Episode 165: Fertility 101: Menopause

Dr. Janet Choi: There was a Mayo Clinic study that came out this spring that got a lot of press, showing that 40% of the workforce are comprised of women in their menopausal years. 45 to 54 is sort of the peak era of timelines when these issues crop up. That’s a pretty significant chunk of your workforce that really needs to be well supported, if you want to retain them. The average age of menopause is around 51 years of age. Less than 1% of women will experience menopause under the age of 40. About 5% of women will experience early menopause when this happens in their early 40s, before the age of 45. But again, if you make it into your 50s and beyond, everyone is going to experience menopause. Females are born with a set number of eggs, one to two million preformed eggs hunkered in their little follicle cells in the ovaries. As we age, the egg count disappears and goes down, the quantity goes down, the quality goes down. At a certain point in time, the egg count is so low or as close to zero, that your ovaries just stopped secreting this very important hormone called estrogen, which then leads to an absent slew of periods.

Dr. Janet Choi: Women in the pre-menopausal period, and this average age starts around age 47, will have regular or irregular periods. Period links become more unpredictable and start to have symptoms like hot flushes like headaches, like vaginal dryness, like mood disturbances, more depression or anxiety, all of those things kind of go part and parcel as your hormones start to change. But again, the most common complaint women in the peri-menopausal transition menopausal years will report back are hot flashes. Another really important thing just to be aware of as your estrogen levels drop, your bone health also declines. And this is something that’s really important to pay attention to because osteoporosis is one of the most common causes of morbidity later on in life for women. Up until menopause, women also have a healthier cardiovascular profile in general compared to their male counterparts. But as the estrogen levels drop, the cardiovascular risks like having a heart attack,  having changes in your lipid, your cholesterol, LDL starts to creep up for a lot of women. So, heart disease risks start to go up as well.

Dr. Janet Choi: If you don’t want to resort to medical therapy straightaway. Some things may actually help with hot flash management if that’s really interfering with your daily living and your sleep habits. Trying to make sure you keep a cool dark room, and temperature-regulate through how you dress. There have been some limited studies looking at dietary management of hot flashes like trying to avoid things like alcohol and spicy foods. Although those have not been well proven to be that impactful, it doesn’t hurt to try. If you are in the obesity category, so body mass index of 30 or higher, there actually have been some good studies showing that weight loss may help lower the rate of hot flashes. When it comes to medical therapy – there’s FDA approved medication out there — hormone therapy that’s in different shapes and forms. It’s not just an estrogen pill, it’s not just Premarin. We also have Estradiol pills, or sticker patches that you could put on once or twice a week. Or for people who don’t want that much systemic estrogen, if your main complaint is vaginal dryness, a little estrogen pill put into the vagina to help with a local lubrication. Those are all remedies.

Now, if you have a uterus, you need to be able to balance out the estrogen impact with progesterone because you don’t want to increase your risk for uterine cancer, that’s controllable by making sure that you and your doctor discuss the scheduled cyclic or continuous use of progesterone. Now, if you don’t have a uterus, this is where you can celebrate, you don’t need the progesterone. There is also now an FDA approved drug that came out this spring or summer called Veozah. It seems to be very effective. And it’s a non-hormonal solution to manage moderate to severe hot flashes., If you don’t want to use estrogen or if your doctor deems estrogen potentially a little risky for you based on your medical profile. If you are having lots of mood disorders, if you’re finding that your depression or anxiety is flaring up with a pre-menopausal transition and you’re having hot flashes — you and your doctor might decide that instead of trying hormone therapy, you might want to try an antidepressant. It’s not just estrogen therapy in the end.

Dr. Janet Choi: Although there are women who are able to conceive healthy pregnancies and babies into their mid-40s, sometimes without any medical assistance. Because those eggs are older in quality. The ability of these eggs to create genetically healthy pregnancies is much, much lower than when you use eggs from, say, someone who’s even 40 or 35. The benefit of IVF is if your doctor is able to extract eggs, and with their lab team create embryos, they can screen those embryos through PGT-A, Pre– Implantation Genetic Testing for Aneuploidy, to let you know before you conceive and use those embryos if there are any embryos that are actually chromosomally normal or euploid, before you go through the embryo transfer process.

It’s also important to stay abreast of your specialist appointments too in terms of health, maintenance, mammograms. It’s really important to stay on top of that, whether it’s once a year, every two years, depending on your doctors’ guidelines and also recommendations. Colonoscopy — colon cancer risks go up as we get older. And you want to just make sure that you’re doing the proper screening of your colon with your proper physician.

It’s the stigma against aging, which shouldn’t be there. And the stigma against having these symptoms, which are, you know, they don’t seem like life threatening, but it is something that most women have to live with. And it should be well supported.