Menopause FAQs

Q: Beginning in my early 40's, I noticed occasional vaginal dryness.  At first it seemed to be right before my period. Now that I am 48, it seems that the dryness is constant.  It is uncomfortable; especially with sexual relations.  What can be done?

A: Nearly every woman will experience vaginal dryness sometime in her life. It is most often associated with the normal decline or fluctuation of the female hormone estrogen. This fluctuation can be triggered by childbirth, breast-feeding, or menopause. Other causes of vaginal dryness include medications, such as antihistamines, oral contraceptives, fertility medications, some chemotherapy and other prescription medications.

It is also common to experience vaginal dryness when douching, using tampons, or at the end of the menstrual cycle. Whatever the cause, women describe the feeling of vaginal dryness along with itching, burning, irritation and painful intercourse.

MenopauseRx has evaluated a number of over the counter products used for vaginal dryness, and has found Replens Long-Lasting Feminine Moisturizer to be the most effective product available. 

Replens is a true moisturizer, delivering continuous moisture for up to three days. This helps to rejuvenate vaginal lining, eliminate dry skin cells and, when used regularly, replenishes your natural vaginal moisture. In contrast, a personal lubricant is intended to provide temporary lubrication to reduce friction during sexual intercourse. Replens will make sexual intercourse more comfortable by restoring vaginal moisture, but many women choose to add extra lubrication during sexual activity.

John A. Sunyecz, M.D.
MenopauseRx

Q: Since I went through menopause, I have noticed more gas and bloating. The symptoms are becoming more embarassing and nothing seems to help. Is there an association between gas and menopause?

A:  Over the last few years, it has become quite apparent that a very common symptom of menopause is bloating in the intestinal tract due to the production of gas. Recent survey results have found over two-thirds of women experience stomach gas during menopause.

While gas and bloating are very common symptoms during menopause, it is unclear if this is related to the actual hormonal adjustments of menopause or solely an issue of aging . Since approximately one quarter of women have noted increased gas during menopause, some doctor’s have suggested that decreasing hormone production may play a role in this process. Other experts have stated that a change in diet around the menopause transition may lead to more gas and bloating. In fact, over 60% of women were eating more fruit and vegetables and over 70% have made changes in their diet during menopause according to a recent survey.

There are many approaches to reducing gas and flatulence. Fortunately, eliminating healthy gas producing foods does not need to be done.

When ingesting gassy foods such as cabbage, broccoli, cauliflower, legumes, grains, cereals, nuts, seeds, and whole-grain breads consider a digestive aid to eliminate gas. Many foods that are part of a healthy diet can cause gas.

Click here for an expanded list of ‘gassy’ foods ( http://www.menopauserx.com/news/gas.htm).

As with all medical conditions, it is recommended to discuss your specific symptoms with your health care provider.

John A. Sunyecz, M.D.
MenopauseRx

Q: My doctor told me I had 'Osteopenia'. What is osteopenia and how should it be treated?

A:  Osteopenia is a recent term that describes bone thinning that has not reached osteoporosis proportions. It is considered a precursor to osteoporosis and defined as a decrease in bone mineral content. In general, the lower the bone density, the higher risk of fracture. When there is a diminished quantity of bone found during a bone density test, but not to levels consistent with osteoporosis, a person may be told they have osteopenia. In essence, the term should be thought of as a ‘warning sign’ that bone health should be addressed and optimized.

Adequate calcium intake is crucial for optimal bone development. If osteopenia has developed, then concentrating on calcium intake should be a major focus. The majority of women do not have an adeqate intake of caclium in their diet. Since multivitamins (and even prenatal vitamins) do not contain enough calcium for your daily needs, many women will need a calcium supplement. TUMS® is a leading source of calcium since its inception. It contains calcium carbonate, which is an easily absorbed form of calcium. In fact, 2 TUMS® EX twice daily will deliver 1200 milligrams of calcium per day, which is what the National Osteoporosis Foundation recommends as the goal calcium intake.

Click here for more information about Osteopenia.

Click here to use the Calcium Calculator to estimate your current daily calcium intake, and learn about sources of calcium to help you achieve your recommended daily intake.

John A. Sunyecz, M.D.
MenopauseRx

Q: Can Hormone Therapy raise my risk for breast cancer?

A: In July, 2002, a large study was stopped prematurely due to an increased risk of breast cancer among women using hormone therapy(1). This study, called the Women's Health Initiative (WHI), found 8 more cases of breast cancer per 10,000 women who were using the hormone therapy combination of conjugated equine estrogen 0.625milligrams per day plus medroxyprogesterone acetate 2.5 milligrams per day compared to women not using HRT. The American College of Ob/Gyn (ACOG) stated that "although the study tested only one drug regimen, all patients on hormone replacement therapy should be made aware of this small but significant increased risk, in particular those taking estrogen and progestin combinations".

The Estrogen-only arm of the WHI study was stopped in March, 2004 after a follow-up of 6.8 years revealed no effect on the risk of heart disease and a slight increase in risk of stroke. 10,739 postmenopausal women were enrolled between the ages of 50 and 79 who had undergone a hysterectomy. Twelve more cases of stroke per 10,000 women was observed during this trial. Six fewer hip fractures per 10,000 women was seen in the women taking estrogen. Importantly, there was no increase in risk of breast cancer in this arm of the WHI trial.

Currently, hormone therapy is the most effective treatment for menopause symptoms, such as hot flashes and night sweats. Each woman should thoroughly discuss her individual risks and benefits with her health care provider before taking hormone therapy.

For more information about hormone therapy, please click here  
(1) Principal Results From the Women's Health Initiative Randomized Controlled Trial - Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women . Writing Group for the Women's Health Initiative Investigators JAMA. 2002;288:321-333.

John A. Sunyecz, M.D.
MenopauseRx

Q: I'm starting to have a problem with urinary incontinence. What are my options for treatment?

A: Urinary incontinence is a very common problem, affecting approximately 10 million Americans. Between 15-30% of persons over the age of 60 are troubled by this problem(1). There are many types of urinary leaking of which stress and urge incontinence are two very common types. Stress urinary incontinence is associated with the involuntary loss of urine with cough, sneeze, or lifting. Urge urinary incontinence (also known as 'over-active bladder') is associated with sudden and strong desire to urinate, often prompting a leak of urine. A number of women have a combination of stress and urge incontinence.

Pelvic floor exercises (also known as Kegel Exercises) have been shown to be effective in controlling incontinence(2). In fact, strengthening the pelvic floor by exercises is associated with a 40-60% improvement in bladder control. Stress urinary incontinence can be treated by surgery. A number of newer treatments have shown significant improvement compared to older techniques. Urge incontinence can be effectively treated with medications that control bladder spasms that can cause leaking. The most important aspect of treating incontinence is identifying when it becomes a problem for you and discussing with your health care provider. A few easy steps can be taken to evaluate this common condition and hopefully lead to dryness.

(1)  Clinical Practice Guidelines - Urinary Incontinence in Adults. AHCPR Pub. No. 92-0038. March 1992.

(2)  Burgio KL, et al. Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women. JAMA. 1998;280:1995-2000.

John A. Sunyecz, M.D.
MenopauseRx

Q: I have been taking estrogen for 8 years after my hysterectomy. With all of the recent information about estrogen, what should I do? I certainly don’t want to get the hot flashes back again!

A: Great question. However, it is extremely difficult to give a concrete answer to your questions. It seems that every Ob/Gyn is interpreting the studies differently. One opinion is that estrogen therapy is helpful for the treatment of hot flashes and other menopause symptoms. Its use for a short period of time can be very helpful. Absolute risks are determined based upon your medical history and family history.

The Estrogen-only arm of the WHI study was stopped in March, 2004 after a follow-up of 6.8 years revealed no effect on the risk of heart disease and a slight increase in risk of stroke. 10,739 postmenopausal women were enrolled between the ages of 50 and 79 who had undergone a hysterectomy. Twelve more cases of stroke per 10,000 women was observed during this trial. Six fewer hip fractures per 10,000 women was seen in the women taking estrogen. Importantly, there was no increase in risk of breast cancer in this arm of the WHI trial.

Many women are seeking alternative ways of obtaining their estrogen therapy. Estrogen patches relieve menopausal symptoms with less hormone compared to pills. Patches use less hormone because estrogen taken via a patch is absorbed through the skin directly into the blood stream to be delivered to the body. The skin efficiently delivers the hormone it absorbs since the hormone does not have to first go through the GI tract and liver. Pills require "extra" hormone because estrogen taken via a pill must be absorbed by the GI tract and liver first (called the "first pass liver effect") where it is metabolized before entering the blood stream. As the estrogen is metabolized by the liver it is converted into a less active form of estrogen before reaching the blood stream to be delivered to target organs. This difference can lead to lower dosages of estrogen for the same relief of symptoms among patch users.

Another major difference between the patch and the pill that also results from the way the hormone is delivered to the body is the consistency of estrogen delivered. The patch releases estrogen evenly over time, maintaining a steady level of estrogen throughout the day. This results in around-the-clock symptom relief, even when changing to a new patch. The pill provides a sudden increase in estrogen and then a drop-off in estrogen everyday it's taken; as a result, some women get erratic symptom relief. If you take oral hormone therapy and still don't feel well, ask your doctor about changing over to a patch.

See the HRT/ERT treatment page for details.

Fortunately, most women will not have debilitating menopause symptoms 3-5 years post-menopause.

Alternatively, some women will opt for discontinuing HRT and still have menopause symptoms. Options for this situation would be to try a lower dose of HRT that will effectively decrease symptoms, versus trying an alternative, herbal product like Black Cohosh. There are concerns about stopping ERT and cardiovascular risks with restarting. This appears to be more of a concern in women with a history of cardiovascular disease.

MenopauseRx always recommends discussing your questions with your health care provider and/or pharmacist.
Sincerely,
John A. Sunyecz, M.D.
MenopauseRx

Q: I have been taking Calcium with Vit. D for years. Which is your recommendation and why: calcium carbonate or citrate.

A: Both forms of calcium are effective. I routinely recommend carbonate calcium because it is more convenient for patients (less tablets per day to achieve same dose), generally less expensive, and equally absorbed compared to citrate products when taken with meals.

I hope this helps.
John A. Sunyecz, M.D.
MenopauseRx

Q: I AM 50 YEARS OLD AND STILL HAVING NORMAL MONTHLY PERIODS. I AWAKEN AROUND 2:00 A.M. WITH VERY SEVERE HEADACHES 3 DAYS BEFORE MY PERIOD, THROUGH MY PERIOD AND ABOUT 3 TO 5 DAYS AFTER MY PERIOD. MY QUESTION IS, COULD MY HORMONE LEVELS BE AT THEIR LOWEST LEVELS WHILE I AM SLEEPING AND CAUSING THOSE HEADACHES. I HAVE TRIED LIMITING DIFFERENT FOODS, ALCOHOL, CAFFEIN, CHOCOLATE ETC. I DREAD GOING TO BED AT THAT TIME OF THE MONTH, KNOWING THAT I WILL BE UP AT 2:00 A.M. TRYING TO GET RID OF THE HEADACHE.

A: Excellent question. Many women experiencing the perimenopause will notice symptoms occurring around their menses. It is known that hormonal levels are constantly changing throughout the day, with the potential for peaks and valleys at different times of the day.

The bottom line is that your doctor should be able to take this information into account and offer you a treatment plan. For instance, using a very low dose of estrogen 3-5 days before your period until 5 days after your period would probably work very well. Alternatively, some practitioners would recommend continuous low dose birth control pills during the perimenopause transition to alleviate the symptoms you describe. MenopauseRx always recommends discussing your symptoms with your health care provider and/or pharmacist.

John A. Sunyecz, M.D.
MenopauseRx

Q: At 51 years of age, I was diagnosed with breast cancer and am having terrible hot flashes. What causes a hot flash and what can be done to get rid of them?

A: The exact cause of a hot flash is not entirely known. Interestingly, there is not a significant rise or fall in blood pressure or internal temperature with a hot flash.

A number of products can be used for hot flashes in women with breast cancer. Ask your doctor about a group of drugs called SSRI's and a medication called clonidine. These are available with a prescription. They are primarily used for mood disturbances and high blood pressure, but have been found to be effective in controlling hot flashes.

A natural product called Black Cohosh has not been shown to stimulate breast cancer cells like estrogen. Therefore, more and more physicians are considering Black Cohosh to help treat hot flashes in their breast cancer patients. The best product available is a very standardized product called Remifemin. (link to online store) As with all medical decisions, please consult your doctor and/or pharmacist before making a change in your medical regimen or starting any new medication and/or natural product.

John A. Sunyecz, M.D.
MenopauseRx

Q: I’m noticing changes in my hair/skin/body associated with the menopause, what’s causing them and is there anything I can do about them?

A: Many women will notice changes in their skin and hair during the menopause. Dry, thin and sagging skin are common complaints heard during menopause. The two main reasons for the change in skin are loss of estrogen during menopause and long-term exposure to the elements, namely sun and wind.

Numerous studies have shown that estrogen protects against menopause-associated skin changes by improving the moisture content, blood supply and collagen content (1,2). These improvements lead to more radiance and less of a ‘weathered’ and dry texture. However, estrogen therapy is not the only treatment option. For many women, proper skin care should include a monthly exfoliation (alphahydroxy products work well) to help clear the skin of dead and dry cells. Follow this with a super-hydrating moisturizing cream on a regular basis. Alternatively, a monthly facial would be worthwhile and invigorating. There are also a number of products that contain ingredients designed to eliminate fine lines noticed during menopause. Lastly, look for products with a SPF rating of 15 or higher to protect against the damaging effects of sun exposure.

John A. Sunyecz, M.D.
MenopauseRx

1 - Arch Dermatol 1997 Mar;133(3):339-42
Does estrogen prevent skin aging? Results from the First National Health and Nutrition Examination Survey (NHANES I) Dunn LB, Damesyn M, Moore AA, Reuben DB, Greendale GA.
University of California at San Francisco, School of Medicine, USA.

2 - Am J Clin Dermatol 2001;2(3):143-50
Estrogen and skin. An overview. Shah MG, Maibach HI. University of California, San Francisco, School of Medicine, San Francisco, California, USA

Q: Why do I have to take Os-Cal more than once a day? Shouldn’t once be enough?

A: Calcium intake should be maintained at 1,000 to 1,500 mg/day(1). The requirements for dietary intake of calcium during the perimenopause and menopause can be difficult to achieve, with only approximately 50% of the population meeting this requirement. The ability of our stomach and intestines to absorb calcium is limited to about 500 milligrams per dose(2). Optimally, it is most effective to take your Os-Cal with meals to enhance absorption. Therefore, by ingesting 500 milligrams of Os-Cal three times a day with meals, you will ensure the best absorption to meet your calcium needs.

John A. Sunyecz, M.D.
MenopauseRx

1 - Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consens Statement Online 2000 March 27-29; 17(1): 1-36.

2 - Nutrition Reviews, Vol 52, No.7, July 1994
A review of calcium preparations. Levenson, D.I., Bockman R.S.

Q: I am taking a prescription product to help treat osteoporosis. My doctor told me to take calcium in addition to this medication to make it work more effectively. Can you tell me if this is correct and why this is the case?

A: The answer to your question is yes, it is advisable to have an appropriate intake of calcium for the treatment of osteoporosis. Established guidelines suggest between 1200 and 1500 milligrams per day of calcium1. There are a number of studies that have shown the beneficial effect of adequate calcium intake and improvement in bone density2. Although the reason for this is complex, a ‘bricks and mortar’ analogy is helpful. To build a sturdy foundation, one needs both bricks and mortar to complete a building as neither one would work very well alone. The same is true with osteoporosis; both calcium and osteoporosis medications are necessary to build the firm foundation of strong bones. Because it is difficult for many to achieve 1200 to 1500 milligrams of calcium intake daily from dietary sources, the use of calcium supplements may be required.

John A. Sunyecz, M.D.
MenopauseRx

1 - Guidelines for Women’s Health Care, 2nd Edition, ACOG. Pg 199.

2 - Consensus Opinion, NAMS. Menopause: The Journal of the North American Menopause Society. Vol. 8, No. 2, pp 84-95.

Q: Can exercises-like swimming and walking-help keep my bones strong?

A: An active, healthy lifestyle can help maintain optimal bone strength. Weight bearing exercises, like walking, jogging, and stair climbing can improve bone strength by stimulating the bone to grow stronger and denser. Muscle strengthening exercises, like swimming and weight training can improve strength and coordination which may decrease your risk of falling and bone fractures. A key point is that our bodies bone structure responds best to regular exercise. In fact, weight-bearing exercise for 22 months was associated with a significant increase in bone density of the lumbar spine region in postmenopausal women.(1) Therefore, a well rounded exercise regimen should be routinely done to maintain or improve your bone health.

John A. Sunyecz, M.D.
MenopauseRx

1. Dalsky GP, et al. Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 1988; 108:824-828.

Q: What happens to my risk for ovarian and breast cancer after menopause?

A: Unfortunately, both ovarian and breast cancer risks increase after menopause. The most common type of ovarian cancer is generally found in post-menopausal women. Approximately 80% of breast cancers occur after age 50. Therefore, strategies to improve early detection of cancers and pre-cancerous changes are very important during the menopause transition and after menopause. Preventative health care is a very important consideration. A well-balanced, low-fat diet of fruits and vegetables provides antioxidants that could help protect against breast, ovarian and other types of cancers.

Exercising daily to prevent obesity and decrease estrogen levels may lower your breast cancer risk. Mammography along with self breast exams can frequently identify pre-cancerous changes or allow diagnosis in the earliest of stages.

General screening for ovarian cancer has been difficult. However, women with a high risk of developing the most common type of ovarian cancer may be a candidate for periodic testing such as ultrasounds and specific blood tests. Fortunately, a number of research studies are actively looking for a better method of detecting ovarian cancer in its early stages.

John A. Sunyecz, M.D.
MenopauseRx

Q: Since I have begun menopause I seem to be gaining weight. Is there any evidence that this could be the result of menopause?

A: Your question is an extremely common one. There are many issues that can contribute to weight gain in the menopause. However, weight gain caused by menopause has not been proven. A review of the scientific studies of menopause and weight gain do not reveal any association between long-term weight and cessation of ovarian function (menopause) or hormone replacement therapy.1,2

There are a number of other factors that can lead to weight gain during menopause. For example, a busy life-style can leave you less time for exercise and create poor eating habits. Medical conditions, such as arthritis, can also lead to decreased activity. Up to 10% of women may have an underactive thyroid gland, which is associated with weight gain. Incidence of this condition increases with age and symptoms are often confused with menopause changes, which can lead to a delay in diagnosis.

Lastly, when women begin taking hormone replacement therapy in menopause there is generally a three to four month transition phase where bloating and fluid retention may be present. This perceived weight gain would diminish gradually and not lead to an actual weight gain.

John A. Sunyecz, M.D.
MenopauseRx

1. Weight gain and the menopause: a 5-year prospective study. Guthrie, J.R., et al. Climacteric 1999 Sep:2(3):205-11
2. Hormones, weight change and menopause. Davies, K.M, et al. Int J. Obes Relat Metab Disord 2001 Jun; 25(6):874-9.

Q: I have taken calcium for many years but I recently heard that it can help prevent colon polyps. How much do I have to take to get the benefit?

A: Much research is being done on the prevention of colon polyps, which is thought to reduce the risk of colon and rectal cancers, which is the third most common malignancy is US women. A large study revealed that calcium intake was associated with a significant reduction in the risk of recurrent colon and rectal polyps1 . This study used 1200 milligrams of calcium over a four-year period and found a 15% reduction in polyp recurrence (check stats). This reduction was seen within the first year of the study. Other studies have also revealed positive benefits from calcium supplementation and polyp protection. Therefore, consuming an adequate amount of calcium for optimal ‘bone health’ may also give protection from colon and rectal malignancies.

John A. Sunyecz, M.D.
MenopauseRx

1. Calcium Supplements for the Prevention of Colorectal Adenomas
   Baron, J.A., et al. N Engl J Med 1999; 340: 101-7.

Q: Can HRT raise my risk for breast cancer?

A: In July, 2002, a large study was stopped prematurely due to an increased risk of breast cancer among women using HRT(1). This study, called the Women’s Health Initiative, found 8 more cases of breast cancer per 10,000 women who were using the HRT combination of conjugated equine estrogen 0.625milligrams per day plus medroxyprogesterone acetate 2.5 milligrams per day compared to women not using HRT. The American College of Ob/Gyn (ACOG) stated that "although the study tested only one drug regimen, all patients on hormone replacement therapy should be made aware of this small but significant increased risk, in particular those taking estrogen and progestin combinations”. It is worth noting that part of this study is still ongoing for those women who have had a hysterectomy and are taking only estrogen. A preliminary data review did not warrant ceasing the trial in this group of patients. Therefore, it is unclear what exact risks are attributed to estrogen alone. The most important aspect of this information is that HRT should not be routinely prescribed to all menopausal women. Each woman should thoroughly discuss her individual risks and benefits with her health care provider before taking HRT.

John A. Sunyecz, M.D.
MenopauseRx

1. Principal Results From the Women's Health Initiative Randomized Controlled Trial - Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. Writing Group for the Women's Health Initiative Investigators JAMA. 2002;288:321-333.