Confronting the symptoms of menopause
Each year, an estimated 1.3 million U.S. women reach menopause. Another 2 million will enter perimenopause as their body’s estrogen levels begin to wane.
One in three women over age 40 experiences severe symptoms but receives limited help from their doctors. UCI Health gynecologist Dr. Rebecca M. Sauer aims to change that with a comprehensive menopause program expected to launch this fall.
Sauer and gynecologist Dr. Donna G. Baick, who are both Menopause Society-certified physicians, already have been enlisting a range of specialists to provide coordinated care that addresses their patients’ menopause symptoms in order to promote longevity and quality of life.
Sauer spoke with Live Well about the importance of providing specialized care for this phase in every woman’s life.
What are your goals with this program?
We want to create a space for women to feel comfortable speaking about their symptoms and to know that they will receive evidence-based treatment options.
We also want to educate primary care providers and community physicians about midlife health issues and to make this training part of the UC Irvine School of Medicine curriculum for medical students and residents. As Orange County’s only academic health system, we already collaborate with our subspecialists colleagues who have expertise in women’s health.
This network of UCI Health colleagues includes cardiologists who specialize in women’s heart health, endocrinologists who focus on osteoporosis and bone health, urogynecologists and urologists who address bladder and pelvic floor issues, as well as a reproductive health psychiatrist.
We also have breast specialists, neurologists and experts in obesity and integrative medicine. By assessing each woman’s unique symptoms and health risks, we can develop tailored, proactive strategies.
What are the stages of menopause?
Women reach menopause when they have experienced 12 months without a menstrual period that is the result of natural causes, rather than from surgery, medication or other therapies.
The median age of menopause for U.S. women is 51, but it can occur naturally anywhere from the early 40s to early 60s. Menopause is preceded by perimenopause, the transitional period when the body’s estrogen levels start to decline. During perimenopause, menstrual cycles may fluctuate by weeks or months. As with pregnancy, the symptoms women experience during perimenopause and menopause can vary.
What are the most common symptoms you see in your patients?
About 85% of women experience symptoms that affect their quality of life. The most common are hot flashes and night sweats. Many women also suffer with sleep disturbances and mood changes, such as anxiety, depression and irritability. We also see urogenital symptoms such as urinary urgency and vaginal dryness resulting in painful intercourse, as well as joint pain and brain fog.
What about weight gain and the so-called “menopause belly”?
With age, the body’s metabolism slows down in both women and men, which can lead to weight gain.
In women, changes in estrogen receptor activity tend to drive added weight to the midsection.
Many women also undergo immense stress during perimenopause and menopause, making it harder to lose weight. When we can improve their sleep and quality of life, they often find it easier to lose or at least stabilize their weight.
How do you treat menopause symptoms?
First, we rule out other medical conditions, such as autoimmune disease, thyroid disorders or vitamin deficiencies that may contribute to their symptoms. Nonmedical approaches such as cognitive behavioral therapy may help some women, as do yoga and acupuncture. Omega-3 supplements have been shown to help with mood swings.
The U.S. Food and Drug Administration recently removed warning labels on menopause hormone therapy (MHT) products, typically estrogen and progesterone. They can help relieve hot flashes, night sweats and sleep and mood problems. We use bioidentical hormones — chemically identical to what the body naturally produces.
Women who’ve had a hysterectomy don’t need progesterone. Women who have been diagnosed with hormone-positive cancer, particularly breast cancer, or who have a history of blood clots should consult their medical oncologist or cardiologist.
Why was hormone therapy discouraged for so many years?
Large studies in the early 2000s linked MHT to a higher risk for breast cancer, but they were conducted on menopausal women in their 60s and 70s. They didn’t look at perimenopausal women. Also, the hormones used then were different from the bioidentical ones we prescribe today.
Research now shows that the risk of adverse effects from MHT is lower in women whose final menstrual period occurred within the last 10 years. Smaller studies also suggest that the breast cancer risk may be much lower than originally thought.
That said, I advise women to continue regular breast cancer screening with mammograms. MHT also carries a slight increase in risk for blood clots, stroke and pulmonary embolism.
But the risks are lower when estrogen is applied by patch, gel or spray. Conversely, MHT can help prevent osteoporosis, slightly lower the risk of colon cancer and reduce urinary tract infections.
What else should women know about menopause?
Women know their bodies best and they should feel confident and empowered to seek help for their symptoms. Menopause is individualized — someone else’s journey is not your own.
Know that your symptoms are real and find a healthcare provider who listens to you.