Menopause

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    AElizabeth Poynor, MD, Obstetrics & Gynecology, answered
    Can an active, healthy sex life help alleviate menopause symptoms?

    Staying sexually active during menopause can help boost body image and mood, says Elizabeth Poynor, MD, PhD, a gynecologist-oncologist in New York City. In this video, she explains other advantages to staying sexually active.


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    ALauren Streicher, MD, Obstetrics & Gynecology, answered
    On average, women put on 1.5 to 4 pounds per year after age 50. A few extra pounds in a year don’t seem like a lot, but if you gain five pounds a year starting when you are 45, by age 55 you are looking at 50 extra pounds! However, it isn’t the lack of estrogen that puts on the pounds, but midlife changes in metabolism and lifestyle. Women who continue to menstruate until they are in their late fifties also start to gain weight even though their ovaries have not shut down. Estrogen does affect the distribution of weight, so you can blame menopause if you suddenly have a muffin top even if you haven’t gained a pound!
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    ARovenia Brock, PhD, Nutrition & Dietetics, answered
    If you find you are having trouble remembering where you put your keys or your purse, don't panic. Many women experience memory and concentration problems during perimenopause and after menopause. Some scientists believe that you may be able to minimize these memory problems with blueberries. Pint for pint, blueberries may contain more antioxidants than any other fruit or vegetable. The most powerful health-promoting compounds in these little blueberries are anthocyanins, phytochemicals that belong to the flavonoid family -- which, in addition to combating the free-radical damage that leads to heart disease, may also boost brain power. In laboratory studies, aging animals fed a blueberry-rich diet for four months performed as well in memory tests as younger animals.

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    AHealthyWomen answered
    Menopause is a natural part of life, not a disease or a health crisis. However, menopause may occur when many other changes are happening in your life. For instance, your children may be marrying or leaving home, your parents may be ill or dying or you may be wondering what you'll do when you retire. That's why it is probably more helpful to think of how your daily activities and lifestyle could affect your postmenopausal years.

    For instance, making sure that you exercise and eat right can make a real difference in how you feel and can even help prevent some of the long-term effects that are linked to estrogen deficiency (like osteoporosis).

    Physical changes do occur with menopause and with aging. But the changes that happen during this period can be minimized by healthy living and a sense of purpose in life. If your symptoms are severe enough to interfere with your life, consult your doctor to go over your options for treatment.
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    AHealthyWomen answered
    Review the following questions about menopause so you're prepared to discuss this important health issue with your healthcare professional.
    • How many women in my age group do you treat? What percentage does this number represent of your total practice?
    • Are you comfortable treating perimenopausal and postmenopausal women? If not, can you refer me to a colleague who is?
    • Do you consider yourself up-to-date on treatment options for perimenopausal and postmenopausal health concerns, including hormone therapy and other medical therapies?
    • Can you arrange for evaluations for osteoporosis and heart disease? At what age should I have these evaluations?
    • If I am interested in alternative therapies, will you work with me to help identify those that might be helpful or refer me to someone who is a safe and knowledgeable practitioner?
    • I don't feel well in several different ways. Are my symptoms due to menopause or another condition?
    • How do I know if my on-again, off-again bleeding is perimenopause or another problem?
    • My sex drive is low. Can this be due to menopause or other factors in my life?
    • Will my incontinence stop after menopause, and what can I do about it now?
    • Can you discuss the most recent research about hormone therapy and its safety with me? How do the benefits and risks of hormone therapy apply to my personal health needs?
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    AHealthyWomen answered
    Because of the potential risks that go along with hormone therapy, the U.S. Food and Drug Administration now advises healthcare professionals to prescribe postmenopausal hormone therapies at the lowest possible dose and for the shortest possible length of time to achieve treatment goals.

    This recommendation, made after findings from major studies of postmenopausal women with and without heart disease, conducted as part of the landmark federal Women's Health Initiative, indicated that while estrogen and progestin are effective for short-term relief from hot flashes and night sweats, they have no significant impact on general health or quality of life factors, such as energy, mental health, symptoms of depression or sexual satisfaction.
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    AHealthyWomen answered
    Some hormones used in menopausal hormone therapy are called "bioidentical," meaning they are chemically, i.e., molecularly, identical to the substance as it occurs in your body. These hormones, however, don't come from your body (or another woman's body). Most bioidentical estrogens and progesterone come from soy (estrogen) or yams (progesterone).

    They are also not "natural," or in their natural state, when you take them. To create a hormone women can use, the plant or animal-based hormones are synthesized, or processed, through a several-step process in a laboratory.

    While all hormonal supplements, including bioidenticals, are made in a laboratory, the difference between a bioidentical hormone and a synthetic hormone is that the synthetic hormone is a patented molecular compound created in the laboratory to mimic the action of naturally occurring hormones and mass produced. Prempro, for instance, is a combination of two synthetic hormones.

    Synthetic and bioidentical hormones work in the same way: by binding in a kind of lock-and-key process to special proteins on cell surfaces called receptors. Once a hormone -- whether synthetic or bioidentical -- locks onto these receptors, the messages from that hormone can be transferred to the cell.

    There are two main types of bioidentical hormones: those that are FDA-approved and commercially available with a prescription, such as Estrace, Climara, Vivelle, EstroGel, Divigel and Estrasorb, and those that are produced on an individual basis for women, in compounding pharmacies.
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    AMichael Roizen, MD, Internal Medicine, answered
    The epilepsy and pain relief drug gabapentin has been shown to ease both the severity and the frequency of hot flashes by almost 50 percent. It may be the new best thing other than estrogen for the flash.

    Also, a class of antidepressant drugs called SSRIs has been shown to reduce symptoms by 60 percent, as have alpha blockers such as clonidine (used to treat high blood pressure). All have side effects that many consider more problematic than estrogens, but some women prefer these choices.

    I do not recommend clonidine because of the risk of rebound hypertension if it's abruptly discontinued. Patients are supposed to taper down use of the drug to avoid the side effects, but many patients don't comply with those rules, risking the chance of developing high blood pressure when they stop taking it suddenly.
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    AHealthyWomen answered
    Some women in their late 40s are frightened by their hearts beating fast in their chests for no apparent reason. This symptom, called a heart palpitation, is caused by the heart beating irregularly or missing one or two beats. Though this symptom can be associated with several types of serious heart-related conditions, it is also common during the transition to menopause and typically is not related to heart disease. For example, a woman's heart rate can increase seven to 15 beats during a hot flash.

    If you think you are experiencing heart palpitations:
    • See your healthcare professional immediately if you have shortness of breath; pounding or irregular heartbeat; dizziness; nausea; pain in the neck, jaw, arm or chest that comes and goes or tightness in the chest. Any could be a sign of a serious heart condition.
    • Ask your healthcare professional to rule out conditions that may cause heart palpitations, such as thyroid disorders.
    • Ask your healthcare professional about appropriate options for relieving heart palpitations, such as decreasing caffeine, and whether any medications are needed.
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    AHealthyWomen answered
    For reasons still not well understood, declining and fluctuating estrogen levels during the menopausal transition can cause emotional highs and lows and irritability. Lack of sleep due to night sweats may also contribute to feeling irritable and depressed. Though your periods are coming to an end, you may continue to experience the symptoms of premenstrual syndrome. In fact, emotional symptoms may become worse for some women as they approach menopause. You may also notice that you've lost interest in sex. Declining estrogen and changes in estrogen/testosterone ratios in women at this time may lower your sex drive.

    Lifestyle strategies for coping with mood swings and sexuality concerns include:
    • Make physical activity part of your schedule; exercise can improve mood and make you feel better about yourself.
    • Try relaxation techniques such as meditation or massage, which can be calming and reduce irritability.
    • Discuss your symptoms and what may be causing them with your partner; try different approaches to intimacy. Nonhormonal vaginal creams or gels (prescription or nonprescription) are available that may help.
    • If moisturizers and lubricants are not enough, vaginal estrogen (a prescription medication) is available as creams, rings or tablets.
    When sleep is disrupted and/or you are experiencing symptoms that affect your relationship with your partner, it can have an effect on your emotional outlook. Discuss with your healthcare professional whether your symptoms may be directly related to menopause or to some other changes that may be happening in your life at the same time.