voice deepening, elevated blood count and potentially mood changes.

maria: Why do some women go through menopause early? Are there any advantages?

Speaker_-_Dr__Holly_Thacker: It is nice to not have a period! And it is nice not to worry about childbearing and unintended pregnancy. However women with early menopause need to be evaluated for osteoporosis risk and for genital atrophy/thinning of the vagina and bladder.


Perimenopause

lazysusn: What is the difference between pre-menopause and perimenopause?

Speaker_-_Dr__Holly_Thacker: Pre-menopause is the normal reproductive time frame with normal menses and no symptoms. PERI-menopause or menopause transition is the time period right before and a year after the final menstrual period where there may be menopausal symptoms, hot flashes and menstrual changes.

kiddiekat: What are some of the signs that menopause or perimenopause is starting? I am experiencing PMS symptoms I have never had before. My nipples are very tender for many days, I have bloating. I also have shorter periods, but heavy, with a lot of clotting. Also I get cramps when I have never had them before. They are also a little irregular. Are these signs or does it sound like some other problem? I am only 42.

Speaker_-_Dr__Holly_Thacker: This sounds like a combination of PMS and perimenopause. I would recommend seeing a women's health specialist for an evaluation.

seagulls: My periods are still regular and I am experiencing night sweats (legs and neck) but not hot flashes yet. I am 53 years old. I have a couple of questions. Is this considered to be perimenopause? Is there any chance that I might not have to experience hot flashes?

Speaker_-_Dr__Holly_Thacker: Yes, this sounds like perimenopause and night sweats are an equivalent vasomotor symptom to hot flashes. You should keep track of your menstrual cycles and visit your doctor.

angelica: How long can perimenopause last? Or to put it another way, what is the oldest one would go through menopause?

Speaker_-_Dr__Holly_Thacker: Perimenopause, on average, lasts for 1-3 years. However, perimenopause can also last for up to 5-7 years in some women. The average age is 51/3 years. However some women may not reach it until their late 50's. Having menopause prior to the age of 40 occurs in 1% of women and is abnormal.

angelica: I am having hot flashes but still get my period regularly. How is perimenopause diagnosed?

Speaker_-_Dr__Holly_Thacker: Ironically, menopausal symptoms are most intense prior to the final menstrual period that is menopause. Perimenopause is diagnosed by looking at symptoms, age and menstrual pattern.

babs: I saw you at Speaking of Women's Health last week. You talked about hormone therapy. Should I begin taking hormone therapy when I begin perimenopause to prevent symptoms?

Speaker_-_Dr__Holly_Thacker: We usually don't start hormones preventatively; rather we use them as treatment. Some women who need contraception may take hormonal contraceptives in perimenopause, which can certainly ease the transition and eliminate many perimenopausal symptoms.

lazysusn: Can I get pregnant if I am perimenopausal?

Speaker_-_Dr__Holly_Thacker: YES! After teenage girls, women in their 40s or 50s are at highest risk for unintended pregnancy. Until you have gone at least 12 months without a period over age 50 can you safely assume you will no longer be ovulating.


Symptoms of Menopause

vparker568: If I already had a hysterectomy at 29 years old and now I am 59 now and have been on 2.5 mg Premarin since then and have had no problems since then, not even a hot flash, I can't even relate to post, pre or and any other word that goes with menopause, should I be apologizing for it?

Speaker_-_Dr__Holly_Thacker: No. No need to apologize for feeling well. However, with aging the metabolism of estrogen changes and the 2.5 dose is a high dose, so I would recommend talking to your physician about lowering the dose to lower the risk of stroke, particularly after the age of 60.

bucq9n: I recently went off HRT after being on it for about 14 yrs (I am 56). Hot flashes and night sweats have returned. I have heard about black cohosh - do you recommend trying it. Do you recommend anything else? The lack of good sleep due to the night sweats is really getting to be an issue. Any suggestions?

Speaker_-_Dr__Holly_Thacker: I would recommend that you read my book "The Cleveland Clinic Guide to Menopause". I don't specifically recommend black cohosh as it does not help that much with hot flashes and has been associated with liver toxicity. You may want to speak with your physician about going on a low dose of hormone therapy as you are one of the few women who still experience symptoms when they go off of therapy.

goldengirl: Many of my girlfriends have said that when they are/were going through menopause that their menstrual flow was so heavy it was difficult to leave home for a day or more? Is this normal for everyone because I am not looking forward to it if that is the case?

Speaker_-_Dr__Holly_Thacker: It is not normal to have heavy flow like that. Any woman who has flooding should be evaluated. There are many NON-hysterectomy alternatives for women.

goldengirl: Would hormone therapy or other options prevent the heavy menstrual flow?

Speaker_-_Dr__Holly_Thacker: Yes, many times hormonal contraception and/or the Mirena IUS can work. First evaluation for anatomic abnormalities and bleeding disorder must be done.

huckster: What can be used to increase libido after menopause. It was never really great to begin with but now there is absolutely no libido to speak of.

Speaker_-_Dr__Holly_Thacker: Many normal women do not spontaneously have a sex drive after menopause as the purpose of the sex drive is for reproduction. Medically what we look for is: Do you have pleasure? Do you have pain and are you attracted to your partner?

freckles: Is there any way to prevent menopause symptoms? Even if it means taking hormone therapy or something else?

Speaker_-_Dr__Holly_Thacker: There are several options to treat menopausal symptoms that can be individualized to the woman. Women should NOT have to suffer. There are many options.


Hormone Therapy & Non-Hormone Options

emogeney: HRT treatments - does it matter at what age you begin taking HRT. Menopause began for me 5 yrs ago at age 53.

Speaker_-_Dr__Holly_Thacker: The benefits are greatest and the risks are the least when you start within 5-10 years of your last menstrual period. If you have symptoms and are under the age of 60 and /or within 10 years of menopause, the benefits of hormones outweigh the risk for most women.

rosalie: Is it safe to take a low dose estrogen (I've read 20 mcg) or another hormone formula to ease the transition when discontinuing BC pills at age 53? Since I stopped the pill I had one period, then missed the next, and am having nausea (have lost 5 pounds), joint pain at night (therefore less sleep), and brain fog/mild depression. Two doctors insisted I come off the pill though I have no risk factors, due to possible blood clots. Thank you.

Speaker_-_Dr__Holly_Thacker: You have a complicated history. I think you would be best served by seeing a hormone expert.

Pauls: I am taking flaxseed. Is this going to affect my hormone levels? Is there a difference if you take hormone therapy or not?

Speaker_-_Dr__Holly_Thacker: No. It is important to ingest omega-3 foods 2x a week. I otherwise don't recommend taking daily flaxseed or fish oil unless there is another reason for it, as this is extra calories.

nystrom: Does everyone have to end up on hormone therapy or only if you are experiencing menopause symptoms?

Speaker_-_Dr__Holly_Thacker: This needs to be individualized. Menopause is a normal life event. Some women make hormones on their own and do well. Others don't and do poorly. Others are in between. However, if you are post menopausal and not on hormones, you need to pay particular attention to the status of your bone and vaginal health as these two areas can be sensitive to the loss of estrogen.

bucq9n: My mother had breast cancer, post menopause, at age 56. I am now 56 and experiencing night sweats so considering going back on HRT. Is my mother's history of breast cancer a significant risk?

Speaker_-_Dr__Holly_Thacker: Having a family history of breast cancer increases your risk of breast cancer. However, most breast cancer is not genetic and taking hormone therapy, particularly for under 5 years, does not increase the risk of breast cancer. Furthermore, estrogen alone in women who have had a hysterectomy does NOT increase the risk of breast cancer. However, if you have a uterus, you need progesterone along with the estrogen. 80% of women diagnosed with breast cancer have never taken hormone therapy, while 20% have.

birdgirl: I was prescribed Premarin® for vaginal dryness. Will this form of estrogen “trigger” more migraines since I have been a sufferer for 40 years?

Speaker_-_Dr__Holly_Thacker: In general, no. As local vaginal estrogen does not have systemic effects.

alexandra: Are there any non-hormone options for symptom relief?

Speaker_-_Dr__Holly_Thacker: Yes, although none are FDA approved.
We can use NSRI medicine such as Effexor® or Pristiq® as well as anticonvulsants like Neurontin® to help reset the brain's thermostat. Many times lifestyle changes can help. Please read the chapter in my book "The Cleveland Clinic Guide to Menopause" for more information on dealing with non-hormonal options for hot flashes. There are alternatives to estrogen for the bone and non-hormonal lubricants and moisturizers for the vagina that can be tried.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Holly Thacker is now over. Thank you again Dr. Thacker for taking the time to answer our questions about menopause.

Speaker_-_Dr__Holly_Thacker: Thanks for having me!


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