Frequently Asked Medical Questions

If you are on a low dose birth control pill, how do you find out if you have crossed over to menopause?

 

You need to stop the birth control pills for a month or two to assess where your body is without supplements.

 

Is it important to add progesterone & testosterone as well?

 

It is important to add progesterone if you have a uterus since estrogen by itself will cause unrestrained growth of the uterine lining and can lead to cancer. If you do not have a uterus, progesterone is not recommended since it does seem to increase the risk of breast cancer slightly. Testosterone levels do not decrease dramatically at menopause. Rather, they slowly decline starting around age 30. Actually, without estrogen circulating, the relative amount of testosterone in our bodies is increased after menopause. There is no approved testosterone product for menopausal replacement except a generic pill for women who have had their ovaries removed at a young age. Sometimes we do recommend compounded testosterone products for women after their ovaries are removed.

 

Can too much estrogen cause hot flashes?

 

Hot flashes may be caused by many different physiological abnormalities including too much estrogen, blood sugar fluctuations, thyroid problems and anxiety.

 

I’ve heard many say that symptoms of menopause/peri-menopause are similar to thyroid problems. What is the best way to find out which hormones are actually the problem?

 

A simple blood test can rule out thyroid problems. TSH – thyroid stimulating hormone is a very sensitive and reliable test of thyroid function.

 

Why does insomnia happen?

 

Insomnia is a very complex medical problem sometimes related to menopausal hormone changes, but often related to other issues as well. There is a great book called “The Promise of Sleep” which you may find helpful. With menopause, the night sweats may cause disrupted sleep patterns.

 

Why does intercourse become painful in a post menopausal woman?

 

The vagina and vulvar tissues are very estrogen sensitive. Without adequate estrogen they shrink and become dry and inelastic. This can be treated with topical estrogen creams in extremely low doses with dramatic improvement. The doses are so small that there is negligible risk associated with this treatment.

 

Are birth control pills the only birth control you use to regulate estrogen or can you use other methods of B.C. (i.e. IUD, DepoProvera shot, Patch)?

 

Combined oral contraceptives, the contraceptive patch and the NuvaRing all contain both estrogen and progesterone to regulate estrogen. Any of these formulations will work although the doses in the contraceptive patch are higher than in pills or the NuvaRing. The IUD has no systemic effects – the progesterone containing IUD, MIRENA, can control bleeding problems but does nothing for systemic symptoms. DepoProvera is a long-acting progesterone derivative. It suppresses estrogen fairly profoundly and is not a great option for peri-menopausal women.

 

What if you had a total hysterectomy, ovaries removed, and haven’t taken any hormones at all, is that bad? Bad health consequences?

 

There is an increased risk for heart disease in women who had their ovaries removed younger than age 65. Replacing the estrogen does diminish that risk. If you are in this situation, I would advise optimizing your cholesterol levels, exercising regularly and controlling blood pressure aggressively.

 

I am 39 (still on low does birth control pills), experiencing hot flashes, night sweats and vaginal dryness. My doctor says I’m way too young to be experiencing menopause even though my mom was in menopause by 43. Do over the counter things like estrogen or remedies at a natural foods store like Marlene’s have any effect on these types of symptoms?

 

Your symptoms are unlikely to be peri-menopausal unless they only occur during the week you are off your birth control pills. Otherwise you are getting plenty of estrogen in the pills you take. It may be that your body doesn’t like the particular combination of estrogen and progestin in the specific product you are taking. I would consider changing the dose of medication. Dryness may come from topical irritation of the vaginal skin. Avoid all soaps and chemicals to the area and avoid using pads (they are treated with formaldehyde and can be extremely irritating!)

 

Over the counter remedies have not been shown to be helpful at all. Since many of the symptoms come and go, it takes very rigorous studies to determine what works and what we just THINK may have helped. Such studies have not shown any benefit from any of these herbal remedies.

 

Can you remain on hormone therapy for a long time or is there a maximum time limit (if peri-menopause lasts 10 years can you be on HRT for 10 years)?

 

The American College of Ob/Gyn and the North American Menopause Society recommend using the lowest dose of estrogen for the shortest duration of time needed to control symptoms. For some women, symptoms persist for many, many years. The risk of breast cancer increases slightly with prolonged use of hormones, but it isn’t a huge risk. When my patients have tried to stop their hormones and continue to have bothersome symptoms we go over the risks and benefits of remaining on the hormones. There are women who have taken hormones for many years without negative health consequences. This is a very individual decision you should make with the advice of your physician.

 

Does a woman who has had a complete hysterectomy (ovaries & cervix removed) need frequent pap tests?

 

Unless the hysterectomy was performed for cervical or uterine cancer, we do not recommend Pap smears at all. Pap smears screen for cervical cancer. When the cervix has been removed, the test is unnecessary.

 

Does HRT help sexual issues like desire & dryness?

 

Hormones do help with dryness. To the extent that dryness and discomfort suppress desire, they do improve desire. Libido or desire is a very complex issue for women and is connected to our feelings about our partners, our own self-esteem as well as many other issues.

 

Is Black Cohash an effective herbal remedy for symptoms? I have been using Estrogen on recommendation of my nurse practitioner.

 

See answer above. Estroven and other herbal remedies, when rigorously tested – that is women were given the herbs for several weeks, then a placebo for several weeks and not told which was which – have not been found to provide a benefit. I have had some patients swear by them, however the science does not support any real benefit.

 

Also: What causes the diminished sex drive during this phase? I seem to have zero drive and what can be done for this?

 

See answer above – sex drive is a very complex issue – typically the reduction in sex drive is not hormonal but situational and often related to some of the symptoms such as hot flashes and night sweats which make us tired and irritable.

 

How would a woman who has been on birth control almost her entire adult life experience menopausal symptoms differently than if she had otherwise NOT been on birth control (ex: symptoms re. weight gain, flashes, lack of sleep and/or interest in sex)?

 

While you are on birth control pills there will not be any menopausal symptoms except possibly during the week off of active pills. Once you stop the birth control your experience of menopause will be the same as if you had never been on the pills.

 

I am scheduled for an ablation on July 2nd because with birth control pills my period was worse and I had very painful cramps – much more than usual – will the ablation cause any problems? Or will it just be a wasted procedure?

 

Endometrial ablation is NOT a procedure to manage cramps. It is to be used for extremely heavy bleeding. Cramps caused by large blood clots passing through the cervix may be improved since the amount of bleeding is reduced, BUT women who experience cramping prior to the onset of bleeding or who are experiencing increasing pain with periods will not generally see any improvement with an ablation. In fact, the ablation may increase cramping and pain.

 

Is thinning hair a condition of menopause? Will this change?

 

Thinning hair is an age-related problem although it can sometimes be due to thyroid problems or iron deficiency. It is not improved with hormones and generally progresses over time – sorry!

 

I’m post menopausal – recently started ‘Estrace’ – for vaginal dryness and thinning tissue (painful intercourse). Will this help with the waning sexual desire? (I’m sixty two but hate to think I’m going to have sex once a month.)

 

Once the pain improves I suspect your desire will increase again. Estrace cream will improve these symptoms MUCH faster than oral Estrace. Once the tissues begin to feel better you should plan a romantic weekend and celebrate!

 

Will you put a little more about the bio-identical hormone therapy versus “regular” hormones on your website?

 

This will require a book. Many “regular” hormones ARE bio-identical. They are made from the same sources and are biochemically indistinguishable.

 

I went off ‘Cymbalta’ for irritability after a few years. Sleeping (NOT!) and hot flashes took over + irritability. My family liked me better before! My primary MD is a good listener but put me on Chlonidine – not helping totally but a little. Are you accepting new patients or should I go to my MD and request HRT? (FYI – I dropped my gynecologist when she went on a one year sabbatical but now I feel I could benefit from a specialist – especially after Dr. Levy’s informative conference!)

 

A gynecologist who specializes in menopausal treatment should take a full medical history to determine what your problems are and which treatment options to suggest for you.

 

What was the name of the book about hormones that you referred to?

 

The book is titled: The Hormone Decision. Author: Tara Parker-Pope. (Available on amazon.com.)