Dr. Daniel Spratt (Guest): Usually, it’s a fairly large span between ages 45-55, your average being about 51. So, anytime in there. You can usually tell because maybe 60% of women have symptoms other than stopping periods. So, the most common thing is periods becoming less frequent and eventually stopping.
Melanie: Okay. So, 51. I, myself, am 51.
Dr. Spratt: Perfect.
Melanie: When you notice these things, maybe a little more bloating than you used to have or really heavy periods and then no period at all for a month, is that the time to go see your doctor? Is there a reason to go see your doctor when you’re in perimenopause?
Dr. Spratt: Yes. There is definitely reason but not for everyone. So, the major reason is if you have bothersome symptoms whether it’s irregular periods or heavy periods or hot flushes, night sweats to review options for relief of those symptoms.
Melanie: Are there some ways that you can recommend relief of those symptoms other than what we typically – is that the time that women go on hormone replacement therapy in peri or do you usually wait for menopause to kick in before we start looking at those kinds of things?
Dr. Spratt: Consideration of therapy is definitely timed with the appearance of symptoms, so you don’t have to wait until your periods are gone.
Melanie: What do you tell women who ask you about the side effects of HRT and they're worried about the risks of breast cancer and those sorts of things? What do you tell women?
Dr. Spratt: I go through one at a time and, as you point out, the top theory is breast cancer. So, I usually focus on that and there is a lot of information on what the actual risks are of breast cancer. So, in perimenopause, a typical 50-year-old woman has a lifetime risk--if she doesn’t have a first-degree relative--a lifetime risk of about 10% of developing breast cancer. For the first four years of combined hormone replacement therapy, estrogen/progestin, that risk is now affected, it doesn’t go up. But, if you go beyond that, there is a slight lifetime risk of breast cancer going from 10% for the rest of your life to 12% for the rest of your life.
Melanie: How long does it take to go through perimenopause before you enter menopause, and how do you know the difference?
Dr. Spratt: The major difference is total lack of periods. So, to go from having irregular periods to no periods can be anywhere from two months to a year, typically. For some women, it can be longer than that. For the length of symptoms, symptoms can persist anywhere from a few months to lifetime. So, you can have symptoms well after perimenopause or you can’t have no symptoms at all.
Melanie: Do you give women any recommendation in dealing with their symptoms and the weight gain that seems to be associated with this?
Dr. Spratt: First, is that any of these hormone therapies that you use for treating symptoms are not associated with a further weight gain. So, they’re safe in that respect. So, as far as weight management, it’s the active physical lifestyle and eating sensibly are the main tools.
Melanie: Are the mood swings normal? Because we’ve heard jokes about them for years and in the media and even women just going through their monthly cycle. But, in menopause, they say our personalities change and we have these huge mood swings. Are those normal?
Dr. Spratt: I think they're frequent. I think that sometimes they can be exaggerated and you don’t want to blame too much on mood swings but they can certainly be bothersome. How much they're related to menopause or other things, it’s hard to tell but it justifies a trial treatment to see if hormone replacement helps them. Two or three months of treatment, which is quite safe, can help tell which of these symptoms may actually be related to perimenopause.
Melanie: As our bodies change, Dr. Spratt, so many things change while that’s happening. Our breasts get more tender, maybe we’re suffering vaginal dryness, any of these things. So, what therapies do you recommend for women to deal with some of these?
Dr. Spratt: It will be different therapies, according to the different symptoms, of course. There are the hormone therapies, which are the most common ones to help out, that is anywhere from if you’re having heavy irregular periods with some breast tenderness to potentially suppress the system for a few months with birth control pills to the very, very low-dose hormone replacement therapies that are used for the hot flushes, night sweats, and vaginal dryness. So, there are a lot of options that can be really individualized and customized for each woman.
Melanie: If we chose not to go on hormone replacement, tell us a little bit about the physiology of menopause and perimenopause. Our bodies stop producing estrogen. What are the side effects of that? Are there any? Because this has obviously been going on for thousands of years. But, are there any side effects to not replacing that?
Dr. Spratt: The biggest studies that we have so far showed that there are less consequences than we used to think. Apart from symptoms, there is an accelerated loss of bone density, so an increased risk of osteoporosis but that can be monitored as appropriate with bone density measurements. There is no clear increased risk of heart disease by having the estrogen or not having the estrogen. Generally, there is very little evidence that adding the estrogen will help besides supporting bone density and helping quality of life.
Melanie: What about supplements, Dr. Spratt? Are there some supplements you recommend as women start to go through this? Do we then need more iron? If we’re having very heavy periods during perimenopause, do you recommend that we take a little bit of extra folic acid or calcium? Any of these kinds of things you recommend?
Dr. Spratt: I think that if you're having heavy periods, there are some things that you’d want to check with a blood test to see if you need the iron to individualize that therapy and some women do. I think with supplements in general, that there is not a lot of information on the non-drug supplements having a lot of effect on symptoms. There is certainly anecdotal evidence. I also want to mention there are also non-supplement, non-drug approaches that are frequently used, ranging from acupuncture, to mind/body therapies, to even deep breathing relaxation and hypnosis.
Melanie: I think those are all great and exercise as well. We have to keep that bone density with some good strength training. In just the last few minutes, Dr. Spratt, give us your best advice when we need to see a doctor if we think we’re starting into perimenopause or menopause and, really, your best advice about what you’d like women to do about it and why they should come to Maine Medical Center for their care.
Dr. Spratt: I think that the most important thing about menopause is, again, focusing on quality of life issues. It’s an important kind of marker. Take an account of health, both reducing bothersome symptoms, particularly lack of sleep and night sweats that may occur; getting exercise and good physical condition in order. I think, with the Endocrinology Centers that Maine Medical Center has, that has physicians with a fair amount of expertise in dealing with these issues. The gyn practices, the gynecologic practices associated with Maine Medical Center also do a lot of this.
Melanie: It’s great information. Thank you so much, Dr. Spratt. You’re listening to MMC Radio. For more information, you can go to MaineMedicalCenter.org. That’s MaineMedicalCenter.org. MMC.org. This is Melanie Cole. Thanks so much for listening