Perimenopause
How can I
tell if I'm going through menopause?
There is a blood test you can
take that will tell you whether you are going through menopause, and if so,
what stage you are at. It is called the FSH, which stands for follicle
secreting hormone. Your doctor can give you this test at the same time your
other blood tests are performed.
Hot
Flashes
I am
starting to have hot flashes and don't know what to do about it. I am afraid
I am going to embarrass myself in a meeting at work or something. I there
anything I can do to prevent them?
During perimenopause,
women go through estrogen withdrawal. Some do it smoothly; others have every
symptom in the book--hot flashes, night sweats, depression, weight gain, and
more. There is an easy way to treat these symptoms--with low-dose birth
control pills. They give you a steady level of hormones, which keeps you from
having the hormonal fluctuations that bring on hot flashes and other symptoms.
Of course, low-dose birth
control pills are good for their normal use, as well--contraception. A lot of
women forget that they still need to protect themselves against pregnancy
when they are having irregular periods, and sometimes skipping them for months altogether.
You can take low-dose birth
control pills right through menopause (which occurs when you haven't had a
period for a year), and a little bit after. But then you should switch to
hormone replacement therapy, which has a slightly lower dose of estrogen.
Hormone
Replacement Therapy
I don't want
to take regular hormone replacement therapy. I just want to take natural,
herbal supplements. What do you recommend?
I am not a big fan of
over-the-counter herbal supplements--too many of my patients have had serious
problems as a result of using them. The two major problems are (1) that they
aren't regulated by the Food and Drug Administration, so you really have no
idea what you are getting or in what actual amount, and (2) that patients
don't treat them with the same respect as prescription drugs because they
don't take them as seriously. If I write a prescription that tells a patient
to take 200 mg. of a drug twice a day, that's more than likely what she'll
do. When she buys an over-the-counter herbal supplement, she sometimes
thinks, well, the instructions say to take 200 mg. twice a day, so I'll get
better results if I take 400 mg.
I have had major disasters with
patients taking herbal estrogen supplements. They don't understand the
difference between opposed and unopposed estrogen. When you take the
unopposed (by progesterone) estrogens found in these over-the-counter
supplements, you can get huge breast cysts or masses, irregular bleeding, and
sometimes ovarian cysts. You are much safer taking prescribed hormones, some
of which, such as Cenestin, Menest, and Ortho-Est, are now
being made from natural plant estrogens.
Sadly, many women don't think
to tell their doctors about the over-the-counter medications they are taking,
and end up getting prescribed medications that make their conditions worse.
So you should bring a list of both prescribed and over-the-counter
medications with you to your appointment so your doctor knows what's really
going on with your body.
I went through menopause ten
years ago. Is it too late for me to start taking hormone replacement?
It's never too late. Even
though you probably have already experienced some bone loss and the other
symptoms that women experience postmenopausally,
hormone replacement can give you a sense of well-being and put the brakes on
any deterioration that has already occurred.
Bone
Density
How can I
tell whether I have good bone density?
It depends on how old you are
and whether you have gone through menopause already. If you haven't gone
through menopause yet, a simple urine test will tell you what you need to
know. It is called the NTx, which stands for n-Telopeptides. It measures how much bone mass you are
losing. Your doctor can give you a container for collecting the urine sample,
which must contain your second urine of the day, and tell you where to drop
it off once you have done it.
If you have gone through
menopause, the best test to use is the DEXA. It measures the density of your
spine and your hips--the two places where you are most likely to have a
fracture. Tests that measure the bone density of your heel are not really as
useful in predicting your actual risk of a fracture.
Unfortunately, most insurance
companies won't cover the DEXA until a woman is 65 years old unless she has a
history of fractures or at least one other risk factor, such as chronic
steroid use, cigarette smoking, or asthma.
Bladder
Control Problems
For a while
now, I have had bladder control problems. I used to use those little pads you
wear during your period, but it has gotten more serious in the past year. It
seems like women have this problem more after menopause, which I went through
last year. Is there anything I can do about it?
Once again, this is a topic
that very little has been written about, despite the frequency with which it
occurs in women after menopause. One of the changes that women go through in
menopause is that the urethra shrinks and gets shorter. Eventually, the tube
that goes from your bladder to the outside of your body is too short to
sustain the pressure of urine in the bladder, and it starts leaking out. The
best solution is to take hormone replacement therapy, which relieves this
problem by thickening the mucosal lining and revitalizing it.
Tooth
Problems
I am 53
years old and I take really good care of my teeth. I floss and brush twice a day.
But in the last couple of months, I have had three teeth come loose. My
dentist says loose teeth occur in women after menopause as a result of bone
loss. Is there anything I can do to prevent it?
Absolutely. I am surprised
that, in all the literature about osteoporosis, there is very little written
about the fact that bone loss can lead to tooth loss. It is a serious
problem, because it can affect your diet and general overall health as you
age. It is one of several reasons that I recommend hormone replacement
therapy to my patients.