written by Deborah McBain, CNM MSN

Test your knowledge of menopause.  Learn all this and more at one of our Menopause Support Circles.  Meetings are held in 4 locations and 4 dates this month. Facilitators are expert  Henry Ford Health System physicians and nurse-practitioners ready to answer your questions.

1.  You know you have reached menopause officially when:

A.  you have not had a menstrual period for 12 months.

B.  you can’t remember when you had your last menstrual period

C.  you’ve had it up to here with your husband, your kids, your boss, your life…

D.  you can’t remember…

2.  The cause of menopause is:

A. a natural decline in estrogen production by the ovaries

B. surgical removal of  the uterus

C. surgical removal of the brain

D. a natural shriveling of the brain

3.  Perimenopause is:

A. a time immediately before menopause  and when symptoms of menopause are occurring.

B. when symptoms are often more severe than actual menopause

C. characterized by heavy, light, short, long, irregular, regular, painless or painful  periods.

D.  Hell

4.  Hormone  therapy is:

A.  the only good treatment for menopause

B.  dangerous therapy for any woman unless “bioidentical”

C.  prescribed to keep the heart, bones and skin healthy.

D.  reasonably safe  for healthy women whose hot flashes are bothersome.

5.  Once menopause is reached it will last until:

A. you stop having hot flashes, about 6 years

B.  you die.

C. you go on hormone therapy.

D. Age 70

Answers:

1.  A, natural menopause is diagnosed retrospectively after no menstrual period for one year.  There is no reliable blood test for menopause.  2.  A,  surgical menopause occurs with removal of the ovaries.  3.  A is most correct.  B, C, D can be true for many women but some women just sail through these changes without a lot of problems.  4.  D,  see the other posts on this blog for more information on hormone therapy and alternatives. 5. B,  Menopause means menses ( periods) stop.  You never go back.  You will be there until you die.  That’s not a bad thing.  It’s a natural part of the life process.  Understanding the process of menopause will help you develop a strategy for coping with the physical changes and recommit to a healthy life style.  Although change can be challenging, it is also a time for reflection and re-evaluation.  Approach menopause with positive thinking.  Science has confirmed this can be helpful in reducing hot flashes, insomnia and pain.

written by Deborah McBain, CNM MSN

I get a lot of questions about how menopause effects mood.  What do you think?  Have your responses to situations changed as you journey through menopause?  How have you coped?  What advice do you have for others?  Your comments are welcome.

On October 9th, the HFHS Neurology Department hosted the second lecture in a series of three focusing on neurological health for women.  Dr. Doree Ann Espiritu, service chief of Psychiatry at West Bloomfield Hospital spoke about mood disorders and women.  Below I share information about mood and menopause and my notes from the lecture.  The final lecture in this series is October 30.  The topic is Memory.  I suspect it will be very popular and space is limited .  Call 313-916-8088 if you are interested in attending.  If you can’t make it, stay tuned here.  I will report back.

It is a common belief that menopause makes you crazy.  In truth, there is no scientific evidence for this.   There is evidence, however, that mood is definitely tied to hormones.  Duh!  Women who have suffered from premenstrual dysphoric disorder or postpartum depression may indeed be at higher risk for mood problems during the hormonal roller coaster of perimenopause.    The good news is that once menopause is acheived (remember this is confirmed 12 months after the last menstrual period) the risk for mood disorders actually decreases.  Whew.

According to Dr. Espiritu’s statistics, a lifetime chance for a women to develop depression is 21%, social phobia,15.5%, drug and alcohol dependence 14%.  Although rates of depression are lower in men, rates of drug and alcohol dependence are higher.  Women are 6X more likely than men to have Seasonal Affective DIsorder (SAD).  We are 3X more likely than men to develop anxiety disorders.  Anxiety disorders include generalized anxiety, phobias, obsessive-compulsive disorders, panic disorder and post-traumatic stress disorder.

Hormones are by no means the only culprit for mood problems in women.  Women with mood disorders should be screened for other causes of their symptoms, according to Dr. Espiritu.  Medical problems, medications and assessment of past and recent traumatic events should be considered.  Some women having their first perimenopausal hot flashes with heat sensations and sweating that take their breath away may mistake them for panic attacks.

Medications and cognitive-behavioral therapies now provide very effective treatment and management of mood disorders.  Like any illness, treatment for a mood disorder is easier when recognized early.   Also, like most other diseases, life-style changes can help.  There is strong evidence that exercise and a healthy diet improves mood. November topic is stress management and I will discuss life style and mood more in the next few weeks.

In Christine Northrup’s book, The Wisdom of Menopause, irritability and menopause is attrubuted to the “lifting of the hormonal veil”.  By this she means that the stopping of the monthly cycle of reproductive hormones which keep us focused on caring for others allows us to consider our own needs more clearly.  You may have a darn good reason to feel irritated!   A surly boss, unhelpful kids or husband,  a higher number on the bathroom scale?   If you are in a bad mood, consider why.  It may be just the motivation you need to change your life in a new and better direction.

Irritability is one thing, clinical depression or other mood disorders are another. If you are stuggling to get out of bed or having difficulty coping day to day then get help.  Talk to your health care provider about your symptoms.   If you thought you had an infection you wouldn’t hesitate to get treatment and a mental illness should be no different.  If you would like more information about women’s hormones and relationship to mood a good book is Women’s Moods: What every Woman Must Know about Hormones, the Brain and Emotional Health by Deborah Sichel, MD, Jean Driscoll MS,RN,CS.  The National Institute of Mental Health web site is another good source for information- www.nimh.nih.gov

written by Deborah McBain, CNM MSN

What symptoms are normal and what is not normal during menopause?
During the perimenopause, irregular menstrual periods which may be longer or shorter, heavier or lighter, skipped periods or periods starting every three weeks are all within the norm. Periods coming less than every 21 days or lasting over 7 days should be reported to a health care practitioner.   Spotting between periods or after intercourse should also be evaluated.  Once menopause is reached, any vaginal bleeding should be investigated by a health care practitioner.  Often these irregularities are a result of  hormonal changes but occasionally they can herald more serious problems which should be ruled out.

Some women sail through perimenopause and menopause with nary a problem. Some have all the symptoms in the book.  Hot flashes, mood swings, trouble sleeping, skin changes, dizziness, heart palpitations have all been attributed to the hormonal changes of perimenopause and menopause.  Many women find these things manageable and do not need treatment.  It is best to discuss symptoms with a health care provider.  He or she can determine if any symptoms are suspicious for diseases like thyroid disease which may minic menopausal symptoms.

Symptoms of depression, weight gain, decreased sex drive, sleep disorders and memory loss are commonly atributed to menopause.  Studies do not show a strong relationship between these symptoms and hormonal levels.  These symptoms are often more related to stress or aging.  Unplanned weight gain or loss for which there is no explanation should be looked into.  Any symptom effecting one’s ability to function at home or at work should be investigated.

Coming- Part 3- ”Ok so now what do I do?”- Remedies and Solutions.

written by Deborah McBain, CNM MSN

The month’s theme for the support group meeting on Thursday, September 18 is the Mystery of Menopause. Over the next few weeks I will be addressing common questions about menopause, symptoms and treatment. I welcome your comments and questions.

Every so often a woman will come to see me and complain that her periods are getting irregular, she is having hot flashes, maybe some moodiness.  “Can you give me a blood test to see if I am in menopause?” she will ask.   The fact is that no women knows the exact moment when natural menopause occurs in her life. It is only after a year of no menstrual periods that anyone can know that she has reached menopause. No blood test, hormone test, medical professional or exam can tell her.  Before that time she is perimenopausal (and those symptoms can last for several years).  After that time until she dies, she is post menopausal (and hopefully that will last for many, many years). That single moment when the exact balance between hormones occurs and stops the monthly ebb and flow which results in menstrual bleeding is a mystery.  Any blood tests done are simply a snap shot of where hormones are at that moment in time.  And hormones can flucuate wildly  during the perimenopausal years.  Just as adolecence is a process that occurs over several years so is menopause.  Perimenopausal symptoms may begin in the 30s. Natural menopause generally occurs between ages of 45-55, average 51.  Before age 40 it is considered early menopause. Menopause can also be induced by surgery and with medications. Sometimes blood tests are appropriate to rule out other problems whose symtoms can mimic menopause, such as thyroid disease.  If a woman is in her 40s or 50s and having typical symptoms I usually don’t need a blood test to tell her what is going on, but I certainly can help her understand the natural process and help her develop strategies to manage symptoms. 

Coming, Part 2- What is normal and what is not during perimenopause and menopause.

written by Deborah McBain, CNM MSN