Signs and Symptoms of Menopause

Intro: MemorialCare Health System Excellence in Healthcare presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to our show This is your Weekly Dose of Wellness. I'm Deborah Howell. And today our guest is Dr. Caroline Conner, an OB-GYN physician with Orange Coast Memorial Medical Center and she's here to help us talk about what to look for when approaching menopause, what is completely normal to experience, and when it may be time to find long-term relief. Welcome Dr. Conner.

Caroline Conner, MD: Good morning and thank you for having me.

Deborah Howell (Host): Oh, it's our pleasure. Now you've been practicing in the Fountain Valley area for about 10 years and you've seen an awful lot of women patients. Some women go through menopause without any complications or unpleasant symptoms, but many women can experience very unpleasant symptoms that can be debilitating during pre-menopause that can persist for years. So first off, let's start with a description. What is menopause and when do women typically begin to experience symptoms?

Caroline Conner, MD: So, as doctors, we consider a woman to be in menopause after she's had no menstrual cycles for a year.

Deborah Howell (Host): Okay.

Caroline Conner, MD: So, with no other biological causes. And many women will start to experience these symptoms in their mid to late 40s and think they're going through menopause, but they're not actually through menopause until they've had no periods for a year. And the average age of menopause is approximately 52, when those symptoms, when those menstrual cycles will come to an end.

Deborah Howell (Host): Okay. That's good news. And so premenopause is anything before that where they have maybe spotting periods?

Caroline Conner, MD: Yes, or they begin to experience the hot flashes or regular menstrual cycles. Mood changes, those kind of symptoms that will start to happen in the mid to late 40s. But the actual menopause will not be until those women have had no period for a year.

Deborah Howell (Host): Okay, that's a great definition. So how long does menopause typically last for most women?

Caroline Conner, MD: 80% of women will have symptoms up to a year, with the average woman having symptoms for about four to five years. And then in extremely rare cases, some women will have symptoms up to 10 years.

Deborah Howell (Host): Wow.

Caroline Conner, MD: But it is good news that this will not last forever.

Deborah Howell (Host): Yeah, because you think it will once you're in it, probably, I'm sure.

Caroline Conner, MD: Yes. Many women do, and it is very distressing to them, and they become very worried that this is going to go on forever, and this is going to be their life forever. But the good news is it's not.

Deborah Howell (Host): Yeah. And men, I'm sure, who have not maybe had a hot flash don't know how bothersome it might be.

Caroline Conner, MD: Yes, many men will also be very distressed about these symptoms. I do have them calling saying, my wife needs help.

Deborah Howell (Host): Oh, that's good. I'm glad to hear that. That's cool. Because otherwise it's like, oh, take your sweater off.

Caroline Conner, MD: Yeah.

Deborah Howell (Host): So we've all heard of hot flashes, but what other symptoms are associated with menopause?

Caroline Conner, MD: Yes, well the hot flashes are obviously the most common and debilitating symptoms that most women will have. And just to review that for many women and men, hot flashes are a hot feeling in the chest that may rise up to the neck and face and dissipate out through the arms. and it can also be accompanied by sweating, a rapid heart rate, and irritability. That's the most common symptom of menopause that many women will have, but there are many others that patients will come in complaining and they really think that something's wrong with them, but in fact they are just going through the premenopausal transition. A lot of times that's insomnia, they can't sleep, they're having mood changes, they become depressed. Also, with the hot flashes, they may have decreased interest in sex, accompanied by vaginal dryness. A lot of women will complain of weight gain, and it's usually about a 5 to 10 pound weight gain, and that's one of the symptoms that's very distressing to them.

Deborah Howell (Host): Of course. Now, what are some uncommon symptoms or signs that women may need to see their OBGYN for?

Caroline Conner, MD: Yes, well, 80% of women will have these symptoms, but only 20% to 30% of them will actually present to us and talk to them about them. But symptoms that women will definitely want to bring up that may not be due to menopause are, these can be irregular periods. So if patients are just skipping their cycles, you know, one or two months, three months, that's normal. But when patients start to have periods every two weeks, they're heavy, lasting more than seven to ten days with blood clots, or they're having severe pelvic pain, those symptoms are not necessarily related to menopause, and they do need to see their doctor properly. Other things, bleeding after menopause. So bleeding once a woman has stopped having her period for a year is not normal, and a woman definitely needs to see their doctor for that kind of a symptom.

Deborah Howell (Host): Do you see that many women are misdiagnosed because they think it's something else, but in fact it's menopause-related?

Caroline Conner, MD: Yes, that can happen a lot of times Women come in thinking that something's wrong with them. And sometimes there can be other hormonal things going on Like thyroid issues that are undiagnosed. So we definitely tend to check all the hormones Including the thyroid to make sure it's not something related to that But women will have other symptoms such as night sweats and rapid heart rate or rapid weight loss or weight gain when thyroid is an issue.

Deborah Howell (Host): Okay, good to know. So what are some of the ways to naturally relieve or minimize these symptoms of menopause?

Caroline Conner, MD: Well, a lot of times just counseling these patients that these symptoms are normal will help to relieve a lot of their anxiety. And then they can start to develop practical ways to deal with these symptoms without the use of medication. Just as we were talking about recruiting the support of family members, explaining to patients' husbands that, you know, I'm having these hot flashes and they're normal and we need to keep the house cool. You need to wear cool clothing, use fans, and just have other family members help out in that situation. You know, just avoid those types of triggers to help relieve some of those hot flashes.

Deborah Howell (Host): Right.

Caroline Conner, MD: And also, regular diet and exercise can help, can help patients to release some of these symptoms. And there is an over-the-counter vitamin that women can take called black cohosh, and this can provide some mild relief of these symptoms. It's not for severe symptoms, but it can provide some mild relief, and this can be purchased at any health food store.

Deborah Howell (Host): That's a new one. Haven't heard that.

Caroline Conner, MD: Yeah. That's a supplement that's been around for a while, and it can provide some relief for some of these patients.

Deborah Howell (Host): You better believe I'm writing it down.

Caroline Conner, MD: Yes, write that one down.

Deborah Howell (Host): I'm amazed there aren't hot flash related clothing on the market.

Caroline Conner, MD: Tank tops and shorts.

Deborah Howell (Host): There you go. Okay. Now, what are some of the more severe symptoms that women can seek help from their doctor for?

Caroline Conner, MD: Well, definitely severe hot flashes. Hot flashes that are keeping patients up at night to where they can't sleep and this is affecting their work life and their quality of life. Many women will seek treatment for those types of hot flashes. If women become severely depressed or having mood changes, and either this is a new onset depression or an exacerbation of a chronic depression, they would definitely need to see their doctor. Also, many women will have very severe vaginal dryness and pain during intercourse that can easily be treated with medication.

Deborah Howell (Host): Okay. So for these treatment options, are there more than medications? Are there other things that they can do?

Caroline Conner, MD: Just like what we talked about before, just mainly avoiding the triggers there are some over-the-counter medications that patients can use for vaginal dryness but other than that and the black cohosh but other than that other than practical solutions most of the treatments would be medical.

Deborah Howell (Host): Because I've also heard that exercise might be helpful.

Caroline Conner, MD: Yes, exercise can definitely be helpful to relieve some of the mild symptoms, but overall, if the symptoms are severe, they will need medical treatment.

Deborah Howell (Host): Got it. What advice can you offer, doctor, for women who are approaching menopause or think that they may be pre-menopausal?

Caroline Conner, MD: So just see your doctor and educate yourself on all the symptoms of menopause and know what's normal and what's not normal. And see your doctor and see what treatment is right for you.

Deborah Howell (Host): And is there counseling available too?

Caroline Conner, MD: Yes, there's counseling available with menopause. Therapists and in our offices, your primary care physician or your OBGYN can counsel you on all the symptoms.

Deborah Howell (Host): Wonderful. Do you have any last thoughts about menopause that we should know?

Caroline Conner, MD: The only thing we didn't talk about were the medical treatment for menopausal symptoms and like I said, this could be a whole other podcast entirely, but just briefly, hormone replacement therapy does continue to be the most effective therapy for menopausal symptoms. However, many women are not candidates. Women that have breast cancer, they have a heart attack or stroke, they're not candidates for these medications. But in the last three years, there's been at least two or three new medications that have come on the market that are good therapies, and some of them are non-hormonal. So there are many new options out there. So I would just suggest to women, if they're having these symptoms, go in and talk to your doctor and... they can decide what's the best therapy for you. Just coming in and getting a full evaluation and making sure there's not other medical problems that may prevent them from taking any medication. So a full evaluation of history and physical is the main thing. And then sometimes also some blood tests to check hormone levels to make sure they're candidates for these medications.

Deborah Howell (Host): Great. Well, thank you so much, Dr. Conner, for coming on our show today. And to learn more or to listen to a podcast of this show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have yourself a fantastic day.