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 usually do. 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 your life after that 12-month period of menopause. All symptoms that occur after the menses stop occur during the post menopause stage.
- 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 20% of OB/GYNs have full menopause training, 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 the majority of people experience, like hot flashes and night sweats, but there are additional common symptoms to look out for that many might not associate with menopause. These other symptoms can include:
- Mood changes
- Weight/body shape changes
- Sexuality and libido changes
- Decrease in 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 will have huge dips 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 cause dryness, itching, or pain. These symptoms can be hard to talk about, but know you’re not alone.
Menopause can also impact your mental health. Lack of sleep can exacerbate your mood and mental health. Additionally, your serotonin and dopamine levels are impacted during this phase of life. Dopamine helps spark feelings of pleasure, satisfaction, and motivation, so if levels are lower, there is a larger chance of mental health struggles. Since we know menopause impacts our neurotransmitters, this increases anxiety and depression.
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 estrogen and progesterone, which are both safe options that can support many different symptoms if you and your doctor agree as the right path for your needs.
- Supplements: if you want to go down a more natural path of treatment, there are many supplements that can help with symptom management. It is crucial to speak with your doctor or do your own research to find out which supplements are evidence based and can support your specific needs.
- 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 vaginal ointments: there are ointments to help with vaginal symptoms. Some of these symptoms can’t be treated, but they can be managed to help with your quality of life.
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. - Is weight gain a common symptom?
Yes. Hormone changes in menopause cause more central weight gain and your insulin sensitivity increases. The change in insulin sensitivity causes larger swings in your glucose, giving you a higher risk of diabetes. During menopause and post menopause, women may gain about a pound and a half per year. Although this occurs, it’s important to set goals and radical acceptance during treatment. What is healthy and normal for you is crucial to focus on. Instead of centering on the number on the scale, think more about what type of diet is best for you and exercises that can help your muscle growth. - 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 back muscle. Muscle loss leads to bone loss, and as we age it is important to keep our bodies strong and healthy. Cardiovascular disease is the leading cause of death for women and obesity highly contributes to that. 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 we 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.