Well Women Care
Time for “the Change”?
Each year, another generation of women begins to see the end of a phenomenon that has played a significant role in their lives for decades-their period. As women enter their forties, what was once a regular occurrence may now start showing up intermittently, and along with erratic periods, other signs may indicate that change is in the wind. Menopause can be a challenging time-physically, mentally and emotionally-but having the facts can make the transition easier.
Perimenopause: Preparing for Change
Perimenopause is the phase that most women experience in their mid-forties (although some women enter perimenopause in their late thirties) when their body starts to make a series of slight shifts. This is because levels of estrogen and progesterone start to drop but rather than dropping gradually, they tend to go up and down like a carnival ride. Perimenopause may include erratic periods, extra light or extra heavy periods, day or nighttime hot flashes, vaginal dryness, trouble sleeping, and emotional ups and downs. You may or may not experience all of these symptoms, but most likely, you will get to know a few of them.
Perimenopause can last anywhere from two to eight years and there are things you can do to make yourself more comfortable during this time.
* Your period: As previously mentioned, your cycle may no longer be consistent, so be prepared with protection on hand at all times, as well as extra protection in case your period is heavier than usual. It’s important to note that if your period is consistently extra heavy or long, you should notify your doctor. This is so conditions such as endometriosis or fibroids can be ruled out. Your period may also be shorter than usual during perimenopause.
* Hot flashes: Hot flashes can last from 10 seconds to 10 minutes and leave you sweating and flushed one moment then chilled the next. The best way to cope is to dress in layers. It can also be helpful to avoid triggers such as spicy foods and to reduce your alcohol intake to a two-glass maximum on the weekends. If hot flashes are so frequent that they are making life difficult, talk with your doctor about other options. Low-dose birth control pills, hormonal patches, some antidepressants and certain herbal remedies may all help. Hormone therapy is also an option, although some women wait until age 55 to pursue this. Hot flashes are most frequent during perimenopause and the first two years post-menopause but some women experience them for a longer duration.
* Vaginal dryness: Many women complain of vaginal dryness during both perimenopause and menopause. This is due to lack of estrogen which can cause dryness as well as thinning of the vaginal walls and atrophy in both the vaginal and vulvar region. However, a fulfilling sex life is still possible. Talk to your doctor about lubricants, estrogen therapy, or medications such as Osphena, a non-hormonal oral therapy which improves vaginal tissue and relieves pain during intercourse. Medications such as Vagifem, a “pill” inserted into the vagina, can also help improve tissues. Low estrogen levels can also make you more prone to urinary infections and some of these treatments will also aid in that department.
Menopause
Most women undergo menopause between age 48 to 55, but some will not experience the change until their late fifties. If your mother was late entering menopause, there is a good chance you will be as well. Menopause itself brings all of the previously discussed changes, but also some other challenges. However, being prepared can help you meet these challenges and undergo an easier transition.
* Keep your bones strong. After menopause your body starts breaking down bone faster than it is building new bone. Exercise is a fantastic way to help fight against bone loss, but be sure that the exercise is weight-bearing. Walking, running, skating, X-country skiing, aerobics, dance and strength training will all help you reduce your risk of osteoporosis. You should also talk with your doctor about your calcium intake. Your provider may recommend calcium supplements or Vitamin D supplements, depending on your bone health. A bone density test is also a good idea at this time. If you are showing signs of osteoporosis, prescription medications may be prescribed.
* Retain a healthy weight. Many women start to see the pounds add on as they enter menopause. This is because our bodies start to lose muscle mass and muscles burn calories. Committing to a regular exercise program will help keep those pounds at bay, as will rethinking your diet. Put your emphasis on whole grains, veggies and lean proteins and you can reduce your chances of getting the dreaded “menopot.”
* Get your sleep. Hot flashes aren’t the only reason perimenopausal and menopausal women have trouble sleeping Hormone fluctuations can make it hard for women to fall asleep or stay asleep. As many as 45 percent of women in transition report nights of tossing and turning. Try to prepare your body for sleep by indulging in relaxation exercises, meditation, deep breathing or listening to relaxing music. Avoid technology, TV and other blue light sources the last two hours before bed; keep your room cool and dark. If sleep still won’t come, talk to your doctor about possible sleep aids, including aromatherapy or natural options such as melatonin.
* Calm those mood swings. Experiencing depression, anxiety and moodiness is common at this time. This whirlwind of emotions will settle down after the transition, although women who experienced severe PMS are more likely to have trouble with moodiness during menopause. Exercise can help, as it releases endorphins, the “feel good” hormones; so can eating a healthy diet and stress busters such as yoga, tai chi and meditation. However, if you feel like your emotions are running your life, talk to your doctor; medication may be of help.
* Protect your heart. During menopause, women need to take steps to protect their heart. This includes exercising and eating right, but also making sure that they get their cholesterol checked, as levels of LDL, the “bad” cholesterol, tend to increase at this time, while HDL, the “good” cholesterol, drops. If your cholesterol is high, your doctor can advise you as to how to get your cholesterol back on track. Some doctors advise seeing a cardiologist or getting some baseline heart tests done at this time, just to check for any abnormalities and be proactive about treatment. This is more likely if you have risk factors for heart disease (obesity, smoking, genetic history of heart disease), but can be a good idea for anyone. In addition to eating healthy, adding in foods rich in Omega-3s, such as salmon and walnuts, can be helpful in reducing LDL.
A few common questions:
What about hormone therapy? For many years, hormone therapy was very successful at treating hot flashes and vaginal dryness, but in 2002, many women abandoned this form of treatment after news surfaced of studies linking hormone therapy to increased risk of breast cancer and heart disease. Many experts have since agreed that the studies were flawed, but some concerns remain. Should women use hormone therapy? It remains a personal choice. Women who have a history of breast cancer, endometrial cancer, stroke, heart attack or liver disease could be at some risk with hormone therapy. Women who do not smoke, and who do not have any of these risk factors, are at far less risk, especially if a low dose treatment is used for a limited period of time. If you wish to consider hormone therapy, talk with your healthcare provider. He or she can tailor a plan specifically to your needs in terms of dosage and how long to undergo the therapy.
Should I take supplements? It’s best to consult with your doctor before embarking on a course of taking calcium or Vitamin D, or any other supplement. If additional amounts of these substances are not needed, they can cause other issues. Your doctor can advise as to whether or not you need supplements and what the correct dosage should be.
Is it time to see a menopause specialist? All obstetric-gynecology physicians, including those at Partners for Women’s Health, are trained to provide complete healthcare for women at all stages of their lives, including menopause. However, many doctors are starting to specialize in the treatment of perimenopause and menopause so that they may better guide women through their middle years. It may be helpful, especially if you are having difficulties with the transition, to see a menopause specialist during this time. At Partners for Women’s Health, Drs. DiNicola, Turer and Browne all have a particular interest in menopause issues. Dr. Deborah Browne also has an extensive menopause background. She is a certified Threshold Menopause Educator, specializing in menopause education and treatment. She is also a member of the National Vulvodynia Association and the International Society for the Study of Vulvovaginal Disease, which helps women with chronic and acute vaginal pain and discomfort. If you are having trouble with perimenopause or menopause, it may be helpful to see a specialist.
For more information about Partners for Women’s Health, call (603) 778-0557.
Obstetrical Tips
Watch for Carpal Tunnel Syndrome
If you are pregnant, and have pain or numbness in your wrist when you perform simple tasks, then you may have Carpal Tunnel Syndrome. Carpal Tunnel Syndrome, or CTS, is the compression of a major nerve as it passes through the narrow tunnel of bone and ligaments in the wrist. The compression can be caused by many things, but in the case of pregnant women, it is usually caused by edema, or swelling of the wrist tissues. Usually, when the edema subsides post-pregnancy, the carpal tunnel subsides as well.
However, during your pregnancy, there are steps you can take to reduce the symptoms of carpal tunnel. First, get it treated right away. The sooner it is treated, the better your chance of finding relief and avoiding permanent wrist damage. Following are a few of the recommendations for coping with CTS.
* Keep your wrist in neutral. Try to avoid keeping your wrist in flexed, extended or twisted positions for any length of time. Try to maintain a neutral or straight position.
* Watch your grip. Gripping, grasping or lifting with the thumb and index fingers puts stress on your wrist. When practical, use your whole hand to grasp an object.
* Rest your hands periodically throughout the day.
* Avoid repetitive movements.
* Build strength. Your doctor may suggest a series of exercises to help build your hand and arm muscles so the wrist doesn’t do as much work.
Your doctor may recommend night splints or occupational splints that will help keep your wrist in a neutral position while you sleep or while you work. Medications may be prescribed to help reduce pain and inflammation. Treatment of the edema may also be discussed.
Remember, if you suffer from persistent pain or numbness, ask your doctor. Carpal tunnel syndrome only gets worse. Early treatment can allow you to function with ease.
For more information about Partners for Women’s Health, call (603) 778-0557.