Exploring Menopause

Today Dr. Jean Marie McGowan joins us to talk about menopause. Jean Marie McGowan, MD NCMP FACP is an Internal Medicine physician with a special interest in Women’s Health. She attended the American University of the Caribbean for medical school and completed Internal Medicine residency, serving as chief resident, at the University of North Dakota in Fargo. Dr. McGowan started working for Sanford Health in the summer of 2016 and focused on improving women’s healthcare. She became a certified provider for menopause management by the North American Menopause Society and became Fellow of the American College of Physicians. She is director of the Pelvic Floor Clinic and co-director of the Preconception Clinic. In addition to seeing consults for menopause, polycystic ovarian syndrome and post-breast cancer treatment, she is a primary care physician. Dr. McGowan is associate faculty for the UND School of Medicine and clinical director for the Women’s Health rotation for medical students, residents, and fellows. She’s dedicated to educating the future generations of healthcare providers as well as the community to improve care for women. Dr. McGowan is also involved in research and won the inaugural Faculty Research Mentor of the Year in 2019 from UND Internal Medicine residents. Dr. McGowan grew up in Brooklyn, NY and currently lives in Fargo, North Dakota. Outside of work, she enjoys singing, running, and playing with her maltipoo, Minnie.

Definitions:

Menopause - occurs after the last menstrual period; a women has formally been through menopause when she has been free of periods for 12 months. Average age is 51.

Perimenopause - the time preceding menopause, lasting about 2-4 years.

Postmenopause - time following menopause.

Surgical menopause - menopause that occurs after surgical intervention (removal of both ovaries). May have more severe symptoms.

Premature ovarian insufficiency - when menopause occurs prior to age 40.

Symptoms - can vary among women, starting 2-4 years prior to last menstrual period and often lasting 2-4 years after menopause (can be up to 10 years or longer)

Perimenopausal: most common are vasomotor symptoms - hot flashes/flushes. Mood can also be impacted by progesterone and estrogen. This tends to be transient during the menopausal time frame.

Decreased estrogen can cause changes in sleep, memory, vision, hearing, skin; vaginal dryness, urinary tract issues.

Postmenopausal: vaginal dryness and urinary tract issues tend to continue. Avoid hot baths, certain wipes, irritating pads.

Decreased estrogen also affects bone health, cholesterol, heart disease risk. These effects tend to be seen 10-15 years after menopause. Exercise, diet, smoking cessation, limiting alcohol consumption can help mitigate these.

Diagnosis of menopause - hormone testing is not needed in most cases and is made based on cessation of periods, age. If considering premature ovarian insufficiency, hormone testing is indicated.

Patients often note decreased sexual desire in the perimenopausal period. This is not related to age or menopause itself.

Treatment:

Vaginal dryness

Vaginal moisturizers & lubricants can help with painful intercourse. Good Clean Love & UberLube are some well balanced options.

The only treatment is estrogen.

Pelvic floor therapy can be effective for pelvic weakness, painful intercourse, and urinary symptoms. Beyond Kegels is a helpful book for pelvic weakness.

Hormone replacement therapy (HRT) is indicated for severe hot flashes and genitourinary syndrome of menopause (vaginal dryness / urinary symptoms). Start within 5-10 years of last menstrual period. Can benefit cholesterol, heart health, ovarian cancer risk. Should be avoided in women who have had a stroke, blood clot, or pulmonary embolism. Evaluate carefully in women who already have heart disease.

Combination therapy: estrogen + progesterone, used for women who still have a uterus.

Estrogen only therapy - lower risk of breast cancer than combination therapy.

Come in pill, patch, vaginal ring, or combination of estrogen pill/patch and progesterone IUD. Estrogen dose is lower than what is found in oral contraceptives.

Vasomotor symptoms: black cohash helps 30% of women who have tried it; it can affect the liver so caution should be taken.

Bio-identical hormones: not regulated by the FDA, not proven to be effective. Not recommended and potentially dangerous.

“Menopause” supplements - not proven to be effective.

Paroxetine (Paxil) - FDA approved medication for hot flashes. Commonly prescribed for depression and anxiety. Side effect is weight gain. Desvenlafaxine (Pristiq) can also help with hot flashes, as can venlafaxine (Effexor). Gabapentin, clonidine are other options.

Weight gain, changes in body shape occur around menopause. Exercise (especially strengthening) and healthy diet will help. Many other menopause symptoms improve with exercise, healthy diet, and good sleep.

The good news: not all women have all symptoms associated with menopause. The positives include no more periods to worry about, migraines may improve, autoimmune diseases may improve.

References & Products:

Good Clean Love Moisturizer

UberLube Lubricant

Beyond Kegels by Janet Hulme

North American Menopause Society website: www.menopause.org

Correction: premenstrual dysphoric disorder is the syndrome of low mood or irritability prior to menstrual periods

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