Menopause is a natural part of life. But because it’s been hard for many people to talk about, many women have faced debilitating symptoms without support.
Host Mikaela Lefrak talked with Dr. Jane Conolly, a gynecologist at Vermont Gynecology in South Burlington and a North American Menopause Society certified menopause practitioner, about menopause and some of the treatment options.
Here are a few key takeaways from that conversation:
ML: A New York Times Magazine article that came out at the beginning of February jump-started the conversation about menopause and went viral. What did you think of the article?
Dr. Conolly: The article is exceptional. It's medically and scientifically accurate and points to a lot of the problems that women experience in getting access to good menopausal medical care.
The article talks a lot about how there is an FDA-approved treatment for menopausal symptoms that is not only effective, but also safe and potentially beneficial for reasons beyond symptom control. That is denied to many women— not because of safety, but because of a lack of information in the medical community and because of misinformation from a study that was done a long time ago that didn’t accurately reflect the risks to women who we actually prescribe these therapies to.
What is menopause exactly?
So, menopause technically is the stopping of ovulation. It's when our ovaries stop producing eggs and therefore stop producing hormones, specifically estrogen and progesterone.
Menopause is a moment in time— it's your last menstrual period or if it's done medically or surgically, it's when the ovaries stop producing these hormones or when the ovaries are removed.
Perimenopause is all the time before, during and after. And that's really the more important thing to be talking about— the time when you are experiencing symptoms and these symptoms come from the roller coaster that your body goes through with the different changes in your hormones leading up to this cessation of ovarian function. Perimenopause can start in your early 40s. The symptoms from this loss of estrogen can last for years, and for some women for the rest of their lives.
What are the symptoms?
The classic symptoms are called vasomotor symptoms: hot flashes and night sweats and extreme experience of heat that comes sort of out of nowhere. But there are so many other symptoms that can be associated with menopause. Every woman experiences menopause and the onset of these menopausal symptoms differently.
Other symptoms are sleep disturbance, mood changes, changes in energy, changes in how their joints feel. Memory disturbances— something described as brain fog —changes in their weight and perceived changes in their metabolism. There’s also changes in vaginal health, dryness, changes in sexual function, changes in sexual interest.
How to find a doctor who specializes in menopause?
One of the problems of menopausal medicine is many people are not exposed to it in their training. And it's because there is a void in knowledge about this. So it's hard to teach something that we don't actually have great information on. Well, that's changing. We now do have a lot of great information on menopause.
The North American Menopause Society offers a certification. You can become a NAMS-certified menopause practitioner, and this can be a physician, a nurse practitioner, a physician's assistant or a midwife. There are now many NAMS-certified providers in Vermont. They can be found on NAMS’s website.
Is menopausal hormone therapy safe?
We think that the benefits of hormone therapy outweigh any potential risks. Hormone therapy is safe when used appropriately and prescribed to an appropriate candidate.
For many years, there were concerns about health effects, as a result of the Women's Health Initiative study in 2002. What we have learned is that study was not very well designed. It wasn't specifically looking at the population of women that we actually prescribe these hormones to. The average age of women in that study was 63, whereas the average age of menopause is 51. And so it wasn't a representative population. As reanalyzed over the subsequent years, what we found was that women who were within 10 years of their menopause, or less than the age of 60, actually did not show this increased risk of cardiovascular disease or coronary events. What it showed is, in fact, women had a lower risk of cardiovascular disease, and lower all cause mortality when taking hormone therapy.
So, that really shifted our thinking and understanding of how to use hormone therapy. No longer was it thought that okay, maybe this is the fountain of youth, and we should give it to everybody to protect them from heart disease, but rather, women who have symptoms going through menopause will have have benefit from taking it relief of their symptoms, and no increased risk to their cardiovascular health and in fact, potentially a benefit.
Are there any higher risk groups for taking hormone therapy?
The approach to prescribing hormone therapy is very individualized. Every woman needs to weigh their symptoms, the impact of their symptoms on their quality of life to their potential risks. There are some absolute contraindications to taking hormone therapy. One of those that's usually a temporary contraindication is unexplained abnormal uterine vaginal bleeding. Also, women who have ever had a heart attack or a stroke, and women who have ever had a blood clot probably should consider alternatives to hormone therapy. Women who've had a history of hormone-dependent cancer, such as a hormone receptor positive breast cancer or an endometrial cancer, probably should consider alternatives to hormone therapy.
And there are nuances, so that's why every person should talk about their symptoms with a provider who understands these nuances and can recommend what are the options for them and what are the best best choices for treatment.
Editor's note: Vermont Gynecology is a Vermont Public underwriter.
Broadcast live on Thursday, Feb. 16, 2023, at noon; rebroadcast at 7 p.m.
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