Demystifying the Change Part I - What is Menopause?

September 10, 2012
By Sarah Burton

Whether you've gone through it yourself or watched a friend or family member, one thing is true-menopause is not something to ignore, but it's definitely not the same for everyone. Sure, hot flashes are the most widely discussed symptom but there's much more to this very normal and natural phase in women's lives. Dr. Jennifer Howell, DO, of Ironwood OB/GYN sheds some light on the actual physical cause, ways to treat symptoms, and related symptoms of menopause.

What is Menopause?
Night sweats, hot flashes, irritability, depression, vaginal dryness, a decrease in libido, insomnia, hair loss, increased abdominal fat, loss of breast fullness, and of course an eventual end to menstruation. These are all normal yet entirely unpleasant symptoms a woman going through menopause may experience. But why? As the female body ages, usually between the ages of 45-55, there is a decrease in the reproductive hormones estrogen and progesterone. "The average age of menopause, defined as one year or 12 consecutive months with no period, in the U.S. is 51," Dr. Howell explains. "The term is derived from the Greek words pausis (cessation) and men (month)."

The transition into menopause, called perimenopause, is when most women begin experiencing fluctuations in their cycle length and as well as those hallmark side effects. For some, it's gradual and with mild symptoms, for others it may be an abrupt change requiring a visit to their OB/GYN. "Sometimes women experience severe symptoms that are excessive and not normal such as heavy vaginal bleeding, passing clots, and bleeding for longer than seven days. In that case, and even with normal symptoms-hot flashes, night sweats, insomnia-when they interfere with daily life, it is time to make an appointment with your doctor," Dr. Howell warns.

What Can You Do About It?
Treatment varies depending on how severe the symptoms are, or how willing patients are to try and find relief. Hormone replacement therapy (HRT) comes in many forms from equine or plant-based estrogens to plain estradiol (the actual human hormone) and there are several delivery routes including pills, patches, creams, vaginal suppositories, gels, injections, and pellets. There is also the choice of FDA-approved pharmaceuticals or compounded hormones which are often referred to as bioidentical or natural-hormone replacement therapy.

But Dr. Howell warns against the assumption that natural hormone replacement is safer. "Patients often think they are getting a more natural option when they choose bioidenticals, but compounded hormones can be made of plant estrogens as well, plus they do not undergo the same strict regulations as traditional medication," she explains. "Menopause is a natural process, and does not always require treatment, but the gold standard is still hormone replacement therapy (HRT) at the lowest effective dose for the shortest amount of time necessary."

Even considering the many options out there, Dr. Howell laments the lack of variety in treatments on the market. "Thinking osteopathically, it's important to take a very holistic approach to menopause, treating the whole body not just singling out hot flashes or going ahead with a hysterectomy," she points out. A solution cannot always be found overnight or in the span of a typical office visit. It takes time to find the right balance for each individual based on the combination and severity of their symptoms, and it's important for patients to be fully informed of all pathways available before proceeding with selecting a treatment.

"I see many patients who end up transferring to my care because their previous OB/GYN just wanted the quick fix or only offered them one modality of treatment," Dr. Howell shared. "I tell my patients they didn't get to this point overnight, so don't expect me to fix it overnight-but let's work together to reach the best possible outcome."

Check back soon to read Demystifying "The Change" Part II - What About Less Invasive Options?

Interested in scheduling an appointment with Dr. Howell?
Dr. Jennifer Howell, D.O., FACOOG
Ironwood OB/GYN
2300 N. Rosemont Boulevard
(520) 881-1977


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