AHN\u2019s existing internal medicine clinic<\/a> in the basement of Allegheny General Hospital: Outpatient Services – Federal North. It\u2019s being offered in addition to AHN\u2019s midlife center at West Penn Hospital, run by that facility’s OB-GYN department.<\/p>\nIdentifying perimenopause: You\u2019re not crazy<\/p>\n
Diagnosing menopause is easy: a year of no menstrual cycles. But there\u2019s no sure-fire test to diagnose women as \u201cperimenopausal.\u201d<\/p>\n
There are sometimes very clear signs, Mehta said, \u201clike your periods are irregular, or you’re having so many hot flashes, but we know more and more that the criteria is not perfect.\u201d<\/p>\n
Fisher said she’s seen two ends of the misinformation spectrum ranging from \u201cthere\u2019s really nothing women can do\u201d to \u201ca product exists to address every symptom.\u201d<\/p>\n
“There\u2019s a lot of false promises out there,\u201d Fisher said. \u201cI think most patients that I see have tried managing this on their own, which is wonderful, but a lot of it has led them down the path of buying things that either are just a waste of money or don’t actually help or even could be harmful.\u201d<\/p>\n
The doctors said patients often request lab tests to measure their hormone levels.<\/p>\n
\u201cThe problem is, you have no idea where you are in that fluctuation at any given moment in time,\u201d Fisher explained.<\/p>\n
While there\u2019s no simple blood test to help women easily pinpoint what stage of development their reproductive bodies might be in, Mehta says there are often many helpful indications.<\/p>\n
\u201cThere are plenty of women coming in, and they’re like, \u2018I haven’t had a period for four months, then I had it for two months, then four months.\u2019 And if they’re above [age] 45 or really close to 45, like within the 40 range and past 45, we can almost pretty much say you’re perimenopausal.\u201d<\/p>\n
Both doctors stress that it\u2019s really important for women to know that if they feel “off,” they’re not crazy. The possible list of symptoms is long.<\/p>\n
\u201cFor anyone who’s experienced hormonal fluctuation \u2014 which is all of us, because we all went through puberty \u2014 and then for women who have gone through pregnancy and seen what hormones can do over time,\u201d Fisher said, \u201cyou know that there are really differences in hormonal fluctuations.\u201d<\/p>\n
Hormone Therapy<\/p>\n
Hormone therapy for menopausal women has continued to evolve since the landmark Women\u2019s Health Initiative launched in 1991 by the U.S. National Institutes of Health with the intention of preventing major chronic diseases in postmenopausal women. Attitudes throughout U.S. households about hormone use have swung from viewing it as a panacea, to life-endangering, and Fisher says the notion that prescribed hormones can solve all problems is once again a popular narrative.<\/p>\n
Unfortunately, reality is more complicated.<\/p>\n
\u201cHormones are amazing at treating hot flashes, night sweats. They’re amazing at actually osteoporosis prevention for people who are at high risk for osteoporosis. Those are currently the only FDA-approved reasons to use hormones,\u201d Fisher said. \u201cAnd there’s some preliminary evidence where it can really help with other things like sleep management, especially progesterone.\u201d<\/p>\n
Mehta added that some good data exists linking musculoskeletal syndrome of menopause and hormone therapy; hormone therapy can also be helpful with joint pain, but physical therapy and sports medicine might be even more helpful, she said.<\/p>\n
Similarly, hormone therapy might be able to help with brain fog, mood changes, and feeling more stable overall, \u201cbut the data on that is new and emerging,\u201d Fisher said. And while she\u2019s seen a push to use hormones to prevent such things as dementia and heart disease, she said that data is still lacking, too.<\/p>\n
\u201cThere are some smaller [heart disease] studies that are encouraging, but the data is not yet strong enough to make it a true recommendation.\u201d<\/p>\n
Fisher explained that patients who already have risk factors for heart disease or who are at high risk for heart disease probably don’t have very healthy endothelium, (the inner lining of their arteries).<\/p>\n
\u201cAnd if you add estrogen to that, it can stir up the problems and actually worsen things. Whereas if they have healthy arteries at baseline and you add the estrogen to that, there may be a protective benefit.\u201d<\/p>\n
Fisher and Mehta both prescribe vaginal estrogen often because they say it\u2019s a localized hormonal therapy that treats symptoms almost every woman will eventually experience.<\/p>\n
\u201cIt’s the one menopause symptom that doesn’t get better with time,\u201d Fisher said. \u201cMost women would benefit from vaginal estrogen, even if they’re not sexually active, just for UTI prevention, yeast, and like keeping everything just healthier down there \u2014 not having discomfort, itching, dryness.\u201d<\/p>\n
Mehta and Fisher both report that testosterone is one of the main hormone panaceas they see pushed through social media algorithms.<\/p>\n
\u201cIt’s like, \u2018T fixes everything,\u2019\u201d Mehta said. \u201cIt fixes brain fog, it makes your weight back to where you want it to be, your sex life \u2014 all that.\u201d<\/p>\n
Mehta and Fisher both prescribe testosterone for postmenopausal women with issues such as Hypoactive Sexual Desire Disorder, but say outside increasing low sex drive, testosterone has its limitations.<\/p>\n
\u201cThe data is actually stronger in postmenopausal women for testosterone than it is in perimenopausal,\u201d Fisher said. \u201cThere’s a lot of talk about muscle gain with testosterone. But in order to get to the point where you’re gaining muscle and having more energy and it’s fixing all these other things, your levels have to be really high. So you’re also getting a mustache and a beard and body hair and clitoral enlargement, and you’re getting true masculinization.<\/p>\n
\u201cAnd so most women don’t want that.\u201d<\/p>\n
Dr. Fisher and Dr. Mehta also stressed that non-hormonal options exist, too, for people who can’t take hormones due to other health issues or conditions.<\/p>\n
Lifestyle recommendations\u00a0<\/p>\n
\u201cPeople have a lot of demands from work, from family, from maybe kids, maybe sick parents, partner stress. Life is just very, very full in your 40s and 50s and 60s,\u201d Fisher said.<\/p>\n
Fisher and Mehta emphasize that lifestyle factors can play an important role in helping people navigate the physical changes that come with perimenopause:<\/p>\n
Prioritize sleep. Rest deeply, well \u2014 and if you can\u2019t, seek help.Eat well. Fisher recommends a Mediterranean-style diet.Keep moving. Regular exercise, particularly strength and cardiovascular training, are especially important.Stay socially connected. Whether it\u2019s through a book club, an art class or simply time spent with friends, meaningful social connection plays an outsized role in health and wellbeing.<\/p>\n
\u201cThose are the hardest things to implement,\u201d Fisher said. \u201cThey are not medication. Everybody has access to them to some degree, and they make a really big difference.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Are you a woman in your 40s and suddenly can\u2019t sleep? Skin changing? Joint pain? Having trouble finding…\n","protected":false},"author":2,"featured_media":887921,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[49,48,84],"class_list":["post-887920","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-ca","tag-canada","tag-health"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/887920","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=887920"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/887920\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/887921"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=887920"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=887920"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=887920"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}