Menopause & Perimenopause
June 17, 2010It is the “hot topic” in women’s health; perimenopause/menopause. We hear dozens of questions from women about menopause, menopausal symptoms, and the perimenopausal transition. Read the transcript from the E-Health Connect Chat, held on June17 at 11am with Dr. Moritz Bartels.
Chat Host
11:00 AM
Welcome to this session of E-Health Connect Chat.
Chat Host
11:00 AM
We will begin in a few minutes.
Chat Host
11:05 AM
Today’s topic is menopause and perimenopause. Dr. Moritz Bartels can provide information advice on menopause, menopausal symptoms and the perimenopausal transition.
Chat Host
11:06 AM
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.
Chat Host
11:06 AM
First question for today. My doctor says that I am perimenopausal. Do I still need to use contraception?
Dr. Bartels
11:08 AM
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.
Rosemarie Bleich
11:08 AM
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?
Dr. Bartels
11:10 AM
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.
Letitia F. Randon
11:11 AM
What do you do if you’re unable to take any type of hormone replacement of any sort whether natural or synthetic?
Dr. Bartels
11:12 AM
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.
Julie
11:12 AM
I was wondering do the peri symptoms end when you actually start menopause?? is menopause ever over or are you menopausal until you die?
Dr. Bartels
11:14 AM
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.
Letitia F. Randon
11:15 AM
What are some things that can help with the insomnia and other stressors of menopause? You don’t feel normal.
Dr. Bartels
11:17 AM
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.
Chat Host
11:18 AM
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.
Dr. Bartels
11:18 AM
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.
Julie
11:19 AM
because I had a stroke 8 years ago my doctor will not allow me to use hormone replacement is this reasonable??
Dr. Bartels
11:20 AM
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.
jessica
11:20 AM
Does going through menopause really make me more likely to develop cancer? There are so many conflicting news stories.
Dr. Bartels
11:22 AM
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.
Chat Host
11:23 AM
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?
Dr. Bartels
11:24 AM
This is not something we routinely use. We usually base our diagnosis on the patient's personal history and a simple blood test, FSH.
Chat Host
11:25 AM
Question from email: I am postmenopausal and am abstinent. Do I still need to get an annual pap smear and exam?
Dr. Bartels
11:26 AM
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.
Chat Host
11:27 AM
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?
Dr. Bartels
11:29 AM
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.
Chat Host
11:29 AM
Email question: I am having hot flashes, mood swings and dryness, but am still having my menstrual cycle. What is going on?
Dr. Bartels
11:30 AM
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.
Chat Host
11:31 AM
Email question: Are natural remedies really as effective? I would prefer not to take more medication.
Dr. Bartels
11:32 AM
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.
Letitia F. Randon
11:34 AM
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?
Dr. Bartels
11:35 AM
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.
Christine
11:36 AM
What causes hot flashes?
Dr. Bartels
11:37 AM
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.
Chat Host
11:38 AM
Email question: My mom took estrogen when she went through menopause and that helped her. Is that the right treatment for me?
Dr. Bartels
11:40 AM
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.
Letitia F. Randon
11:41 AM
Are there any particular vitamins/mineral supplement that can be taken to help with menopause, the tiredness and lack of energy?
Dr. Bartels
11:43 AM
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.
Barbara
11:43 AM
Do I need medication for menopause even if I'm not having any bothersome symptoms?
Dr. Bartels
11:45 AM
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.
Chat Host
11:45 AM
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?
Dr. Bartels
11:48 AM
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.
Chat Host
11:49 AM
Email question: Do bioidentical hormones help menopause symptoms?
Dr. Bartels
11:54 AM
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.
Tanya
11:54 AM
What is the difference between HRT and ERT?
Dr. Bartels
11:56 AM
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.
Chat Host
11:57 AM
That is all the questions we can take for today. Thank you Dr. Bartels for your time and expertise.
Dr. Bartels
11:59 AM
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.
Chat Host
12:00 PM
Join us July 20th at 11am for the next E-Health Connect Chat with Dr. Kimberly Mebust on Sleep Issues.