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Managing Menopause

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Dr. Abha Gupta is an OB-GYN at Nanticoke Women’s Health Center in Seaford. Photograph by Jared CastaldiBoard certified in obstetrics and gynecology, Dr. Molly McBride has the hows, whys, and whats of menopause covered.

But for all her knowledge and expertise, perhaps McBride’s best trait when treating patients is something that wasn’t learned in a book or laboratory. It’s compassion, and in the daily management of menopause, it’s probably more important than any weapon she has in her medical arsenal.

“About 75 percent of our day is counseling and just listening,” says McBride, of the Women’s Place at St. Francis Hospital in Wilmington. “We’re validating our patients that they’re not crazy.”

Crazy? No. In need of support, treatment and lifestyle changes? Absolutely. McBride’s ability to help patients through the unpredictable ride that is menopause relies on a body of know-how, not a pill or a quick fix. This is serious business, as any woman who has been through it—or is going through it—certainly knows. So McBride understands that there can be no generic solution to a problem with so many variables.

“All you need to do sometimes is to validate [patients],” McBride says. “They’re bloating. They don’t sleep well. Estrogen dominance can make you edgy. They just don’t want to be like that.”

Menopause, or the “change of life,” as some women call it, is a natural ending of the female reproductive years. The true definition of the term is one full year without a menstrual period. During menopause, a woman’s estrogen level diminishes, causing an end to her menstrual cycle and the ability to have children. The change doesn’t happen overnight, and it can wreak havoc on a woman’s system, causing a variety of conditions—none pleasant.

Women are born with a finite number of eggs in their ovaries. When that supply begins to dwindle, menstrual periods become more erratic, and levels of the two hormones produced by the ovaries during those times—estrogen and progesterone—can fluctuate. That’s when the trouble starts.

For some women, menopause can begin as early as the mid 30s, with slight, albeit very real shifts in hormone levels. This perimenopause phase is characterized by inconsistent (even more frequent) periods, hot flashes, mild depression, trouble sleeping and irritability. According to McBride, progesterone starts to fall off first, which causes an estrogen dominance. That can lead to mood swings and sleeping difficulties. When the estrogen starts to go, things can get worse.

Every woman is different, therefore each experiences the symptoms differently. “Some women have no symptoms, and they deal with it without any help,” says Dr. Miaohou Xu, an OB-GYN physician at Bayhealth Medical Center. “Some people feel horrible and are searching for some help from a doctor.”

Perimenopause is something of a warm-up act for the big show. While women can experience some of the symptoms they will encounter later on, they aren’t fully involved. But they can still be uncomfortable and confused. “They don’t know what is happening,” McBride says. “They think they’re losing their minds.”

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One of the most common, and most uncomfortable, side effects of the process is the hot flash. Women with hot flashes can often appear as if they have just run five miles in the scorching July sun. Lack of estrogen causes an instability of a woman’s blood vessels, which can increase blood supply to the skin.

“It’s intense heat that starts in the chest, goes up to the face and can go throughout the entire body,” says Dr. Abha Gupta, an OB-GYN at Nanticoke Women’s Health Center in Seaford. “It can last 30 seconds or a couple of minutes or as many as 10 minutes, and it can be accompanied by heavy sweating.”

The most effective treatment for menopausal women is compassion, validation and encouragement. “Don’t overreact,” McBride says to men. “It’s not personal. Leave her alone. Give her some space. It’s not about you. If you want to help, give her the gift of a personal trainer and the time to exercise.”

When those hot flashes occur at night, they have the double effect of causing tremendous discomfort and interrupting sleep. As a result, women can often become fatigued, then depressed. Couple that with many of the traditional mid-life concerns women (and men) have and menopause can pack quite a wallop.

While McBride emphasizes the need to validate the feelings and physical discomfort, she also recognizes that there are many things that can be done to help minimize menopause’s impact. A lot of them are simple, common sense lifestyle alterations that pay dividends. One is exercise. “That fixes 70 percent of the symptoms,” McBride says. The reason is the release of endorphins—natural pain relievers—that takes place when you exercise. The muscles may ache, but a consistent exercise program is vital for women who want to manage their menopause.

Other ways to help ward off the worst effects include not smoking, cutting back on caffeine and limiting alcohol consumption.

Some women can manage their menopausal symptoms with lifestyle adjustments, but some need more help. Until recently, that meant hormone replacement therapy, which substituted synthetic versions of estrogen and, to a lesser extent, progesterone for that which was lost. When studies began to show that higher doses of the hormones led to some instances of breast cancer and heart disease, physicians moved away from replacement therapy.

Some doctors won’t prescribe hormones, choosing instead to focus on lifestyle changes, counseling and herbs such as black cohosh, a traditional Native American remedy for menopause and related symptoms. But it has had mixed results in clinical studies, and it can have some of the same side effects as hormones when taken in high doses.

Other doctors still treat with hormones, but much differently than before. Instead of trying to replicate pre-menopause levels of estrogen and progesterone, they give patients smaller doses for shorter durations. The idea is to provide some help in the face of the symptoms while giving women’s bodies the chance to adjust more naturally and without anything that could lead to health problems later. McBride says that even a low-dose birth control pill can provide some hormonal equilibrium in women who suffer severely. Those looking for few side effects can consider estrogen and progesterone creams, which are safer than oral medications.

Doctors will also give their patients a mild anti-depressant to combat the drop in the neurotransmitter serotonin, which can accompany estrogen’s departure.

But, as McBride says, the most effective treatment for menopausal women is compassion, validation and encouragement. And those are the best traits husbands and partners can use to approach their women.

“Don’t overreact,” McBride says to men. “It’s not personal. Give her some space. It’s not about you. If you want to help, give her the gift of a personal trainer and the time to exercise.” And get ready to listen. There’s going to be a lot to talk about.

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