Chrysten Cunningham, D.O.
“The change” is a term often used to describe the 10-year period directly before menopause, known as perimenopause. Menopause, which is officially one year without a menstrual period, can raise a lot of questions and uncertainty. In the United States, most women experience menopause around age 51, but it can occur sooner or later, depending on a woman’s general health, smoking history and family history. It can be a time filled with anxiety, but it can also be an opportunity to increase health awareness and fine-tune exercise and diet regimens.
Here are some of the most common questions I receive from patients in this age range:
I have horrible hot flushes that disrupt my day and keep me up at night — are there alternatives to hormone therapy?
Some women find dressing in layers and staying well-hydrated is helpful. Over-the-counter options may include supplements containing soy and black cohosh. Some medicines for high blood pressure and depression can also be used to limit warm flushes and sweating. When you discuss symptoms with your physician, she can recommend the most helpful options for you based on your medical history.
What if I decide to take hormones?
The new recommendation for hormone therapy is to use the lowest effective dose for the shortest amount of time to treat symptoms. Hormone therapy options include progestin or estrogen alone (following a hysterectomy), combinations of estrogen and progesterone (to protect the uterus), and potentially, testosterone added to the combination. These medicines can be used as pills, patches, creams, gels or vaginal preparations in ring, cream or pill form. There are risks and benefits to hormone therapy that you can review with your physician.
My moods have been up and down, sometimes anxious, sometimes sad. What’s going on?
It is not unusual to have mood alterations during the perimenopausal time. Your body is experiencing many changes that your mind has to process. Depending on a woman’s symptoms, simple diet and exercise programs can help. Some women will see improvement after counseling with a therapist or psychiatrist or find short-term use of medicines helpful in stabilizing their moods. Your physician can help you decide which path may give you the most success.
My interest in sex has decreased substantially. Is this normal?
Decreased libido can have numerous causes. Changes in a woman’s body, lower hormone levels and vaginal dryness can all contribute. Open communication and relationship building are always an important part of resolving this problem. After your physician has ruled out any health problems, she may suggest vaginal lubricants or hormone therapy.
Why do I seem to be getting shorter every time my height is measured?
Women are at an increased risk for low bone mass, known as osteoporosis, and bone fractures. Petite, fair-skinned women are at an even higher risk for osteoporosis, so it’s important to monitor this with your physician carefully. To improve bone health, women should do weight-bearing exercises and consume 1,500 mg of calcium daily through their diet and supplements and, most importantly, not smoke.
What about all of my friends who do not have any menopausal symptoms?
Tell them they are lucky, but they still need to maintain and monitor their health. Exercise recommendations have now increased to 30 minutes for heart health maintenance, 60 minutes most days to maintain weight and up to 90 minutes for weight loss. Enjoy a walk together for the improvement of everyone’s health and some friendly support.
Remember, your doctor is your best resource for questions and concerns about menopause. Talk to your doctor about what’s on your mind, and together the two of you can help make this a healthy change.
Chrysten Cunningham, D.O., is a Fellow of the American College of Obstetrics and Gynecology. She is on staff at Scripps Mercy Hospital. For more information, call 1-800-SCRIPPS (1-800-727-4777).