I don’t feel beautiful anymore. I feel old and wrinkled and my hair is thinning. I’m depressed and can’t sleep. “These are some of the ‘glass half empty’ comments that I often hear from my mature patients going through menopause,” said Kari Lynn Purcott, MD, a board-certified obstetrician/gynecologist at Pacific View OB/GYN, Tri-City Medical Center’s newest OB/GYN clinic. “But I try to encourage them to see the ‘glass half full’ and celebrate this time in their lives. Menopause is the beginning of freedom from monthly periods, cramps and worrying about getting pregnant.”
“I also reinforce that menopause is a normal part of the aging process and that it is OK to talk about it,” added Dr. Purcott. “Women readily share issues related to pregnancy, but are often afraid to open up about their experiences during menopause. I’ve seen the relief on my patients’ faces when they finally get over that fear and self-imposed shame. Once they ask questions and learn what is happening to their bodies, they realize that they are not ‘broken’ and feel empowered. It makes me so happy to see them embrace this change.”
Menopause occurs when a woman’s ovaries no longer produce eggs and the level of estrogen and progesterone, female hormones, declines. A woman officially reaches menopause only after it has been 12 months since her last period. From this point on, a woman can no longer have children and will be in “postmenopause.”
Women may begin to experience menopause symptoms during their mid to late forties, and most will reach this milestone by age 52, according to the Office on Women’s Health at the U.S. Department of Health & Human Services. This transition period, which may last about four years, is referred to as “perimenopause” and is often when women begin to see irregularities in their periods and experience symptoms, such as hot flashes, night sweats, vaginal dryness and low libido due to changes in hormone levels.
“It’s important for women to understand that just like they are uniquely different, so too will be the ways in which they experience these symptoms and the treatments that work most effectively for them,” said Dr. Purcott. “Some women will only have few hot flashes throughout the day, while others will have many and these hot flashes can last for one to five minutes or more. Fortunately, there are several treatment options and lifestyle changes to improve these various symptoms that may continue for years.”
Hormone therapy entails either estrogen therapy or combination therapy (estrogen and progesterone) if a woman still has her uterus. It is sometimes called hormone replacement therapy, or HRT, and the drug is synthetic (man-made). According to the American College of Obstetrics and Gynecology (ACOG), there are different forms of hormone therapy: pills, skin patches, gels and sprays are used to release the hormone into the bloodstream so that it travels to the appropriate part of the body, whereas vaginal rings, tablets and creams release the hormone directly into the vaginal tissue. As with any prescription medication, there may be some risks such as heart disease, stroke or breast cancer. Women should discuss dose, duration, regimen and route of administration with their doctor based on their individual needs.
“The standard of care for treating menopause symptoms is hormone therapy,” said Dr. Purcott. “Local vaginal treatments for dryness are very safe as they are at a lower dose and only affect that area of the body. Although some of my patients use supplements, I do not recommend them as they are only weakly supported by scientific evidence, if at all. Similarly, hormone pellet therapy is a new option that may prove beneficial but is currently not regulated by the U.S. Food and Drug Administration (FDA).”
Hormone pellet therapy is an in-office, minimally invasive procedure during which a doctor places implants, smaller than a grain of rice, under the skin near the hip that slowly and continuously release hormones over three to six months. These “compounded bioidentical” hormone pellets contain a mixture of hormones that are derived from plants that mimic human hormones. These drugs are prescribed off-label by a physician, customized for each woman and mixed by a licensed pharmacist.
Exercising, eating a healthy diet, losing weight, quitting smoking, meditating and getting enough sleep are all lifestyle changes that may help to improve symptoms. “Changes in a woman’s body from childbirth, age, menopause or genetics can weaken her pelvic floor and may cause urinary incontinence,” added Dr. Purcott. “Strengthening the muscles in the pelvic floor through Kegel exercises, can help. I often recommend a woman physical therapist who specializes in the female pelvic floor to work with my patients to get these muscles back in shape.”
Most symptoms will eventually subside over time and become more related to aging than menopause. Since women are at greater risk for conditions such as heart disease, stroke and osteoporosis when they reach postmenopause, it is essential that they continue to see a doctor.
“As women, I think we’re fabulous because we are,” said Dr. Purcott. “It may take a little bit more effort for a woman to understand her body and really get to know what’s normal, which is why I am passionate about teaching my female patients about menopause, so that we can celebrate this time in their lives. The end is just the beginning!”
To schedule an appointment with Dr. Purcott to discuss menopause, please call 760-476-2929, or visit Pacific View OB/GYN.