Navigating symptoms, misconceptions, and treatment options
This Menopause Awareness Month we hosted a conversation with three experts in the menopause space to address common questions, break down what to expect including how to navigate the different symptoms that occur from perimenopause throughout post menopause, the importance of getting the right care, and clarifying common misconceptions.
This webinar featured:
- Dr. Janet Choi, Chief Medical Officer at Progyny
- Dr. Kathleen Jordan, Chief Medical Officer at Midi
- Dr. Rebecca Dunsmoor-Su, Chief Medical Officer at Gennev
If you are a Progyny member with access to our menopause and midlife care benefit through your employer, call Progyny at 888.597.5065 to activate your benefit and schedule a virtual appointment with a menopause specialist.
What is menopause and why are we talking about it?
- Menopause is defined as a point in time where you haven’t had menses for 12 months that usually happens during the early 50s. However, there are two other phases that are bookends of that 12-month period without menses. Perimenopause is the phase prior to menopause where your ovaries begin working differently than they have in the past. Many describe this period as a roller-coaster with symptoms changing constantly. This typically occurs in your 40s but can happen earlier or later and last anywhere from 2-10 years. Post menopause is the phase of (the rest of) your life after that 12-month period of menopause. All symptoms that occur after the menses stop occur during the post-menopause stage. A little confusingly, there is some overlap in terminology as “perimenopause” also encompasses the first year post-menopause.
- Menopause often feels like a taboo topic as it has to do with aging which is often seen as a negative thing in our society, especially for women. It’s important that we all take steps to reduce the stigma, and that goes for both patients and clinicians. It is important to talk about your experiences with your friends and your doctors. Only about 30% of OB/GYNs receive any menopause training during their four years of residency, and the percentage of primary care physicians with the training is even less. The more we speak about our experiences, the less stigmatized menopause will be, which can lead to expanded resources and access to care.
What are common signs and symptoms?
There are a lot of common symptoms that people experience, like hot flashes and night sweats, but there are additional common signs and symptoms to look out for that many might not associate with menopause such as:
- Mood changes
- Weight/body shape changes
- Bladder, vaginal, vulvar and sexual health changes
- Disruptions with sleep
These symptoms can be distressing because many people aren’t expecting them and the symptoms also change throughout each stage of menopause.
In perimenopause, you may experience large swings in estrogen and progesterone which will cause a fluctuation of symptoms. One week you may have a lot of different symptoms and then the next week you may experience none. This change may cause you to second guess yourself, but these inconsistencies should be a sign that you may be entering perimenopause. One symptom or change that is prevalent in perimenopause is an inconsistent period. Your periods may get closer together some months and then farther apart the next, or you may get extremely heavy periods during one cycle but the next it’s just spotting. If you are experiencing these changes, you can probably assume you are in perimenopause and should talk to a provider.
In post menopause, some of your symptoms will shift. Mood changes tend to get better in post menopause because you are no longer going through the roller-coaster of hormones that occurs during perimenopause. However, symptoms that can remain consistent are poor sleep and mental health concerns. Vaginal symptoms are prevalent symptoms during this stage when you’re in a period with no estrogen. The vagina will change, and this can lead to dryness, itching, or pain. These symptoms can be hard to talk about, but know you’re not alone and that support and treatments are available.
Menopause can also impact your mental health. Lack of sleep can exacerbate changes in your mood and mental health. Anxiety and depression can increase during menopause.
It may be difficult to prevent these common menopause symptoms, but it is important to talk with your provider so you can find relief. The more your provider knows about your symptoms and how you feel overall, the better they can help you along your journey.
Why should I meet with a menopause specialist?
Many PCP and OB/GYN providers aren’t adequately trained in menopause and therefore not able to provide solutions or answers to a patient’s symptoms. These symptoms are not just “a part of life” and you deserve to walk away from a meeting with your doctor with less questions than you walked in with. There are menopause trained and certified experts/physicians around the United States that can help you get the right information and create a path forward. There is a lot of data that menopause care experts can go through with you to understand the benefits of each treatment plan and how your long-term health will be impacted. Your care and your path forward is your decision and a menopause certified provider can present you with the information needed.
Resources
The internet can provider valuable resources but ensure you are looking for evidence-based information. A couple of websites to explore menopause specific resources are:
Additionally, there are recommended books to learn more:
- The New Menopause by Dr. Mary Claire Haver
- You Are Not Broken by Dr. KJ Casperson
- The Menopause Brain by Dr. Lisa Mosconi
- The Menopause Manifesto by Dr. Jen Gunter
If you are a Progyny member with access to menopause and midlife care through your organization, contact Progyny to learn more about the support and care available to you.
What are some treatment options I would discuss with my provider?
There are many treatment options available when it comes to treating symptoms. It’s important that you and your provider align on your treatment and that you feel comfortable with your plan. Treatment options can include:
- Hormone therapy: this therapy centers around prescription versions of estrogen and progesterone, which are both safe options that can support many different symptoms if you and your doctor agree this is the right path for your needs.
- Non-hormonal medications: depending on the symptoms and severity, there may be effective non-hormonal solutions your provider can prescribe for you after reviewing your medical history and concerns.
- Lifestyle interventions: exercise and diet are great interventions that can help manage some symptoms, especially weight gain, which is one of the top symptoms experienced. Exercise is also a great option to help with changes to mental health as it helps release serotonin.
- Topical creams, inserts, lubricants: for those of you suffering from vaginal dryness or pain with intercourse or symptoms associated with urination (urgency, frequency, discomfort), both hormonal and non-hormonal vaginal treatments may be available via your Menopause provider.
Before deciding which treatment path you think is right for you, speak with a menopause certified expert who can provide all information necessary to help you move closer to a better quality of life.
True or False?
- Does diet impact menopause symptoms?
The answer to this is a little more complicated than yes or no. During menopause your metabolism will slow down. As it changes, you can control some menopausal symptoms by managing different aspects of your diet. As you’re looking to change your diet there may be foods that stick out claiming to have “phytoestrogen.” This is not actual estrogen, so if you start eating more of those foods for that reason, you won’t see symptom relief. - Help me better understand MHT and breast cancer risk.
Menopausal Hormone Therapy (MHT) is generally not recommended for women with a personal history of breast cancer. However, for most healthy women seeking relief from menopausal symptoms, even those with a family history of breast cancer, MHT poses little if any increased risk of developing breast cancer.
The type of MHT used and the duration of treatment is thought to influence breast cancer risk. For instance, studies indicate that estrogen-only MHT for less than five years is associated with a lower risk of breast cancer, but this option is only suitable for women without a uterus. Women who still have a uterus require a combination of estrogen and progesterone for both symptom relief. While some trials with combination MHT showed a small increased risk of breast cancer, this risk is comparable to other modifiable factors, such as moderate daily alcohol consumption (e.g., one glass of wine or one beer) and largely reference studies using synthetic progestins, that are not used today in most hormone replacement therapies.
Although further research is needed, emerging evidence suggests that lower-dose, bioidentical MHT options may be linked to lower risks for breast cancer.
It is crucial to discuss your personal medical history with a qualified menopause provider to thoroughly review the potential risks and benefits of any MHT options before making a decision that best suits your needs. Note, too, that because of the high prevalence of breast cancer with up to 1 in 8 women developing breast cancer in their lifetime, some women taking MHT will develop breast cancer–just based on the risk of being female and not necessarily due to their hormone therapy. These women experience no greater risk of mortality from breast cancer than those who are diagnosed and not on MHT– they have similar stage at time of diagnosis, similar response rates and longevity. With a new diagnosis of breast cancer, providers do usually advise stopping the MHT to allow for optimal treatment that may or may not include hormone receptor active therapies. - Is weight gain a common symptom?
Yes. Hormone changes in menopause can cause more central weight gain as well as decreases in insulin sensitivity. During menopause and post menopause, women may gain about a pound and a half per year. At the same time, it can be more difficult to lose weight during menopause. When it comes to seeking help and support with weight management during menopause it is important to set health goals and approach this with “radical acceptance.” Instead of focusing on the number on the scale, think more about what type of diet and exercise works best for you and improving your ongoing health. - Can GLP-1 medicines help with menopause symptoms?
When GLP-1’s are used in trials, they are also done with lifestyle interventions. This medicine can be very effective for the right woman, but it’s not a magic fix. When you lose weight, you also lose muscle mass so it is extremely important to counter it with weight training exercises to help build and maintain muscle. Muscle loss leads to bone loss, and as we age it is important to keep our bodies strong and healthy. Post-menopausal hip fracture is one of the leading causes for morbidity and mortality as women age. Cardiovascular disease is the leading cause of death for women and obesity is a key contributing factor. While GLP-1 medicines may be a good solution for you, it is necessary to keep tabs on the new information that comes out every day. This is still a newer medicine providers are working with, so doctors are learning more about how to effectively use it each day. You should always consult with your provider to understand what is right for you.
If you have any other questions related to this webinar, please don’t hesitate to reach out to education@progyny.com. If you are a Progyny member and have any questions about your benefit or coverage, please call 888.597.5065.
For more information on menopause and midlife care, visit our Menopause Education Site.