How to find hormonal balance and feel better.
In the United States, an estimated 75 million women are currently in perimenopause, menopause or postmenopause. Yet many medical schools and residency programs don’t offer a dedicated menopause curriculum. “It’s a problem that the majority of us physicians had limited training in menopausal care,” says Dr. Fonda Martin, obstetrician-gynecologist at BoutiqueGYN Wellness Center in Brookhaven. “I wanted to better treat and serve my patients, in addition to supporting my own journey, which is why I chose to get certified through the Menopause Society.” Here, Martin explains what every woman should know about her changing body.
The Beginning
The perimenopausal phase leads up to menopause, and symptoms can start as early as your late 30s. “This is when you still have estrogen but not at the same level as before,” Martin says. Menopause is defined as going 12 consecutive months without a period and, on average, begins around 51 years old in the U.S.
Symptoms of Perimenopause
Symptoms are wide ranging and can vary from woman to woman, Martin says. You may notice your period becomes shorter, lighter, longer or heavier, or possibly skips a month. Other symptoms include hot flashes, night sweats, mood swings, anxiety, depression, sleep disturbances, eczema flare ups, itchy ears, joint pain, vaginal dryness, decreased libido, pain with intercourse, increased urinary tract infections, incontinence, body odor changes, thinning hair, ringing in ears, frozen shoulder, migraines and brain fog.
“If you are unsure whether your symptoms are related to perimenopause or menopause, keep a journal of what you’re experiencing, as well as what you are eating, drinking and doing, and bring it to your doctor’s appointment,” Martin says.
Internal Changes
The ovaries produce hormones estrogen and progesterone on a cycle (aka menstruation). “During the perimenopausal phase, the once-controlled release of estrogen and progesterone becomes erratic over time. Essentially, hormone levels are all over the place and no longer follow a predictable pattern,” Martin says. Additionally, women naturally produce testosterone, and, as these levels decline, they can significantly impact sex drive, muscle mass and energy.
Finding Relief
Unlike many conditions physicians treat based on lab values, with menopause, it’s all about treating the symptoms. This is most effectively done with hormone replacement therapy. “Because hormones fluctuate so much, treating based solely on blood test values doesn’t work well since they can change from day to day. When women go on HRTs, they begin to feel much better,” Martin says. She recommends finding a physician—a gynecologist, urologist or internal medicine doctor—who is certified in menopause care and is knowledgeable in prescribing HRTs. They come in the form of FDA-approved pills, patches, creams and rings, and non-FDA-approved options such as pellets (a small capsule injected under the skin) and troches (lozenges). Martin says the safest options are transdermals—patches and creams that can be applied to the inner forearm, back or stomach—because they don’t go through the liver and therefore do not increase the risk of blood clots.
Those with a uterus must use estrogen and progesterone together to protect the endometrial lining. Not everyone needs testosterone. If you do—for instance, if you have no desire for intercourse—insurance might not cover it because it is considered an “off-label use” for women, Martin says. She likes to see patients four to six weeks after initiating HRT to check on symptoms or side effects such as breast tenderness and irregular bleeding that are common for up to six months, and adjust doses if needed.
BOUTIQUEGYN WELLNESS CENTER
404.334.0003
myboutiquegyn.com
@boutiquegynwellnesscenter
