In different ways, cultures around the world celebrate when young girls become women around the time of their first menstrual period, but few celebrate the milestone of menopause. Why is that? Perhaps because we focus on the negative aspects of menopause, the effects that leave some women experiencing hot flashes at inopportune moments, and so we view this process in a negative light. But it can be perceived and experienced positively, according to medical experts.

Understanding Study Outcomes
As clinical professor of obstetrics and gynecology at the George Washington University in Washington, DC, and a Past President of the North American Menopause Society (NAMS) I’ve studied these issues closely. I revisited the menopausal hormone therapy research in the Women’s Health Initiative (WHI) first reported in 2002, which was loosely translated to mean that all forms of estrogen, and all types of progesterone were risky for all women, always. But when looking more closely at the patient population in that study, it showed that some of the women were already at high risk health issues and underlying disease.

“Be aware that the findings for the two WHI hormone studies should not be compared directly because of differences in the women’s characteristics at the time of their enrollment. For example, those in the estrogen-alone study had a higher risk of cardiovascular disease than those in the estrogen-plus-progestin study. Women in the estrogen-alone study were more likely to have such heart disease risk factors as high blood pressure, high blood cholesterol, diabetes, and obesity,” according to the National Institutes of Health (NIH).

Mitigating Symptoms
In wanting to help my patients find helpful ways to treat their symptoms, I analyzed a database of 13 million patients to investigate whether two forms of estrogen (oral versus transdermal) differed in how patients experienced negative side effects, particularly focusing on heart attack, stroke and deep vein thrombosis (blood clots in the veins). I concluded that patients who used transdermal estrogens had significantly fewer: blood clots in their veins, pulmonary emboli, and heart attacks than those who took an oral estrogen pill. Stroke risks were also slightly lower for transdermal estrogens.

“The women who were using transdermal estrogens had a lower risk of blood clots in the legs deep vein thrombosis (DVT), had a lower risk of pulmonary embolism—those blood clots in the legs traveling up to the lungs—and a decreased risk of heart attacks” I said in a video on My Menopause Mag, run by Editor Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty. I caution though, that patients who are at risk for blood clots may need to talk with their doctor to weigh the benefits versus the risks of all estrogen therapies.

Questions to Ask Your Doctor

  • When does menopause begin?
  • How long does it last?
  • Should I take hormones?
  • What kind of hormones should I take and for how long?

Available Resources
Great online resources such as this website help educate women to know more about how menopause effects the whole person and how to navigate this new time in life.

“Women don’t learn about menopause until they are going through it. I think if we as young women know about it and understand it, then we’ll be much more equipped.” from the trailer for the movie, “Hot Flash Havoc” available on local PBS stations. I have a cameo appearance.

In addition, this website: answer a lot of these questions women have, understanding that there is no one-size-fits-all model for making the transition.

Understanding Perimenopausal Symptoms
Women commonly experience the following perimenopause symptoms:

  • Hot flashes
  • Lower sex drive
  • Irregular periods
  • Difficulty sleeping
  • Mood swings
  • And many others

Many of these symptoms often continue into menopause. Women in menopause may also experience:

  • Vaginal dryness
  • Urinary problems, including incontinence and/or urgency
  • Night sweats
  • Weight gain and slowing metabolism
  • Thinning hair
  • Loss of breast fullness
  • And others



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