REDUCING THE CONFUSION SURROUNDING MENOPAUSE
Dr Steven R. Goldstein is a Menopause Specialist in NYC and one of the nation’s leading gynecologists. When it comes to Menopause, even the terminology can be confusing to some people. There is pre menopause, perimenopause, menopause, post menopause. So, let’s see if we can simplify this for everyone.
Menopause is defined as when there is no more ovarian function. The ovaries no longer make estrogen, and you no longer ovulate. PreMenopause means you are still making estrogen, though you may not be ovulating on a regular basis. Perimenopause is technically the first break in cyclicity.
When the ovaries stop making estrogen, that is defined as Menopause. Some people like to use twelve months of making no estrogen, or
twelve months of no period as the definition of menopause. However, that is somewhat arbitrary. Blood work can be done to measure estrogen in the blood and a thing called FSH (Follicle Stimulating Hormone). The pituitary puts out FSH which gets the ovary to respond, so in a premenopausal patient, the ovary responds, estrogen is high and FSH goes down. In Menopause, the ovary is incapable of responding so the FSH is very high and estrogen is very low.
However, blood work for estrogen and FSH is just a snapshot of that day. So, it is quite possible that both estrogen and FSH point to menopausal ranges. However, Dr Goldstein, a Menopause Specialist in NYC doesn’t tell women with these blood results that they are definitely menopausal, because there may be a future sputtering of ovarian function months later and the patient may get a spontaneous bleed. Instead, Dr Goldstein advises that their blood results show they are in a menopausal range.
There is no need to wait twelve months to begin treating the symptoms of menopause. Once a woman becomes menopausal (the ovaries no longer make estrogen), that condition remains the same for life, it will never change. In menopause, the most common symptoms early on are hot flashes and night sweats. Women also report on sleep disturbances, joint pains, weight gain mostly in the midsection. A much later sign of menopause is atrophy or dryness in the vagina which can make intimacy or sexual intercourse very painful or difficult.
Estrogen is a very important bone hormone, as it inhibits the taking away of bone, which is a dynamic process all of your life. So, when estrogen is lost due to menopause, women will lose bone. Bone health is an important topic as women are living much longer lives. Consider that survival for stage 1 breast cancer is 99%, yet if a woman breaks her hip due to poor bone health, 21% are dead within a year and 25% don’t
live independently again. So bone health becomes extremely important as women are living much longer, healthier lives.
The good news is that four to seven years into the menopause, those typical symptoms of menopause such as hot flashes and night sweats often tend to ameliorate or become minimal or absent. However, for about 25% of women, these symptoms can continue indefinitely, especially sleep disruption where women are waking up two to three times a night in a pool of sweat, and are not very productive the following day.
Dr Steven R. Goldstein is Menopause Specialist in NYC. He is a past President of the International Menopause Society, a past President of the North American Menopause Society and a Certified Menopause Practitioner.
If you are struggling with the symptoms of Menopause or Perimenopause, then a consultation with Dr Goldstein may be in order.