***PLEASE LISTEN TO THIS GREAT PODCAST ON CURRENT EVIDENCE ON HRT***
I believe the menopausal transition is an opportunity for women to refocus their attention and energy on their physical health and wellbeing. For some women, this can mean making lifestyle changes to improve their day-to-day quality of life and prevent chronic disease. For others, hormonally-mediated symptoms may motivate them to search for relief, possibly through the use of hormone replacement therapy (HRT) and alternative therapies. Navigating the immense quantity of information that is available from the internet, medical providers and friends can be understandably overwhelming. As such, all women can benefit from the individualized education, counseling and evidenced-based therapies only a specialist in this realm can provide.
Education & counseling on the menopausal transition including up-to-date health-related research focusing on menopause & women over 40 in a relaxed atmosphere with plenty of time for questions.
General physical exams with a focus on individualized, age-appropriate screening recommendations and proactive preventive care based on an assessment of personal & family medical history as well as evaluation & management of current complaints, including
Diet & lifestyle assessment & counseling in accordance with the basic tenets of “Health at Every Size”.
Screening for & treatment of other conditions which can co-exist with, mimic or exacerbate menopausal symptoms, such as
vaginal & urinary tract symptoms,
breast & bone health,
issues related to fertility & contraception.
FDA-approved bio-identical hormone replacement therapy when appropriate.
Acupuncture for symptom alleviation, general health and in conjunction with fertility treatments.
Convenient & accessible follow-up, including phone and email communication when appropriate.
Referrals to other health care providers & specialists as needed.
It is encouraged that you maintain a close relationship with a primary care provider and to continue to seek regular care from your doctor, nurse practitioner or physician assistant for any illness and/or needs that are not listed above and referral back to your primary care provider or other specialist may be recommended and I am happy to coordinate with your provider if you like.
IT IS HELPFUL IF YOU BRING ALL TEST/LAB RESULTS FROM THE PAST 2 YEARS AND ALL CURRENT MEDICATIONS AND SUPPLEMENTS TO YOUR FIRST APPOINTMENT.
Frequently asked questions
Are my symptoms related to menopause?
Menopause is not like a light switch, where one moment you are pre-menopausal and the next you are post-menopausal. Unfortunately, it is quite the opposite: erratic hormone production fluctuates from day to day and month to month, thereby causing changeable and varied symptoms. Menopause is the spontaneous, permanent ending of menstruation, and is literally one day, typically the day that is one year after the last menstrual period, usually around age 50, but can be anywhere between age 40-60. Symptoms may begin up to 15 years before cessation of menses and may last for several years after. Many factors may impact this transition, from genetics, to thyroid function to lifestyle habits. However, some women may enter into menopause through surgery or medication.
Special consideration should be given to issues related to fertility. Pregnancy can occur even in the presence of menopausal symptoms and menstrual irregularity into the mid-40’s. However, others may have difficulty achieving or maintaining pregnancy in the absence of these symptoms at any age. Contraception and/or fertility-preserving strategies should be a part of every woman’s assessment and plan during the perimenopausal transition.
When a woman suspects she is having menopause-related symptoms, it is an excellent time to have a complete medical examination by a qualified health professional. The diagnosis of perimenopause can usually be made by reviewing a woman’s medical and menstrual history in addition to her specific symptoms and treatment recommendations can be made accordingly.
The North American Menopause Society is an excellent resource for high quality information: http://www.menopause.org/for-women.
Do I need hormones?
Not all women need hormones. This decision should be based on a detailed conversation or series of conversations between a woman and her physician. Therapies with less associated risk, like diet and lifestyle, should be tried first. Screening for other conditions that can cause similar symptoms, like hypothyroidism, should be excluded. A considered assessment of a woman’s potential benefits vs. risks should be conducted. While risks are possible with any use of hormones, the symptoms can negatively impact a woman’s day-to-day quality of life, affecting relationships with family and friends and performance at work and the degree to which this happens may outweigh these potential risks. Medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition. What we’ve learned so far about the benefits and risks comes from large groups of women, but each woman is unique. The question is whether it is the right choice for you. Only after you and your doctor have a thorough discussion about your individual risks, benefits, and preferences can you make a decision that’s right for you.
Why do I need to see a menopause specialist?
Maybe you don’t. Maybe you only need to take a sweater off to alleviate a hot flash. Maybe you have lighter, less frequent menses. Maybe you are tired, but you sleep a bit more and feel fine. Hooray! You may not need treatment for menopause. This is not rocket science or magic, menopause is a stage of life and, like menstruation and pregnancy, is not a disease that requires treatment. However, like menstruation and pregnancy, some women have symptoms associated with menopause that can be managed to improve overall comfort and quality of life. A menopause specialist can provide individualized risk assessment and evidenced-based treatment of menopause-related symptoms and conditions, including osteoporosis, cardiovascular disease, diabetes, migraines, contraception, and sexual dysfunction.
Do you prescribe bio-identical compounded medications?
There is a lot of confusion regarding bio-identical hormones. In brief, hormones may be synthetic or bio-identical. “Bio-identical” refers to hormones that are chemically identical to those made by a woman’s body. There are studies that suggest bio-identical hormones seem to be somewhat safer than synthetic, but they are not risk-free.
Bio-identical hormones may be custom-compounded or prepared by pharmaceutical companies. Many years ago, patients and physicians chose compounded preparations because conventional bio-identical options were scarce. However, today several pharmaceutical companies offer FDA-approved bio-identical hormone products are available in an array of doses and formulations. Compounded hormones may be necessary when there is not an equivalent government-approved option (i.e. testosterone) or when a woman has an allergy to a component of a commercially-produced product. Compounded products are often not covered by insurance and are not supervised as closely as the FDA-approved products and there is no evidence that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies. As such, the FDA-approved products are a great choice for most women.
Are there non-hormonal treatment options available?
There are non-hormonal options for women who prefer to avoid hormones or in whom the risk associated with hormone use outweighs the potential benefit, such as breast cancer survivors. There are several studies confirming the positive impact of diet, exercise, acupuncture, stress management and lifestyle changes for women with mild menopausal symptoms and should be first-line therapy. Vitamin and herbal supplements may be helpful in some women, but research is mixed and appropriate dosing and use of high-quality products is necessary to know if these may be effective. Finally, there are non-hormonal prescription medications that may do double-duty in decreasing menopausal symptoms while treating other conditions, such as depression and anxiety. My goal is to help patient’s manage menopausal symptoms without needing a grocery bag full of medications or supplements by utilizing targeted therapies that are supported by research.
Aren’t hormones dangerous?
There are several benefits to using hormones including decreasing the typical menopausal symptoms such as hot flashes, night sweats, insomnia, mood issues, “brain fog”, urinary symptoms, vaginal dryness and painful intercourse, preventing bone fractures later in life and lowering the risk of heart disease & diabetes if hormones are started early.
However, despite some claims, there is no such thing as “risk-free” hormone treatment for menopause when used systemically to achieve these benefits. The potential risks include stroke, blood clots, and uterine and breast cancer.
In general, hormone therapy may be an acceptable option for women up to age 65 or within 10 years of menopause and healthy older women who continue to be bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke, and breast cancer. New studies are frequently published, so this topic is constantly in flux.
Many women are told that they must stop hormone therapy by 60-65, but NAMS released a position statement in April, 2015 indicating that many women will continue to experience menopausal symptoms that negatively impact their quality of life well past this age and, therefore, may benefit from continued HRT. These decisions are nuanced and must take into account several factors that are best considered with the help of a menopausal specialist.
What lab work or testing will I need?
For most women, hormone tests are not helpful because levels change throughout the menstrual cycle. A single hormone level can be misleading since production does not fall at a steady rate, but varies greatly during perimenopause and therefore cannot predict or confirm menopause. Furthermore, normal hormone levels in the presence of menopausal symptoms does not eliminate the likelihood that the women is perimenopausal. Also, if a woman is currently taking hormones, hormone testing will not be valid. Testing may be helpful with, complaints of sexual dysfunction, fertility problems or when periods stop at an early age. Some lab tests can identify other causes of symptoms that mimic or worsen the symptoms of perimenopause, such as thyroid disease or vitamin deficiencies, and diseases that can increase during perimenopause, such as cardiovascular disease and diabetes. Though often recommended, salivary hormone levels are not accurate and should not be used to evaluate or treat menopausal symptoms. Treatments should never be prescribed to treat hormone levels, but solely to decrease symptoms and therefore hormone levels are unnecessary to determine or adjust dosing.
Still have questions? Feel free to email me: email@example.com