The definition of menopause is the spontaneous cessation of menstrual periods for one year. The average age of menopause is about 52 but can occur anytime from age 40 on and some women don’t stop having periods until their late 50’s. Furthermore, the perimenopausal symptoms can occur five to ten years before actual menopause. Also, menopause can occur at any age if the ovaries are surgically removed for a variety of medical reasons.

Menopause is a “natural” part of aging, so no big deal, right?

For a few lucky women, that is correct. But menopausal symptoms vary greatly from one woman to the next. Some women can find the symptoms very distressing. The flushing and sweating can be uncomfortable and embarrassing, and hamper their activities and desire to be around others. The changes in sexual drive and response along with vaginal dryness can cause real issues in intimacy. The poor concentration and “mental fog” that many women experience can adversely affect job performance and ability to get things done at home. Women with underlying depression or anxiety problems often find their symptoms worsened. Top this all off with sleepless nights, and many women find the perimenopausal time a real challenge.

So, how can I tell if I will have trouble going through menopause?

For the most part, you can’t. Genetics have a part to play, so if your mother had a tough time, you are more likely to also. Women who had difficulty with other hormonal changes (puberty, postpartum, PMS) are also more likely to have more difficult transition into menopause. Women in good physical and mental health coming into menopause seem to get through easier. This includes regular exercise, eating healthy, quitting smoking, having a good support system, and keeping a good sense of humor.

How long will I have to endure menopausal symptoms?

Many of the symptoms tend to improve with time. Hot flashes and night sweats usually lessen in frequency and intensity. Eighty-five percent of women have resolution within four to five years of menopause. An unlucky few will continue to have them indefinitely. Some symptoms such as vaginal dryness may continue to worsen if not treated.

What can I do to decrease menopausal symptoms once they are present?

Many lifestyle changes can be helpful. Keeping the thermostat a couple degrees cooler and dressing in light layers that can be removed may help. Avoid triggers such as alcohol, hot fluids, spicy foods, caffeine-whatever you notice seems to make symptoms worse. Learn how to relax and reduce stress. This is not the time to take on a bunch of new responsibilities at work or remodel the house. Use your support system to help get you through this rough time. Chances are some of them are going or have been thru similar experiences. Try a couple of the over the counter products. Some women have had significant improvement with these. Also, consider a good medical checkup. Several medical conditions can have similar symptoms or worsen menopausal symptoms.

I’ve tried self-help and I’m still miserable! Can I safely use hormones?

Short answer-Yes-for most women. Newer regiments with lower doses and transdermal (thru the skin) absorption instead of oral dosing are safer and can benefit many women. Vaginal dosing for local symptoms are appropriate for nearly all women. There are some non-hormonal alternatives for women who don’t want to or medically should not use estrogen. Two quick notes:
1. Salivary testing of hormones is expensive and doesn’t reflect blood levels, and therefore not recommended.
2. “Bioidentical Hormones” is a marketing term not a medical term. The same hormones are available in FDA approved formulas which are usually cheaper and have better quality control.

Discuss your options, risks, and benefits with your gynecologist or other female health care provider.

Recent technology now allows the procedure to be done laparoscopically. A Laparoscopic Supra-cervical Hysterectomy (LSH) preserves the cervix. Retaining the cervix plays an important role in pelvic support. Using a thin, lighted instrument called a laparoscope, which acts like a video camera, along with small surgical instruments that are inserted through 3 to 4 tiny incisions (less than 1/4 inch each) in the navel and abdomen, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, the patient will not have the same kind of visible scar typical with most traditional open surgeries.

We now offer the Laparoscopic Supracervical Hysterectomy (LSH) to select qualified patients. Our observations, after performing some 50 procedures, is that there are significant advantages compared to the standard vaginal hysterectomy that does remove the cervix.

Advantages for the LSH Cervical Retaining Procedure:

For patients

• Shorter hospital stay (usually only over night)
• 3 to 4 small incisions (no major scarring or long recuperation period)
• Smaller dosages of pain medication
• Quicker return to full activities (1 to 2 weeks)
• Less vaginal discharge and bleeding than other types of hysterectomy

Surgical advantages

• Decreases operative time
• Less blood loss
• Less annoying vaginal discharge

Each patient’s needs are individually evaluated for the best type of hysterectomy to be performed. The evaluation may include blood testing and/or pelvic imaging by ultrasound. It’s important to discuss thoroughly all concerns and options with your physician or gynecologist.
More information regarding LSH can be found online at www.LSHinfo.com

Uterus is separated from cervix and removed, leaving the cervix in place. The LSH minimally invasive procedure greatly reduces HEALING TIME.

The Mirena is a levonorgestrel (progestin)-releasing intrauterine system, which is an estrogen-free device that delivers small amounts of hormone directly into the uterus.  As a result, the hormone level is almost undetectable in the bloodstream as it is concentrated right in the uterus to help protect against pregnancy. The Mirena provides lower and more balanced hormones than the pill.   The Mirena, made of soft flexible plastic, is inserted into the uterus during an office visit.  It is good for five years, is 99.9% successful in preventing pregnancy and is easily removed when you wish it to be.

The Mirena does not cause significant weight gain and does not impact fertility once it is removed.  However, the Mirena does not protect you against HIV or sexually transmitted diseases.  IUDs date back to 1968, but the Mirena is far different than the early IUDs. The Mirena IUD has been available in the US since 2001 when the FDA approved it. However, over the past 16 years more than 10 million women around the world have used the Mirena successfully.  It has been a very safe and effective form of birth control.

How it works

It is believed the Mirena works by all three of the following actions to help prevent pregnancy.

1. Thickens the cervical mucous
2. Hinders sperm from reaching or fertilizing the egg
3. Thins the lining of the uterus

Noncontraceptive Benefits
During the first three months or so after the Mirena is inserted, women may have spotting or bleeding between periods as the uterine lining is thinning out.  After one year of having the Mirena, there is a 90% reduction in menstrual bleeding and approximately 20% of women who use the Mirena have no bleeding or spotting at all. The Mirena is also an excellent option for women who may or may not need birth control, but who have heavy, painful, or prolonged periods.

Dispelling common myths.  IUD’s:

• Do not cause ectopic pregnancies
• Do not cause pelvic infection
• Do not increase the chance of getting a sexually transmitted disease
• Do not affect future fertility
• Do not cause abortions
• Are not large in size

Mirena is a safe and reliable form of birth control with noncontraceptive benefits as well.  Talk to your primary care provider or gynecologist about whether the Mirena
might be right for you. You may also visit www.mirena-us.com.

For more information or to schedule an appointment with Dr. Donna Schoenfelder or Jamie Lamm, FNP-BC, APNP, Eau Claire Women’s Care, call 715.834.9998.