To survive the inconvenience of menopause, Samantha takes daily doses of supplements by the handful and rubs hormones on her arms and privates. When Miranda asks Samantha about the logic of taking so many supplements, and where she got her menopause treatment strategy, she replies, “from Suzanne Somers.” Surprised, Miranda asks, “you are getting information from someone who invented the thigh master?”

When her hormones are confiscated at customs in Abu Dhabi, Samantha resorts to consuming and applying yams and chickpeas, hoping she is getting a “natural” dose of hormones so she does not “ricochet back into menopause.” This Somers devotee makes for good comedy, but propagates gross misinformation about hormones and menopause management options.

Many remember and love Suzanne Somers from Three’s Company, but it is time to come clean. I was a victim of Suzanne Somers’ irresponsible claims that her way of managing menopause is the “natural” way using compounded bioidentical hormones. Today I want to set the record straight.

I slammed into menopause, suffering from hourly hot flashes, itchy skin, horrible weight gain and miserable moodiness. Desperately wanting to feel normal and sexy again, I purchased Suzanne Somers’ book, Ageless: The Naked Truth About Bioidentical Hormones.

I assumed Somers word to be trustworthy, because a publisher printed her book. Living in Southern California, I splurged for Somers’ expensive Beverly Hills doctor recommendation, assuming he must have the answers. He confirmed I was menopausal and gave me tubes of compounded triple estrogen gel and compounded 10 percent micronized progesterone gel, with orders to apply them regularly. I was just like Samantha in Sex and the City 2. It was also suggested that I apply the estrogen gel to my face to “soften your wrinkles.” I dutifully rubbed in the compounded “bioidenticals” religiously.

After a few months of visiting this overpriced Beverly Hills doctor, my menopause symptoms were exaggerated and my moodiness turned into depression. Once again desperate and now at the lowest point of my life, I returned to a previous gynecologist. A blood test revealed that my estrogen levels were seven times higher than normal, my increased weight now placed me into the overweight BMI category, and my severe crankiness made it impossible to work.

What went wrong? I trusted a resource not supported by science. I was taking unregulated hormones. Like many other women, I was gullible and uneducated about my options, leaving me vulnerable to buying anything labeled HOPE in a bottle.

After the 2002 Women’s Health Initiative results, many women were scared of hormone therapy, myself included. Somers repackaged hormone therapy using the buzzwords “natural,” “bioidentical” and “compounded” as the new healthy menopause management option.

What I found when I started to burrow into the scientific research was a far cry from the claims made by Suzanne Somers. It was eye-opening to learn that natural compounded bioidentical hormones were unregulated by the FDA. There was no standardization for producing the product, and no tests on the formulations. There are NO real natural hormone products available.

When we see Samantha from Sex and the City 2 rubbing yams on her face in hopes of getting a dose of estrogen, the only thing she got was a good laugh.

10 Hormone Therapy Facts Every Woman Should Know

1. Natural: The word “natural” is a marketing term. There is no scientific evidence that custom-compounded bioidenticals are safer or more effective or more “natural” than standard pharmaceutical bioidentical prescriptions. The only “natural” hormones are the hormones being made by your body.

2. Bioidenticals: Laboratories create formulations that are either identical (bioidentical) or not (non-bioidentical) to those in your body. There are FDA approved prescription estradiol products that are bioidentical that are not “compounded.”

3. Compounded hormones: Made in a pharmacy by combining, mixing or altering ingredients to create a customized hormone for an individual patient. Compounding pharmacies must be licensed and regulated by the State Pharmacy boards. However, they do not have to demonstrate the safety, effectiveness and quality control, based on large, scientific studies, that the FDA requires of pharmaceutical manufacturers. Compounding pharmacies use chemically synthesized hormones made from plants — the same government-approved ingredients that are used in a manufacturer’s laboratory. “Compounded” formulations are neither safer nor more “natural.”

The North American Menopause Society, a non-profit organization of expert scientists and clinicians, “does not recommend custom-compounded products over well-tested, government-approved products for the majority of women.”

The Endocrine Society has stated that, “Post-market surveys of such (compounded) hormone preparations have uncovered inconsistencies in dose and quality.”

4. All estrogen products are chemically synthesized, primarily from an active ingredient called diosgenin, a molecule extracted from the tubers and flowers of various plants including Dioscorea, a wild yam.

All hormones, whether made in compounding pharmacies or in manufacturer’s laboratories, are synthetic in the sense that they are made by a chemical process. All estradiol, even “compounded,” is derived from similar chemical compounds.

5. To determine whether hormone therapy is appropriate and safe, one’s risk factors must be assessed based on personal and family medical history, as well as personal preference. There is no “one size fits all.”

6. Low dose hormone therapy, used judiciously, still remains the most effective way to treat the troubling symptoms of menopause for those who need it and who can use it safely.

7. There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. Unless there are unusual complications, it is the standard of care to treat symptoms if needed and adjust medications according to response, not saliva levels.

The North American Menopause Society says, “Saliva testing to determine if a woman has the ‘right amount’ of hormones has not been proven accurate or reliable. Even blood testing of hormone levels has the drawback that levels vary throughout the day as well as from day to day. More important, the desired levels in postmenopausal women have not been established. In addition, an individual woman’s physical comfort may not even be related to her absolute hormone levels.”

8. Standard prescription hormone therapy is the safest form available. It has been tested by the FDA and manufactured in a highly regulated manner. Doses are consistent.

9. There are also FDA approved non-hormonal therapies available to treat menopause symptoms for those who cannot take hormones.

10. Whether hormone therapy is needed depends on severity of symptoms, including hot flashes, night sweats, vaginal dryness and irritability. Hormone therapy should be individualized, which may mean trying different doses and schedules, as well as different routes of administration.

When we see Samantha squirting hormones on her arms in Sex and the City 2, we are watching drug dosing that is uncontrolled and dangerous. Hormone therapy, whether bioidentical or not, whether compounded or manufactured, is a drug with benefits and risks that must be taken seriously.

Somers says in her blog, “I just wanted to feel good when I went into menopause and I didn’t want to take drugs… When I found total and complete relief from natural non-drug hormones … I thought wow, women and men need to know this. And that’s how it began.”

While Somers had good intentions in sharing her “natural” hormone therapy strategy, she remains misinformed and misleading. Her “non-drugs” are still drugs, and her “natural” products are derived from synthesized chemical compounds.

Unregulated formulas and inconsistent compounded dosing can be dangerous and has jeopardized the health of many women, including myself. I wished I had known the dangers involved with compounded-hormones.

The North American Menopause Society reviewed Somers’ book saying, “Ageless is a tribute to pseudoscience, to safe and wishful thinking against facts, to claims of safety without proof … the uninformed reader is misled to believe the fallacies rather than the truth … the result is a book with overwhelming misinformation. The dangers are to women who may be misled into ‘buying into’ the products, thereby putting themselves potentially at greater risk than protection.”

After my menopause symptoms were stabilized with a standard prescription of bioidentical estradiol, I found a new way of eating, lost 30 pounds and updated my beauty regime without cosmetic surgery or alterations. I have never been healthier.

Being informed is the first step to managing your symptoms. Know where your health information is coming from. Make your decisions based on the solid scientific research that is readily available. You CAN take control of your health and beauty during menopause.

References

The North American Menopause Society. Menopause Practice: A Clinician’s Guide,
3rd Edition. Cleveland: The North American Menopause Society, 2007.

Sturdee, David W., The Facts of Hormone Therapy for Menopausal Women. New York: The Parthenon Publishing Group, 2004.

Somers, Suzanne. Ageless: The Naked Truth About Bioidentical Hormones. New York, NY: Three Rivers Press; 2006.

International Menopause Society, Recommendations on Postmenopausal Therapy, 27 February 2007

The North American Menopause Society, Early Menopause Guidebook. Cleveland: NAMS, 2006.

Hemelaar, Marjorie; van der Mooren, Marius J.; van Baal, W. Marchien; Schalkwijk,Casper G.; Kenemans, Peter; Stehouwer, Coen D A, “Effects of Transdermal and Oral Postmenopausal Hormone Therapy on Vascular Function: a Randomized,Placebo-controlled Study in Healthy Postmenopausal Women,” biomedexperts, New York, 2005;12(5):526-35.

Simon, James A. “Understanding the Controversy: Hormone Testing and Bioidenticals Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 5, 6, 7

Vogel, John J. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 23, 24, 26

Richardson, Marcie K. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 28

Allen, Loyd V. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 12, 13

The Endocrine Society. Bioidentical Hormones. Position Statement.

Patsner, Bruce. “Understanding the Controversy: Hormone Testing and Bioidentical Hormones” 17th Annual Meeting of The North American Menopause Society, October 11, 2006, p. 10, 11

Department of Health and Human Services, “Questions and Answers About the WHI Postmenopausal Hormone Therapy Trials“, National Heart, Lung and Blood Institute, April 2004.

Haimov-Kochman, Ronit and Hochner-Celnikier, Drorith, “Are There Second ThoughtsAbout the Results of the WHI Study?“, University Medical Center, Jerusalem, Israel. Department of Obstetrics and Gynecology, 4 March 2006, p. 387-393.

Kalvaitis, Katie, “Compounded Hormone Therapies: Unproven, Untested – and Popular“, Endocrine Today, 25 March 2008.

Pines A.; Sturdee, D.W.; Birkhauser, M.H.; de Villiers, T.; Naftolin, F.; Gompel, A.; Farmer, R.; Barlow, D.; Tan, D.; Maki, P.; Lobo, R.; Hodis, H., et. al., “HRT in the Early Menopause: Scientific Evidence and Common Perceptions“, International Menopause Society, 29-30 March 2008. The Hormone Foundation, January 2008

Medline Plus, “Complementary and Alternative Approaches to Health,” 2008.

National Center for Complementary and Alternative Medicine.

Heart disease is the number one killer of women today. Dr. Chrisandra Shufelt, assistant director of the Women’s Heart Center at the Cedars-Sinai Heart Institute, shares valuable information about heart disease during menopause.

Interview with Chrisandra Shufelt, M.D.
Assistant Director of the Women’s Heart Center
at the Cedars-Sinai Heart Institute.

1. Question: How can women approaching or experiencing menopause protect themselves from heart disease?

Chrisandra Shufelt, M.D.: The best protection is in knowing your heart health numbers. By that I mean you should know your blood pressure, LDL and HDL cholesterol, weight, body mass index (BMI) and fasting blood sugar level. If your numbers are out of whack, see your doctor, start exercising, change your eating habits, lose weight if you need to and stop smoking. You also need to be aware of your family medical history. Women who have a first-degree relative diagnosed with heart disease at an early age are at an increased risk of developing heart disease themselves. Heart disease is the number one killer of women so the first step in preventing it is to know your numbers.

2. Question: Does a woman’s heart disease risk increase during menopause?

Dr. Shufelt: One in seven premenopausal women die of heart disease compared to one in three postmenopausal women. We know that blood cholesterol levels can often change for the worse within six months to a year from the onset of menopause, which on average is the age of 51. The risk of high blood pressure triples with menopause; after the age of 55, more women have high blood pressure.

3. Question: Does hormone therapy increase a woman’s risk of developing heart disease?

Dr. Shufelt: Hormone therapy may be an effective way of controlling the moderate to severe night sweats, hot flashes and other menopause symptoms that can wreak havoc in a woman’s life. Start by seeking a certified menopause specialist who can weigh the risks and benefits for each patient. If your doctor considers hormone therapy safe for you, be sure to reevaluate annually. Starting hormone therapy many years after a woman has gone through menopause does increase the risk of heart disease. Women who are not good candidates for hormone therapy do not need to suffer in silence. There are many nonhormonal options to treat menopause symptoms.

4. Question: Are women who take oral contraceptives at an increased risk for cardiovascular disease?

Dr. Shufelt: Oral contraceptives are the most commonly prescribe hormones with approximately 80 percent of women in the U.S. using them at some point. In healthy younger women – young than 35 and nonsmokers – oral contraceptives do not increase a woman’s risk for heart disease. And we know that birth control pills can be helpful in controlling symptoms around perimenopause. That’s why you should re-read my answer to the first question and get to know your heart health numbers!

5. Question: Is it possible to treat menopause symptoms while simultaneously preventing heart disease?

Dr. Shufelt: Yes. That is exactly what we do at the Women’s Heart Center at the Cedars-Sinai Heart Institute. And it’s why menopause transition is such an important time for all women. I want women to know that when they reach menopause, it’s time to take stock of their health and their individual risk factors. Because when we know a patient’s numbers, we can help her assess the side effects and risks that come with all treatments and also help ensure that the second act of her life can be just as vibrant and active as the first.

6. Question: Does estrogen provide heart protection?

Dr. Shufelt: No, estrogen is not prescribed to prevent heart disease.

7. Question: What else should women know about heart disease?

Dr. Shufelt: When it comes to heart disease, women need to recognize that often, our symptoms are different from men’s heart disease symptoms. In addition to chest pain, women are more likely to have shortness of breath as a first sign of heart disease. Women more commonly experience extreme fatigue and persistent chest pain. Unlike men, women generally have major arteries that are clear of plaque, but the smaller coronary blood vessels cease to constrict and dilate properly, creating the lack of blood flow and oxygen to the heart.

One of the first symptoms you may notice during perimenopause is irregular periods.

I was on birth control pills so I did not experience irregular periods. But for those of you not on birth control pills, noticing a change in your period may be an indication you are perimenopausal.

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Interview with Dr. Wendy Klein, leading menopause expert and co-author of The Menopause Makeover

Staness: What is one of the first symptoms of perimenopause?

Dr. Klein: The hallmark of perimenopause, which is the phase prior to menopause, is irregularity. We all grow up thinking that when you enter the change of life and become menopausal, your periods just stop. That is not the case.

What happens is your periods start to become irregular. You can have too many periods, you can have too few, you may skip a period and then get regular again, and you may skip a few periods. You may think, “oh my, I am in menopause,” and suddenly your period comes back again.

Staness: Why does this happen?

Dr. Klein: Prior to menopause your periods are usually very regular. The amount of hormone that you are producing is very regular and predictable. However, as you approach menopause, entering the perimenopausal phase, the ovaries are unpredictable. You will have months when you don’t ovulate, and that causes irregular bleeding.

Staness: How long does period irregularity last?

Dr. Klein: How long that lasts is highly individual. Could be a year, could be two years, could be three years and that is all normal variation. I like to say that the ovaries are stuttering. You don’t always ovulate and your previous hormonal milieu begins to change.

Eventually you will experience fewer periods and finally your periods will stop. You are not officially in menopause until you have skipped 12 consecutive periods.

Staness: How does a woman know her periods are irregular?

Dr. Klein: You may get too many periods. You may get too few. You may skip them. The bleeding may become heavier, or it can become lighter.

Staness: What should a perimenopausal woman with irregular periods do?

Dr. Klein: Well the easiest thing to do is keep track of your periods. Write them down in the your calendar and track them. Keep a record of when you are having your periods and what your symptoms are, so when you visit your clinician you can discuss the changes using actual dates.

If you are troubled by irregular periods, you can discuss the option of low dose birth control pills. This can help with regulation, with excessive flow, and also with contraception.

One of the issues of which you should be aware is that even in perimenopause you can still become pregnant and since your periods are not regular you have an increased risk of unintended pregnancy. Birth control is still necessary as long as you continue to ovulate, even if you are irregular.

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Menopause is a normal and natural part of a woman’s life. Arm yourself with knowledge, build a strong relationship with your clinician and manage your menopause empowered.

Are you suffering from hopelessness, apprehension, and deep sadness for prolonged periods?

Most perimenopausal women do not experience major depression, but many have symptoms of feeling depressed, stressed, and anxious.

If you are experiencing menopausal symptoms such as severe hot flashes and lack of sleep from night sweats, it may be causing you to feel depressed. Are you in a depressed mood and feeling sad, or are you suffering from clinical depression resulting from a chemical imbalance in the brain?

I recently teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on perimenopausal depression.

Perimenopause Depression Interview

Staness: What are the most common signs of depression?

Dr. Klein: The most common signs of depression are feeling sad, feeling worthless and losing interest in the things that normally engage you. Having no “get up and go,” you would rather sit on the couch doing nothing than get up and do something that would normally engage you. Other symptoms include the loss of libido, changes in appetite – too much or too little – feeling very sleepy and tired and fatigued, or having insomnia, not being able to sleep. A common sign of depression is a change in your normal habits.

A more serious symptom of depression is sustained loss of interest in things that you just can’t seem to break out of, which is called dysthymia. Things seem really bleak and you just can’t quite punch your way out of this paper bag of darkness and it lingers. If it lingers or if you have thoughts that are scary, such as wanting to give up or wanting to hurt yourself or even suicidal thoughts, you must talk to your clinician because there are things that can be done to help you.

Staness: What can cause these feelings of depression during menopause?

Dr. Klein: Depression is multi-factorial. There are many factors that can cause an increased risk for depression. If you have depression in your family, a prior history of depression, and even some medications can cause an increased risk of depression. Certain endocrine disorders, such as hypothyroidism, or other illnesses, such as chronic fatigue syndrome, are also associated with depression.

Depression is an illness that can be triggered by the chemicals in your brain. Serotonin regulates your moods. It is the “feel good” hormone. When serotonin levels drop you can experience extreme episodes of depression.

You also want to look at lifestyle stressors – a change in relationship, finances, loss of a loved one, caring for parents – and consider the many modalities of treatment that are available to help you.

You approach depression in menopause the same way that you would approach depression at any other time: you first want to rule out other medical causes, or other medications that might be contributing.

Staness: Many women live with daily stress and then throw in menopause and a few medications, and it is no surprise menopausal women may suffer from depression. What depression treatment options are available?

Dr. Klein: A number of options are available, including psychotherapy, and antidepressants and can assist you if you are suffering from depression.

There are degrees of depression. Mild depression, feeling blue or sad, can be dealt with cognitive therapy, psychotherapy, meditation, yoga, eating healthfully, and exercise. We know that exercise does boost your endorphins and can lift your mood. Also, engaging in new activities may help, such as making yourself take classes, making yourself get out and do things, and enlisting the support of your family and friends.

If you have lingering or worsening symptoms, you may need medication, because we know that depression can be a malfunction of your neurotransmitters, particularly serotonin, which is the feel good neurotransmitter. Medicines can be enormously helpful, although you will want to incorporate lifestyle changes as well.

In short, if someone is experiencing the signs or symptoms of depression, there are number of things you can do. Eating healthfully, exercising regularly, and seeking support from family and friends may help. Also, you can engage in any activity that gives you a sense of achievement. It may be taking a class, taking up something new such as yoga, or trying the drawing class that you always wanted to take, or volunteering and getting outside yourself. All of these things are very useful.

If you are still feeling very stuck and sad, talk to your clinician so you can get a referral to a good psychotherapist. If you need medication, in the broader context of menopausal symptoms, there is some evidence that hormone therapy can augment treatment and help people who are on anti-depressants feel even better. That is a decision for you and your clinician.

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If you suffer from depression or someone you love is depressed, get support, visit your health care provider and discuss your options for treating depression.

The most common and often the most irritating symptom associated with menopause is the hot flash. As many as 75 percent of women going through menopause in the United States experience hot flashes with 10% to 15% of women having severe or frequent hot flashes. I had miserable hot flashes that heated up at the most inconvenient times and sometimes flaring up every few hours. I tried every trick in the book to eliminate this miserable symptom – from herbs, to teas, to exercise, to diet, to praying hourly that they would disappear – but they persisted.

With confusing and conflicting information online and in best-selling books, I teamed up with leading menopause expert and co-author of The Menopause Makeover, Dr. Wendy Klein, to get the latest scientific information on alternative, complementary and medical options to relieve hot flashes.

Understanding available hot flash options will give you the opportunity to discuss menopause management with your clinician. This interview with Dr. Klein is the first in a series that addresses the various menopause symptoms.

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Hot Flash Interview

Staness: Dr. Klein, what exactly is a hot flash?

Dr. Klein: A hot flash is a sensation of extreme heat in the head and upper body generally associated with sweating.

We know from studying women that the internal core temperature does increase. You can a put a sensor on the skin and before a woman experiences a hot flash she will be able to tell you, “I am going to have a hot flash.” And sure enough, there will be an increase in internal core temperature followed by profuse sweating which is very uncomfortable. As you know, the purpose of sweating is to cool the body so there is often a reflex of sort of chill that follows the hot flash. It is a very uncomfortable and distracting sensation. It can occur at any time of the day. It can occur with tremendous variability, it can happen many times an hour or only just once or twice a day. Some women have one or two hot flashes a day, and get through menopause with no problems while other women have fifteen or twenty a day. We are all different.

Staness: What causes a hot flash?

Dr. Klein: We are still trying to understand exactly what causes hot flashes. We know that they are related to the hypothalamus, which is in the center of the brain and acts like the thermostat for the body. What we don’t understand is why some women are so troubled by them and others are not.

Certain women seem to have triggers. An alcoholic beverage may bring on a hot flash, or a change in external temperature can cause a hot flash for some women. In general, the hormonal flux or variation in hormone levels seems to be related to this sensation in some women.

Staness: Are there other causes?

Dr. Klein: We know that smoking is associated with hot flashes. Women who smoke have a higher risk of troublesome hot flashes, so obviously you should not smoke.

Also certain medicines can cause hot flashes such as certain antidepressants SSRI, Selective Serotonin Reuptake Inhibitors, are common antidepressants that can actually cause an increase in hot flashes. Yet, for some women, a very low dose can actually alleviate hot flashes, making antidepressants an alternative to hormone therapy.

Illnesses and fever can cause hot flashes, as can malignancies, and tuberculosis – many illnesses can cause hot flashes.

Increased BMI, Body Mass Index, has been associated with hot flashes. We used to think that women who were heavy had excess estrogen, and therefore fewer hot flashes. Now from the major study that was done in the SWAN, Study of Women Across the Nation, we know that women who are heavy, who have abnormally high body mass index, are at increased risk for hot flashes.

Staness: What’s a menopausal gal to do if she suffers from hot flashes?

Dr. Klein: The real issue is how troubled are you. Some women find that they can manage their hot flashes with simple lifestyle changes, such as wearing layered clothing, lowering the thermostat, carrying a fan, drinking cool beverages, avoiding triggers like caffeine and alcohol. Some women can have a few hot flashes a day and over time, seventy-five to eighty percent of cases the hot flashes will diminish and disappear. Then there is a subset of women for whom hot flashes are really troubling and don’t go away. Lots of women have recurring hot flashes waking them up over and over again and they can’t go back to sleep. They are not getting enough rest; they wake up grouchy, tired, and sweaty. If it is really a problem, there are hormonal therapies that will alleviate these symptoms. As you know hormone therapy can have side effects, so you must always weigh the benefit versus the risk. There are very low dose hormone therapies that are now available that can be extremely useful for alleviating hot flashes.

There are some other options to consider such as soy and black cohosh. The studies regarding soy are mixed, with some showing that soy can be helpful; while there are other studies that show soy may help with mild symptoms. Soy is benign and easily available and may be worth trying. Black cohosh is another herb and has been used in Europe widely, but you have to be careful because there have been reports of toxicity with high doses. Used in limited amounts in standardized doses black cohosh supplements may help some women with hot flashes. Again, there have been mixed studies, so whatever you do, and with anything you take, you should always discuss with your clinician.

You can also try lifestyle changes – wearing layered clothing, practice deep breathing, meditation and yoga, exercising – all of these things that can be really helpful in learning to live with the symptoms if they are moderate.

Another option to treat hot flashes is gabapentin. This is a drug that was originally developed as an antiseizure medicine. Gabapentin is widely used for pain relief, because it was discovered that with patients in whom it was used for seizures, it helped with pain. It was then found that it helped with hot flashes. Gabapentin is a reasonable alternative to discuss with your clinician if you do not want to or if you cannot take hormone therapy.

Staness: I was on birth control pills for years and had no idea I was perimenopausal until I stopped them, then the hot flashes started erupting. Are birth control pills a good option for hot flashes?

Dr. Klein: Birth control pills are a form of hormone therapy. They are a higher dose than standard menopausal therapy, but there is estrogen in most birth control pills and that keeps hot flashes away. If you are in the perimenopausal phase, birth control pills can also be useful for regulating your periods, plus they keep hot flashes away.

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Understanding the causes and solutions for hot flashes is the first step to managing your menopause. If you suffer from hot flashes, discuss your treatment options (alternative, complementary and medical) with your healthcare provider.

Going through the menopause transition is the reverse of puberty. Puberty was the transition in your life when your hormones were gearing up for your reproductive years to come. Remember your first period? Emotional outbursts, swollen breasts, restless nights, and feeling bloated? Now, at the menopausal transition you may experience many of the same symptoms, but for different reasons. Instead of “turning on” your hormones, your body is now “turning off” your hormones. Many women who had difficult puberties have challenging menopause. Women who got through adolescence easily often have the same experience with menopause. We are all different and menopause is no exception.

So how do you know you are going through menopause?

Let’s identify your symptoms. You may have one, some or all at different stages of menopause. Sixty to eighty percent of women experience mild to moderate symptoms, 10-20 percent suffer from severe symptoms, and 10-20 percent have no symptoms. Your symptoms can be a guide to what is happening in your body. These clues are the hard evidence you will need when deciding what course of action you may wish to exercise.

Do you experience any of these symptoms?

• Weight gain
• Mood swings
• Night sweats
• Heart palpitations
• Changes in your period
• Migraine headaches
• Bladder changes
• Vision changes
• Joint aches
• Nail and tooth problems
• Breast tenderness
• Memory loss
• Hot flashes
• Sleep problems
• Loss of libido
• Dry vagina
• Hair and Skin changes

These are all messages from your body.

If you are experiencing one or many of these “changes” you may be perimenopausal, menopausal, postmenopausal or having symptoms from surgical menopause (hysterectomy). You are not alone; 44 million women are going through similar transitions with 4,000 a day joining the club.

If you suspect that you are going through one of the stages of menopause, call you doctor and request a FSH (Follicle Stimulating Hormone) blood test. The results of this test will allow you and your doctor to determine how best to treat your symptoms.

While waiting for test results, start an exercise program. Regular exercise can improve the symptoms of menopause. It helps regulate weight, benefits your heart and bones, and contributes to a sense of overall well-being and improvement in mood.

Document your symptoms, develop a strong relationship with your health care provider, and discuss treatment options.

Document your symptoms and discuss them with your practitioner.

Irregular Periods: At the onset of perimenopause, irregular periods can be the first symptom you notice. Your natural cycle is changing, some months you may ovulate and some months you may not. As a result, irregular periods may occur. Some months your period may be longer or shorter. Discuss your menstrual patterns with your health care provider.

Weight gain: Another early symptom, which is often the hardest to live with, is weight gain. I wish I could say all weight gain could be blamed on menopause; that would just make the experience a little easier to life with. Only some weight can be blamed on our ever-changing hormones. Many of us over the years had less time to exercise and eat properly, and when we enter menopause the effects are unforgiving. Getting back in shape and losing weight may feel like an uphill battle. A commitment to healthy lifestyle changes regarding food intake and exercise is now a necessary step to feeling better. This weight gain is a wake up call. As you gather information and make eating and exercise choices for your plan, you will start seeing and feeling results.
Breast Tenderness: Changing hormones may cause fluid retention in your breasts. Once your hormones are in sync again, you will notice this uncomfortable symptom alleviated. Cut back on caffeine and salt consumption.

Mood Swings: When you are experiencing life changes, whether emotional or physical, getting moody is perfectly understandable. Throw in hot flashes, weight gain, and vaginal dryness, and you wonder why you are moody? During menopause there are also biological reasons you may get moody and irritable. When your ovaries start making less estradoil (the active form of estrogen made in your ovaries) it starts affecting other bodily functions including the estradiol in the brain and that causes a decrease in your endorphin levels (the body’s natural feel-good regulator). When your endorphin levels drop, your brain sends out adrenaline that can increase your heart rate and dilate your blood vessels causing hot flashes and anxiety. This cycle can make the best of us cranky and moody. Then throw in life’s general ups and downs, you are now on a moody roller coaster. Declining estradoil that is fluctuating daily can ensure moods swings in many of us making it difficult to cope with daily challenges. If you are experiencing mood swings, this is a good time to start making time to relax, mediate, get a massage, take yoga, enjoy herbal teas and pamper yourself. Some women with severe mood swings that lead to depression consider taking Serotonin-reuptake inhibitors (SSRIs) a drug that can balance your brain chemicals. Exercise and a healthy diet can also help with moodiness.

Heart Palpitations: If you suspect heart disease or it runs in your family, it is best to have these heart palpitations checked out by your doctor. No one knows for sure why some women suffer from heart palpitations during menopause. It is usually attributed to fluctuating hormones. Discuss this symptom with your practitioner.

Migraine Headaches: If migraine headaches are new to you, or only happened during the first few days of your period or during ovulation, it indicates that you are responding to changing estrogen levels. During perimenopause these fluctuating hormone levels may trigger more migraines than you experienced during a normal cycle. For some women balancing their hormones alleviates migraines. For others, hormone therapy makes it worse. The good news is those migraines that appeared during menopause will probably disappear during post menopause. The medical community is still trying to figure out the connection of female hormones and migraines. Practice relaxation techniques, keep a migraine journal and track your migraine triggers (caffeine, medications, dieting, stress). Discuss treatment options with your doctor.

Memory Lapses: Often short-term memory loss can be experienced during menopause. There are many factors that may affect your memory: stress, age, medications, lack of sleep, and overall health. Ask for support from your loved-ones, so they may nurture you through forgetful moments. Keep your mind stimulated. Use a planner and practice a healthy lifestyle.

Hot Flashes and Night Sweats: The number one symptom that most people associate with menopause is hot flashes. Feeling flush, overcome with perspiration, and dizzy, is no fun. Being disturbed from a good nights sleep with a hot flash (aka night sweats) that sends you to the bathroom to splash cool water on your face and change into a dry nightgown, is no fun either. When your estrogen levels suddenly plunge it can create a hot flash. Being overweight, diabetic, suffering from an under or over-active thyroid, and certain medications can also cause hot flashes. Wear layered clothing and bring a fresh blouse when you leave the house. In the summer, wear a cotton sundress and keep a stylish fan handy in your purse for instant hot flash relief. Discuss this symptom with your practitioner. Often low-dose hormone therapy can bring relief. Practice relaxation techniques, get regular exercise and maintain a healthy weight.

Sleep Problems: If you are experiencing night sweats due to changing hormones, it is no surprise you are not sleeping at night. A sleepless night may bring a day of irritability and mood swings. Non-menopausal sleep problems, such as consuming caffeine or alcohol before bedtime, may also cause sleepless nights. If these sleep problems are caused by menopause symptoms, discuss hormone therapy with your practitioner. Avoid caffeine and alcohol before bedtime. Prescription sleep aids can also bring relief. Practice relaxation techniques and eat a healthy diet.

Vaginal Dryness: Intercourse can be painful if you are experiencing vaginal dryness. When your estrogen levels drop, vaginal dryness can occur, your vagina can tear more easily from friction, and the vagina tissues can loose their elasticity and become smaller. Estrogen plumps up the cells in the vaginal wall so they produce more lubrication. Hormone therapy may bring relief. A bioadhesive lubricant, such as AstroGlide that can be purchased over- the- counter, may also bring relief. If vaginal dryness is your only menopause symptom, you may consider using an estrogen cream applied vaginally.

Loss of Libido: If you are experiencing vaginal dryness and sleepless nights it is no wonder you lack interest in sex. Besides the effects of menopause, it is also normal for your libido to decline with age. Between the ages of 55 and 65 sexual activity slows for men and women. Don’t let a decrease in hormone levels blow the flame of desire out of your love life, visit your doctor, take the appropriate tests and discuss hormone treatment options. Certain medications may also contribute to a declining libido: blood pressure, depression, heart disease, or diabetes medications. If you need to treat your relationship, visit a counselor. A healthy sex life is possible during and after menopause.

Skin Changes: There is no escaping the aging process, but during menopause you really start seeing the effects of less estrogen. Your skin is supported by collagen and elastin fibers, which are supported by estrogen. That is why your skin looked so soft and contoured to your face before menopause. For those of you who loved getting a summer suntan, the affects of sun on your skin are damaging, with or without estrogen. Gravity plays a big role here too. After 40 plus years of being on this planet, gravity takes a toll on everyone. What most of us notice during menopause is that the elasticity and firmness of our skin decreases rapidly due to less estrogen production. Wear sunscreen (SPF 15+), exfoliate regularly, practice good skin care, and moisturize daily.

Bladder changes: Just as lower levels of estrogen can affect your skin, it can also change the flexibility of the muscle fibers around the urethra (the tube that lets urine out of the bladder). Age, obesity, family history, and hysterectomy may also contribute to bladder changes. Kegel exercises are a great option to reduce these effects and help firm up your urethra muscle. Just squeeze your vagina muscles and hold them for 10 seconds, then relax and count to 5, then repeat. It is best to do 5 sets 3 times a day. You will see a difference within a month. Also, start wearing a light mini-pad; they are much easier to change than your panties or slacks. You may notice when you balance your hormones this symptom improves. If not, your doctor may suggest medications.

Hair Changes: Almost 50% of women complain of hair changes during menopause. Age, family history, high blood pressure, medications, depression, thyroid disease, stress and hormones can be factors contributing to hair loss or excessive hair growth. You can have thinning hair and you can sprout some hairy growth on your face. For a few rogue hairs or peach fuzz try tweezing, Jolen Hair Bleach (sold at most pharmacies), electrolysis, and waxing works well. If you are suffering from hair loss, Rogaine 2% may bring relief.

The more educated you are about your body’s changes going through menopause, the more you will be able to embrace this transition. Fluctuating hormones, age, genetics and lifestyle can all affect your menopause journey. Empower yourself to take action and manage menopause.

Dear Crabby,

My husband and I are going on a cruise in about 3 weeks. I thought I would have my next period by now but haven’t. Actually I had one in June on the regular date and skipped July and had another in August but about 2 weeks before the normal date.

This all does not bother me because I do know these are all symptoms of menopause starting. But my question is, about anything I can do to control my period not starting on the trip.

I can’t get into my regular doc before we go.

Thanks!

In No Mood for a Period during Vacation

__________________

Dear In No Mood for a Period,

The most common symptom women notice during perimenopause is both menstrual flow and frequency changes. Per the North American Menopause Society, approximately 90% of women experience 4 to 8 years of menstrual changes before natural menopause. Some women experience lighter bleeding while others have heavier bleeding. The cycle length may also change, or you may completely skip a period. Every woman will experience a pattern that is irregular for her. We are all different.

Changes in your menstrual patterns and flow are considered normal during perimenopause, and are attributed to decreased frequency of ovulation and changing levels of ovarian secreted hormones.

Whether a woman is menopausal or not, wishing to manipulate your period start date, so it does not occur on a special occasion, is an age-old desire!

Many women who have irregular periods find success using a low-dose combination estrogen-progestin oral contraceptive. Clinical trails have demonstrated that oral contraceptives have normalized irregular bleeding and decreased menstrual flow.

Seasonale and Seasonique are oral contraceptive products that are formulated so you get your period about once every three months. Lybrel is another low-dose extended-use combined oral contraceptive that is formulated to be taken for one year with no breaks, no periods. These products also provide birth control, something perimenopausal women must consider until they have reached menopause (12 months without a period). Oral contraceptives may also provide relief for hot flashes, night sweats and menopausal crankiness.

Discuss these options and your risk factors (are you a smoker, high blood pressure, personal history of stroke, heart attack, blood clot or liver disease, breast or uterus cancer, or history of thrombosis) with your doctor.

You mentioned that you cannot get in to see your doctor, try a phone call – a brief conversation may answer your questions and/or requests.

If you are not a good candidate for oral contraceptives or prefer not to take them, consider embracing Mother Nature.

Have a wonderful cruise!

Signed,
Dear Crabby

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

Resources:
The North American Menopause Society, “Menopause Practice a Clinician’s Guide”
www.menopause.org
Mayo Clinic
www.mayoclinic.com

Dear Crabby,

How long do heart palpitations last going through menopause? I have had them for almost 2 years. I already had my heart checked and all is okay. I am on oral natural progesterone which helps some. Is this a fairly common symptom of menopause?
Signed,
Pounding Heart from Oregon

Dear Pounding Heart,

Yes, for some, heart palpitations can be a common occurrence during menopause.

During menopause, heart palpitations can be scary, happening at inappropriate times. Sometimes palpitations accompany hot flashes.

Keep a hot flash/heart palpitation diary.

No one knows for sure why some women suffer from heart palpitations during menopause. It is often attributed to hormonal fluctuation. You may wish to discuss hormonal balance with your healthcare provider. Usually heart palpitations go away within a few months after your hormones have settled down. Hormonal balance often relieves heart palpitations.

If you suspect heart disease or if heart disease runs in your family, discuss these symptoms with your healthcare provider. From your inquiry it appears that you have had your heart health checked by your doctor. This is good news.

The most common non-hormonal cause of heart palpitations is ingesting too many stimulants: alcohol, nicotine, caffeine, decongestants, and diet pills all contain chemicals that stimulate the heart. Too much of these stimulants can confuse your heart and cause it to beat out of control.

Other causes of heart palpitations could be more serious and require medical attention: anemia, hypoglycemia, and certain thyroid conditions.

Stress can also cause irregular heartbeats. Practice relaxation techniques.

Consider:

-Limiting alcohol and caffeinated beverages
-Do not smoke
-Exercise regularly, after discussing with your doctor
-Avoid stimulant medications
-Decrease stress
-Keep blood pressure and cholesterol under control
-Manage a healthy weight
-Practice relaxation techniques
-Avoid activities that tend to activate or increase your palpitations
-Tracking your heart palpitations may help identify triggers.
-Make sure to share your heart palpitation journal with your clinician. Even if you have previously talked with your doctor regarding your heart palpitations, it is still important to inform her that they are continuing.

I am not a doctor, and encourage you to continue communication with your healthcare provider. I applaud your commitment to seek out information. We are all different. It is important to maintain good health, eat healthy and exercise during menopause.

Once I obtained hormone balance my heart palpitations disappeared. It took a few tries with different hormone therapies before finding a program that effectively managed my menopause symptoms.

If you need a second opinion, The North American Menopause Society has a wonderful list of healthcare providers:

http://www.menopause.org/cliniciansus.pdf

I hope the next heart pounding experience you encounter is one stimulated by love – not fluctuating hormones.

Signed,
A calmer Dear Crabby

NOTE: Pounding Heart from Oregon continued her search for heart palpitations solutions working closely with a naturopath. She discovered taking a compounded progesterone lozenger place under the tongue helped with heart palpitations. If her symptoms worsen she will consider estrogen/progesterone therapy. I applaud Pounding Heart for her extensive research and exercising an open conversation with her healthcare provider. It is the first step to managing menopause. We are all different. Each of us will have different solutions to treating menopause symptoms.

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com

Dear Crabby,

My doctor has informed me that I am in perimenopause. My children are grown and it would be a relief if I no longer had to worry about birth control. I have used a diaphragm most of my adult life with great success, but it is inconvenient and kills “the mood”. In addition, my periods have been irregular. Do I still need to use birth control?

IN THE MOOD FOR LOVE IN CINCINNATI

DEAR IN THE MOOD:

The good news is you are “in the mood”. Many women experiencing perimenopausal symptoms lose their interest in sex. If your only concern is birth control-lucky you!

One of the benefits of menopause or post menopause is not worrying about birth control.

First, let’s define the three stages of menopause:

Perimenopause begins about 6-8 years before you reach menopause. During this time the levels of hormones produced by your ovaries start to fluctuate leading to irregular menstrual patterns; such as, irregularity in the length of the period, the time between periods, and the level of flow. At this time you are ovulating on and off, so you could become pregnant. Other common perimenopause symptoms are: hot flashes, night sweats, mood swings, vaginal dryness, weight gain, fluctuations in sexual desire, fuzzy thinking, trouble sleeping, fatigue and depression.

You are officially in menopause when you haven’t had a period for 12 consecutive months. At this point there are no more eggs left for your ovaries to release and pregnancy is impossible.

Post-Menopause is the period of life after you have reached menopause.

Since you are perimenopausal and still having periods it is advisable to continue practicing birth control because your ovaries have not completely stopped producing hormones. You may still ovulate and could become pregnant.

When your ovaries start producing lower levels of hormones you begin to experience symptoms associated with perimenopause. Irregular periods can be the first symptom you notice. Because your natural cycle is changing, some months you may ovulate and some months you may not. Menopause happens when the ovaries stop making enough hormones to stimulate your monthly cycle then your periods stop permanently. Only then can you stop worrying birth control. It is advisable you get confirmation from your doctor.

Since using a diaphragm for birth control can be inconvenient, and “kill the mood”, you may wish to consider one of these other methods of birth control.

Top five most popular forms of birth control

-Birth control pill, 96-99% effective. Using “the pill” is not only effective at birth control (diaphragms are only 85-90% effective) but the pill can help with perimenopausal symptoms. You may wish to discuss this option with your doctor.
-Condoms, 90-95% effective.
-Vasectomy, 100% effective. Many couples opt for this option after they have had their children.
-IUD (Intrauterine device) last six to ten years. This permanent device allows you to be “in the mood” without disrupting spontaneity.
-Norplant, a chemical contraceptive, is a match-sized rod that is inserted into the woman’s arm. It is time released into the woman’s system for up to five years.

Of course, abstinence is 100% full proof, but you signed your letter “in the mood,” so I’m sure that wouldn’t be an option. Continue practicing birth control until your doctor confirms that you are in menopause. If you have more than one partner, practice SAFE sex to avoid any sexually transmitted diseases.

Signed,
Less Crabby practicing birth control

Write to Dear Crabby and get advice about your menopausal symptoms.
If you have:
• Hot flashes
• Itchy skin
• Breast tenderness
• Mood swings
• Memory lapses
• Fuzzy thinking
• Night sweats
• Sleep problems
• Loss of libido
• Dry vagina
• Irregular periods
• Headaches

Dear Crabby has tips to make your life easier.
She wants to hear from YOU.
Send your questions to: DearCrabby@MenopauseMakeover.com