Menopause is a significant phase in a woman’s life, marking the end of her reproductive years. During the “Healthful Woman” podcast, host Dr. Nathan Fox and guest Dr. Michael Silverstein explain menopause, its symptoms, and the various treatment options available. At Carnegie Women’s Health, we aim to help patients navigate this transition with understanding and effective care.
What is Menopause?
Physiologically, menopause occurs when the ovaries cease growing follicles. Contrary to popular belief, it’s not about running out of eggs; the follicles simply atrophy. The average age for menopause onset is 52, though this can vary. Symptoms often begin in the mid-forties and can include hot flashes, insomnia, vaginal dryness and mood swings. Menopause is defined as 12 months of no vaginal bleeding.
Treating Menopause Symptoms
Among menopausal symptoms, Dr. Silverstein identifies hot flashes as typically the most disabling. While many symptoms can be treated without hormones, hot flashes often require more specific interventions. Most symptoms are due to falling estrogen levels. Hormone replacement therapy (HRT) remains the go-to treatment. Dr. Silverstein emphasizes the importance of calcium supplementation and weight-bearing exercise, which he encourages for women of all ages,
Hormone Replacement Therapy (HRT)
Since menopause is due to falling estrogen levels, supplementing this hormone is essential for symptomatic patients. Modes of administration include pills (taken daily), patches (applied weekly or twice weekly) or pellets (placed under the buttock skin at 3 month intervals). Progesterone is used to reduce risk of bleeding, unless the patient has previously had a hysterectomy (removal of the uterus). Testosterone is another hormone that can be used with HRT, with the advantage of increasing energy, reducing depression, increasing libido and diminishing sleep disorders.
About Menopause
Every woman’s experience with menopause is unique, ranging from no symptoms to a potential lifetime of symptoms. On average, when present, symptoms last between three and nine months, but predicting an individual’s experience can be challenging.
Gynecologist as Primary Care Doctor
Dr. Silverstein notes that many of his gynecology patients do not have a regular medical doctor, and gynecologists often serve as primary care providers. Women must assess whether their gynecologist is meeting all their healthcare needs or if they need to consult another doctor. Dr. Silverstein urges patients to ask, “Am I getting everything that I need from my gynecologist, or do I need to see another doctor?”
In the absence of a family history of breast cancer, Dr. Silverstein recommends starting annual breast ultrasounds and mammograms at 40. Colonoscopy is recommended at age 45, and pending results is repeated at 3-, 5- or 10-year intervals. Pap smear is most patients are performed every three years. In addition, regular well-woman visits are strongly recommended. He also advises bone density assessment shortly after menopause.
What to Look Out For
Women in their 40s and above should be vigilant about heavy and frequent bleeding, which can indicate and endometrial disorder such as polyps, hyperplasia (excess growth of tissue) or cancer. Management of these concerns is usually medical and rarely surgical, and early detection often leads to successful treatment. Any change in the menstrual pattern pre-menopausally and any bleeding post-menopausally should be brought to the attention of your gynecologist.
Learn More
At Carnegie Women’s Health, we are committed to providing comprehensive care for women experiencing menopause. By understanding the physiological changes and exploring effective treatments, we help our patients maintain their quality of life during this transitional phase. To schedule an appointment, please fill out our online contact form.
