Sept. 29, 2010 -- Every woman goes through menopause, but there are some common misconceptions about "The Change."
Savard tackles the most intimate questions women have about the female reproductive system in her new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions."
You Asked, We Answered
Note: Some questions have been slightly edited for clarity and to ensure anonymity for the submitter.
Joni asked: I'm 52 and have already gone through menopause. I have been through it about a year and a half. Is there anything that can help with hot flashes/night sweats. I know that caffeine and alcohol are to be avoided or restricted. It doesn't seem to matter what I do, the hot flashes/night sweats just don't stop. I am hesitant taking HRT. Are the hot flashes/night sweats going to be with me forever?
Savard answered: You are not alone. About 80 percent of women will experience hot flashes to some degree at menopause and unfortunately for some women they can last years. I have a few patients who took small amounts of estrogen for their lifetime just to dampen their hot flashes. But for most women they will eventually disappear. Unfortunately the other effects of low estrogen such as bone loss and urinary and vaginal dryness will get worse with time. There are ways to minimize the symptoms, but studies have shown that there is nothing better than estrogen to relieve hot flashes and night sweats. A large analysis of alternative therapies found that nothing else worked -- except perhaps for soy foods and the herb black cohash (which can effect the liver and is only advised for up to 6 months of use). Unfortunately the decision to start estrogen is a big one -- but well worth a consideration if you are losing sleep and the hot flashes are impacting your life. Most experts now agree that for women in the throws of menopause, taking estrogen in the smallest dose to relieve symptoms is safe and quite effective. I take a small dose of an estrogen patch which minimizes any bad effects of estrogen pills and helps yet is enough to help me with sleep and dry vaginal tissues. If you have a uterus, you would need to add progesterone each month as well to balance out the estrogen. I take a natural progesterone capsule that comes as a prescription. I would recommend however that you work with your practitioner to make this decision. Women with a history of breast cancer and blood clots are generally not advised to take estrogen. If living a healthy lifestyle, which it sounds like you are trying to do, is not enough then perhaps just a short period of a year or so of estrogen may make all the difference. You can stop estrogen at any time.
Lana asked: For many women, menopause begins long before we become grandmothers. Could you please explain a bit about peri-menopause? When does it begin, at what age, and what are the signs and symptoms to look for?
Savard answered: As I mentioned in the segment on GMA today, a woman's ovary can begin to slow down production of eggs and the hormones estrogen and testosterone over a 5-10 year period. As the hormone levels become more erratic and decline, women can experience irregular and often heavier periods, reduced libido or sex drive, night sweats, and even mood changes and palpitations. Dry vaginal and urinary tissues tend to come later. Every women is different. The average age for most women to be at menopause (meaning no period for 12 months) is about 51. If your mother and grandmother went through earlier menopause -- you may as well. On the other hand environmental factors like smoking can bring on menopause about 2 years early. With the onset of perimenopause it is a good time to adopt as many good health habits as possible including adding extra calcium and vitamin D to your diet to minimize the inevitable bone loss -- and ask your practitioner to review your heart risks as well.
More Menopause Questions
Janet from Va., asked: I'm 48 and still getting normal periods. Right before my period I get extremely agitated with a racing/fluttering heart. I sometimes worry that maybe I am having a heart atttack, but am pretty convinced it is a pre-menopausal condition. Are agitation and heart racing a condition of pre-menapause?
Savard answered: The quick and easy answer is YES -- agitation and heart palpitations are common symptoms in women going through menopause. HOWEVER, as I am sure you know, heart disease is also a big concern in 48-year-old women and often can get missed. Before simply assuming your symptoms are all hormonal, I would have your regular physician do a complete check up including test of thyroid function, blood pressure check and a heart assessment.
Madeline from Calif., asked: I went into early and haven't had a period since I was 37. I was on Prempro for 5 years. I am now 47. I was wondering if since I haven't had a period for ten years, and since I went into menopause early will I age more quickly? I no longer have night sweats and hot flashes as I did for about 2 years. I also would like to know what I can do or take to enable a healthy life after menopause.
Savard answered: You experienced what we now cause premature menopause. Heredity and autoimmune conditions such as thyroid disorders and chemotherapy can lead to ovaries reduced function and menopause. Women who go through early menopause before age 40-45 should consider hormone therapy -- which you did. The two years of hormones likely helped you. Hormones help preserve bone mass and reduce future risk of heart disease and even reduced life expectancy for young women. I would recommend that you get a bone density test to evaluate your bone mass and to have your practitioner review your heart risk factors such as blood pressure, lipid levels, etc. Depending on the results you will want to reduce any risk factors as much as you can. We do know that extra calcium and vitamin D with exercise can minimize bone loss ? and a healthy diet, exercise and avoiding smoking and stress can reduce heart risk. Also look to your family history and lifestyle as the biggest clues to your future health. Your age at menopause is only one factor.
Patti asked: If you are on estrogen replacement, how long do you need to stay on it? Is it for the rest of you life or just for a certain time period?
Savard answered: Although for many years we believed that many women could benefit from lifelong estrogen treatment, we no longer think this way. Most research suggests that the increased risk of breast cancer is very small if any after the first few years but rises somewhat after 4-5 years on estrogen. On the other hand, once you stop estrogen, progressive bone loss and dry vaginal tissues will continue. Some women try to taper off estrogen slowly after a few years and see how they feel. If hot flashes don't come back, they then stop altogether and use other means to improve their bone strength and minimizes vaginal dryness.
Carolyn asked: Is it normal to have a little spotting ten years after your last period?
Savard answered: It is not normal to have any spotting or bleeding 10 years after your last period unless you are on hormones. If you are on hormones, some typical bleeding pattern or spotting may be seen, but even then you should alert your doctor to your bleeding pattern. Although a common reason for spotting is dry atrophied vaginal tissues and spotting after painful sex, a worrisome cause would be cancer of the lining of the uterus. All women who spot after they go through menopause should have a thorough gynecologic exam and a uterine ultrasound and or uterine biopsy. I have had both and can assure you they provide great peace of mind and can be done in a doctor's office. Only if something suspicious is found will you be advised to have a surgical procedure. Please don't hesitate or be afraid of getting checked out by a gynecologist.
Ann asked: I'm 50 years old. My periods have been irregular and appear to have stopped. My doctor did a blood test and followed up that my hormone levels are consistent with menopause and that if I have any bleeding I should come. I really have no symptoms that are unbearable -- a few hot flashes -- more like small panic attacks. I don't sleep as well at night, etc., but nothing that warrants taking medication for. Do I need to do anything besides my annual checkup, eating right and getting exercise? Also when filling out other forms, such as for an X-ray of my shoulder, how do I answer the question: "Date of last period?"
Savard answered: Not until your period has stopped for 12 months can you say you are definitely in menopause. Your blood test (the FSH test) may be high consistent with menopause, but it is not precise and may still be fluctuating. Until it has been a full 12 months I would answer that you are in the perimenopausal period. So far it sounds like you can avoid estrogen for now. As long as you are living a healthy lifestyle, have good bone density and low heart risk, you don't need to do anything more. Don't forget a colon cancer and breast cancer screen too however. By age 50, all adults need some colon cancer screening.
Kathleen from Pa., asked: I hear all these women my age telling me the problems they are having with menopause. I'm 50 and have no symptoms. I hope this continues. But, maybe I have not started it yet. When does menopause start and how long does it last?
By age 50 your ovaries have surely begun to reduce hormone production however some women have absolutely no symptoms and their period abruptly and permanently stops. Congratulations if that is you. Don't count yourself through menopause until you have gone 12 months without a period.
Roberta asked: I'm 55 and have been struggling the last three years with menopausal symptoms. I finally gave in and started taking hormone treatment last May (2009). I suffered from night sweats, insomnia, hot flashes, mood swings, you name it up to the point it was overwhelming and interfering with my day-to-day life. My doctor put me on Angeliq, a pill that is a combination of estrongen and progesterine. The first months were great -- it was like a miracle pill! My symptoms vanished. However, one problem was that I was bleeding constantly. My doctor ordered vaginal ultrasounds and even a uterine biopsy (very unpleasant) to rule out medical issues. But now, many months later, I have my symptoms back and the bleeding issue continues. I am told by my doctor I only have one other alternative and that is to take a different hormone for the first 25 days of the month, then go off, have my period and the at the first of the month go back on the pills. I am not convinced this is best for me. I still take the Angeliq, but I know it is what is causing my bleeding. Before the pills, I was barely ever having a period. Please give me some advise. Should I see a different doctor? My doctor is good, but his practice centers around his OB patients more than those in my situation.
Savard answered: Angelique is a newer hormone therapy that combines the traditional estrogen (in the form of estradiol) and a progestin (a newer chemical called drosperinone which is promoted to be safer on the heart, but not proven so) in one pill that you take continuously. I'm generally opposed to taking continuous hormones as the risk of spotting and irregular bleeding can sometimes persist for up to a year or more and the theoretical risk to the breast is greater with continuous treatment. There is no long term safety information on the use of this particular combination in postmenopausal women. Your doctor is correct to recommend as an alternative: take estrogen daily each month and add 10 -12 days of a progestin to balance out the estrogen and bring on a period. In this case, the period is often light, predictable, and may eventually disappear. On the other hand, many women eventually stop bleeding on Angelique or the combination hormones if they give it enough time. I talk about the precise hormone treatment that I take in the book -- and why that makes sense for me.
Gail from Ill., asked:I've been on the pill for years and years. I'm now 54 and the doctor wants me to go off of it. I'm scared. Should I go off or stay on? What affect is it having on me and going through menopause?
Savard answered: As I mentioned on GMA today, birth control pills are up to 10 times stronger than postmenopausal hormone therapy and obviously much more than you need to be healthy. There are potential risks to continued use of birth control pills including blood clots and high blood pressure ? and possibly breast cancer. It is not uncommon for women to take low dose birth control pills up until they go through menopause and beyond. Unless you stop the pill there is no way to know whether your ovaries have stopped functioning. Just because you got a period on the pill doesn't mean your ovaries were still working. As women approach the menopause age, most doctors will suggest a woman stop the pill and then check a blood test about 5 days into the next cycle. If the FSH is very high in menopause range, this is a clue that menopause may have occurred. By age 54, you are likely near if not already through menopause. The pill will not hasten or postpone menopause -- it simply gives you the hormones you need to suppress an egg (if you are still premenopausal) and will cause regular bleeding for any women regardless of her menopause status. As I mentioned in my book, my blood pressure went up on the low dose pill that I was taking to regulate my heavy periods before menopause. I am glad I discovered it and stopped the pill as my blood pressure is now fine on a low dose estrogen patch.
Carole from Wash., asked: I'm 75 yrs old and still having hot-flashes. Mostly at night, so I guess they are called "night sweats." Is this normal? And what can I do for this problem? My gynecologist (many years ago when I stopped taking hormones), said they could stop tomorrow and could continue forever. Don't really enjoy the "forever."
Savard answered: About 80 percent of women will experience hot flashes to some degree at menopause and unfortunately for some women (such as you) they can last years. I have a few patients who took small amounts of estrogen for their lifetime just to dampen their hot flashes. But for most women they will eventually disappear. Unfortunately the other effects of low estrogen such as bone loss and urinary and vaginal dryness will get worse with time. I presume you have experienced these problems to some degree. There are ways to minimize the symptoms, but studies have shown that there is nothing better than estrogen to relieve hot flashes and night sweats. A large analysis of alternative therapies found that nothing else worked -- except perhaps for soy foods and the herb black cohash (which can effect the liver and is only advised for up to 6 months of use).
Most doctors would not begin estrogen at age 75 because the risks would outweigh the benefits. Other medications that doctors have tried successfully include a low dose of some of the antidepressants, a blood pressure pill (clonidine) or gabapentin (a sedating pain and seizure medication). For some reason, these pills can be effective but I would only recommend if the hot flashes were incapacitation.
Menopause and Sex Drive Questions
Chris from Fla., asked: My wife has been going through menopause for a couple years now and as a husband I do have a question or two. She is also suffering from severe bone loss due to the menopause. With all these problems, sex between us has come to a complete stop. I have tried to be a completely understanding husband of 39 years, but is there anything I can do to make life a bit easier? I truly love her and intend to remain a completely loyal and understanding husband. Is there anything I can do? Pleasse advise and thank you in advance!
Savard answered: Not that it helps to say this, but you are not alone. I would first recommend that your wife have a good working relationship with a practitioner who can help her diagnose and treat all the potential medical problems she is having -- including giving her a low dose of vaginal or patch estrogen if she can safely take it. On the other hand, there are so many reasons why women have a reduced interest in sex at menopause that I hesitate to suggest that estrogen alone will solve the problem. Estrogen does not improve the libido. Sometimes stress, lack of sleep, worry about all sorts of things can make matter worse. Perhaps once she has had any possible medical things treated (including any depression, thyroid disease, dry vaginal tissues, etc.) -- perhaps you can both ask her physician to refer you to a kind sex therapist. They can be of tremendous help.
Paula asked: I'm 58 years old and going through menopause. My main concern is I have little or no libido. Can hormone replacement help? Is there anything that can help with this problem. My husband would so appreciate your help. Thank you.
Savard answered:I will answer you as I have answered previously: Not that it helps to say this, but you are not alone. I would first recommend that you have a good working relationship with a practitioner who can help you diagnose and treat any potential medical problem you may be having, including trying a low dose of vaginal or patch estrogen if you can safely take it. On the other hand, there are so many reasons why women have a reduced interest in sex at menopause that I hesitate to suggest that estrogen alone will solve the problem. Estrogen does not improve the libido. It is testosterone, which also goes down by 50 percent at menopause, that is important for libido. Typical hormone replacement does not include testosterone although there is one prescription that does. "Bioidentical" hormones often have testosterone as part of the mix, but you need to find a special physician to prescribe and I am not totally convinced of the long term safety of the hormones with added testosterone. Studies have shown in women that testosterone patch can help but there are safety concerns including possible increased breast cancer risk. Sometimes stress, lack of sleep, worry about all sorts of things can make matter worse. Perhaps once you have any possible medical things treated (including any depression, thyroid disease, dry vaginal tissues, etc.) -- perhaps you can your physician to refer you to a kind sex therapist. They can often be of tremendous help.
CLICK HERE to read an excerpt from Dr. Marie Savard's new book, "Ask Dr. Marie: Straight Talk and Reassuring Answers to Your Most Private Questions."