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- Hi, I'm Susan Taylor was Scripps Health
in San Diego, California.
Are you experiencing hot flashes, fatigue,
mood swings, irregular periods,
you might be heading toward menopause.
Joining us to talk about menopause and perimenopause
is Dr. Katrina Kelly.
She's a gynecologist at Scripps Clinic
in Rancho Bernardo, California.
Dr. Kelly, thanks so much for being with us.
- Thank you, Susan, for having me.
- Sure, alright, well, let's start with the basics.
What is perimenopause?
- Perimenopause is a frame of time
which could even last 10 years before the menopause
where women start noticing that their menstrual periods
become somewhat irregular.
They may become closer together for a while,
every 21 days instead of the usual 28 days.
And then eventually they may start missing periods
where they have a period every one to three months,
eventually they stop having periods.
- And what what age
do women start experiencing perimenopause?
- It can be late 30s, early 40s,
that's pretty typical.
- And then what is menopause?
- Menopause technically is
no period for one year, 12 months.
- And what are the signs
that you have gone into full menopause
aside from the fact that
you're no longer getting your periods.
- Symptoms can vary from woman to woman.
Some women go through a smooth transition
where that's the only thing that they notice
while it can be quite severe in other women,
they may have hot flashes, night sweats,
insomnia, mood changes as you mentioned before,
you know, they may notice vaginal dryness,
they may be having pain with intercourse,
they may have palpitations.
There's a whole host of symptoms that women may have.
- So what are the long-term effects of this reduction,
this big reduction in your hormones?
- Over the course of the 30 years
that a woman may live beyond the menopause,
let's say she goes through an average age of menopause at 51
and lives to an average age in the United States of 81.
Over the course of those 30 years,
she may develop osteoporosis,
which is a thinning and inflexibility of the bones,
which can lead to fracture and disability,
can lead to heart disease, stroke, and heart attacks
and can lead to dementia.
- So what is hormone replacement therapy?
- The idea of hormone replacement therapy
is to replace the hormones that a woman makes
in her reproductive years,
which are estrogen, progesterone, and testosterone.
- And what are the benefits
and risks of hormone replacement therapy?
- The benefits are that
hormone therapy can help protect the bones
from osteoporosis.
It can also help protect against heart disease
and protect against dementia,
all different types of dementia, including Alzheimer's.
- And what about the risks of hormone replacement therapy?
- Hormone therapy does,
depending on the type you're using
carry a small increase in the risk of breast cancer.
But if you look at the North American Menopausal Society's
statement in 2017,
they stated that they felt the benefits outweighed the risks
in terms of hormone therapy.
- So let's say you don't wanna do
hormone replacement therapy,
there is another option it's called
bioidentical hormone replacement, what is that?
- It's a product that's synthesized from plant sources
and it is synthesized to look like your natural hormones.
So for example,
your main estrogen that you make is estradiol.
It's going to look like the chemical structure
of your estrodiol
and be absorbed in a way that your natural estrodiol
would be into your system.
- So what are the benefits and risks
of this bioidentical hormone replacement therapy?
- So the benefits are that
bioidentical hormone therapy
can help keep your bones strong,
prevent osteoporosis,
can prevent heart disease as well as prevent dementia.
In addition to helping with quality of life issues
and helping the vaginal and bladder tissues.
The risks that are considered are
a slight increase in the risk of breast cancer.
And the most important study that was done
showed there was one more women per thousand per year
who developed breast cancer
over not being on hormone therapy at all,
and that was the women's health initiative study.
- Why would someone choose
the bioidentical hormone replacement
versus the traditional hormone replacement therapy?
- Bioidentical hormone therapy
because it looks like the hormones that your body produces
is gonna bind to the receptors in your body
the way it should,
therefore women tend to feel better on it.
They also have,
we believe there are less risks involved
with bioidentical hormone therapy.
- So in addition to hormone replacement therapy,
what kind of lifestyle changes can you employ
to reduce your symptoms?
- In terms of hot flashes and night sweats,
we know that women who weigh less
tend to have less hot flashes and night sweats.
So weight reduction can be helpful,
eating a healthy diet,
avoiding alcohol, too much caffeine,
too many sugar products can be helpful.
Regular exercise can be helpful.
Some products can be in terms of tolerating the symptoms,
for example, wearing breathable clothing at night,
when a lot of women are woken up by their night sweats,
wearing a cool pad underneath your sheets on your mattress.
There are pillows that are made now where you can
have a coolness on your head,
so if you're experiencing a night, sweat,
you sleep a little bit better.
So those are some practical things that can be done.
Some women get a little benefit out of
over the counter supplements
that's non-prescription supplements,
whether it be soy products
or black cohosh based products,
those can be helpful as well.
And there are some other prescription medications
that we give to women that are non-hormonal
that can be helpful with some of the symptoms
that women have.
- Any final thoughts doctor?
- I think that whether you're a woman
and you're going through your late thirties
and starting to have symptoms,
or into your fifties or beyond,
it's important to talk to your gynecologist
about what you may be experiencing,
and we can help you to figure out an individualized plan,
whether it be hormone therapy or something else
to help you through this transition.
- Dr. Kelly, thanks so much for being with us.
We appreciate you taking the time.
- You're welcome.
- Want more information about menopause and perimenopause,
just click on the link or go to scripps.org/videos.
Want more critical information about your health,
please subscribe to our Scripps Health YouTube channel
and follow us on social media at Scripps Health.
I'm Susan Taylor, thanks for joining us.
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