Welcome to this session of E-Health Connect Chat.
We will begin in a few minutes.
Today’s topic is menopause and perimenopause. Dr. Moritz Bartels can provide information advice on menopause, menopausal symptoms and the perimenopausal transition.
Moritz Bartels, MD is a board certified OB/GYN physician Women’s Health and Wellness Center at the MultiCare Gig Harbor Medical Park. Dr. Bartels completed medical school at Medizinische Hochschule in Hannover, Germany and his residency at the University of Texas Southwestern Medical Center.
First question for today. My doctor says that I am perimenopausal. Do I still need to use contraception?
Yes. Every patient told she's perimenopausal should continue use birth control. Even though the chance for pregnancy decreases, it is not zero until the patient has reached full menopause.
I am 61 years old and have recently stopped taking my hormone replacements. My questions is: when do the hot flashes and night sweats end? Or doe they ever end?
Nobody can predict exactly when hot flashes end. Some patients have no symptoms whatsoever, and others have them for a very long time. Stopping hormones suddenly can worsen symptoms short term. Ideally, HRT should be tapered off over a longer period of time.
What do you do if you’re unable to take any type of hormone replacement of any sort whether natural or synthetic?
It depends on the individual patient and the reason why you cannot take those medications. Usually, there are some,at least alternative options available. These should be discussed with your doctor.
I was wondering do the peri symptoms end when you actually start menopause?? is menopause ever over or are you menopausal until you die?
Definition of menopause is no bleeding for one year. So this is a retrospective diagnosis and the age when this occurs varies dramatically between individuals. The average age of menopause is 51. Even if a patient has gone through menopause by definition, she may still experience symptoms. Usually, symptoms resolve over time and it should not bother her for the rest of her life.
What are some things that can help with the insomnia and other stressors of menopause? You don’t feel normal.
Insomnia is a secondary symptom of menopause. Other reasons for insomnia need to be ruled out too. If menopause is the reason, then general treatment options for menopause become available. These would include HRT or insomnia specific type of drugs, like sleep aids.
Another question from email. I started having some memory loss and was concerned I was experiencing early signs of Alzheimer's (family history) and saw my doctor. He said I was just perimenopausal. I don't get it.
Alzheimers or other types of dementia should ideally be diagnosed by a neurologist. Menopause can potentially cause symptoms like memory loss. However, Alzheimers itself should not be caused by menopause itself.
because I had a stroke 8 years ago my doctor will not allow me to use hormone replacement is this reasonable??
Yes this is reasonable. HRT is contraindiciated in certain patient populations, included patients who have suffered stroke in the past. Non-hormonal medications may work in this scenario.
Does going through menopause really make me more likely to develop cancer? There are so many conflicting news stories.
No. Menopause by itself is not a risk factor for cancer. Hormone replacement therapy has been associated with minimally increased risk for breast cancer. It protects or decreases the risk for colon cancer.
Another question from email: A girlfriend of mine was diagnosed as being in menopause by a saliva test. I have never heard of that. Is it really that easy?
This is not something we routinely use. We usually base our diagnosis on the patient's personal history and a simple blood test, FSH.
Question from email: I am postmenopausal and am abstinent. Do I still need to get an annual pap smear and exam?
The fact whether or not a patient needs annual pap smears after menopause is based on if she did have abnormal pap smears in the past. If a patient never had an abnormal pap smear in her life, she may not need paps anymore. However, obtaining the actual pelvic exam is still important on a yearly basis.
Email question: I started taking hormone therapy two weeks ago and am still having wild mood swings and hot flashes. Should I try something else?
Usually, it takes more time to be able to accurately assess whether or not hormones work. An increase of the hormonal dose may be necessary, but this needs to be determined by your doctor.
Email question: I am having hot flashes, mood swings and dryness, but am still having my menstrual cycle. What is going on?
All of these symptoms are normal in perimenopause. The monthly cycle does not have to stop before hot flashes and night sweats actually start. In fact, periods may become more frequent and closer together right before menopause starts.
Email question: Are natural remedies really as effective? I would prefer not to take more medication.
There are no studies which have shown that natural alternatives are as effective as HRT. Some options may help relieve symptoms, however, HRT still seems to be the most effective way of treating hot flashes, night sweats and vaginal dryness.
Because of these rare tumors I had (LMA), what do you do if you’re unable to take any type of hormone replacement of any sort whether natural or synthetic?
Your medical history seems complicated and for that reason requires an individualized consultation, ideally with a GYN who is experienced treating signs and symptoms of menopause.
During menopause, ovaries stop producing hormones. The lack of those hormones, we think, causes changes in the thermal regulation of the brain. We are not entirely sure about this, but this seems to be the most plausible explaination.
Email question: My mom took estrogen when she went through menopause and that helped her. Is that the right treatment for me?
There are risks and benefits associated with the use of estrogen (HRT). In recent studies, we know from recent studies that the risk for stroke, development of blood clots, breast cancer and heart disease may be minimally elevated. The risk for colon cancer and osteoporosis including fractures may be decreased. We are individualizing whether we are offering HRT to our patients. Generally, the lowest effective dose for the shortest period of time is recommended.
Are there any particular vitamins/mineral supplement that can be taken to help with menopause, the tiredness and lack of energy?
No particular vitamin has been proven to show that it relieves menopause-specific symptoms. Vitamins generally may help with fatigue, etc. However, this is not age or menopause specific. Natural remedies like black cohosh or primrose oil may help relieve hot flashes and night sweats.
Do I need medication for menopause even if I'm not having any bothersome symptoms?
No. If a patient is asymptomatic we usually counsel them regarding the above mentioned course of menopause. We talk to the patient about HRT, however, with recent studies having identified risks with HRT, we tend to not offer HRT to asymptomatic women.
Email question: I am 35 and recently had a total hysterectomy. I feel like I am experiencing the worse PMS of my life. I have been avoiding going on hormone therapy, but do you think that is my only option?
In your case, it matters whether your ovaries were taken during your surgery. If your ovaries are absent, you may very well experience perimenopausal symptoms. If the ovaries were left behind, you should be evaluted for other causes of your symptoms.
Email question: Do bioidentical hormones help menopause symptoms?
Yes. Bioidentical help relieve menopausal symptoms. In certain indiviuals, they may be a great alternative to traditional HRT. They do not offer a clear reduction risks associated than HRT.
What is the difference between HRT and ERT?
HRT usually refers to the combonation of estrogen and progesterone replacement which may be more appropriate in patients who still have their uterus. ERT refers to estrogen replacement therapy which should only be given to patients who have undergone a hysterectomy.
That is all the questions we can take for today. Thank you Dr. Bartels for your time and expertise.
I would like to thank everyone for participating in this web chat. Individual decisions need to be made with each patient's personal medical provider. If you are interested in making an appointment, please contact my office at 253-530-8122. Thank you.
Join us July 20th at 11am for the next E-Health Connect Chat with Dr. Kimberly Mebust on Sleep Issues.