Menopausal Health
Conditions We Treat
Menopause is a significant stage in a woman’s life. Officially, menopause begins after 12 months of the cessation of a woman’s menstrual cycle. While the average age of menopause is 52 years, the age range is from 40 – 55 years of age. Some women may experience menopausal symptoms earlier due to medical interventions such as “partial hysterectomy”, tubal ligation, cancer treatments, or other medical procedures. However, with this phase comes other changes that include, but are not limited to the following:
Hot flashes are the most common menopause-related symptoms. Hot flashes are due to changes in the hypothalamus which regulates the body’s temperature. Once the hypothalamus senses a rise in the body temperature, it begins a series of events to lower the body temperature through dilating blood vessels to release body heat. This causes facial flushing and sweating. Since the hypothalamus is not as accurate as in our younger years, the body may cool down too much and cause shivering – hence the nighttime fight with the bed covers. Studies have shown that as many as 75% of women in the U.S. experience hot flashes.
Hot flashes primarily begin with fluctuations in hormones, this is why stabilizing hormonal changes reduces vasomotor symptoms. However, there are nonhormonal approaches to treating vasomotor symptoms for individuals who prefer a nonhormonal approach or are unable to use hormones.
It is important to consider that menopause is not the only cause of hot flashes and a comprehensive evaluation is in order to isolate the cause.
Hormonal fluctuations, like the magnitude of those taking place during menopause, can wreak havoc with your emotional and physical state and disrupt sleep enough that they can produce insomnia symptoms. Because menopause occurs over a period of years, insomnia symptoms can go from transient and temporary, to chronic and severe.
Peri-menopause Symptoms of Insomnia
Peri-menopause can begin as early as 10 years prior to menopause, but for most women the most noticeable signs and symptoms may not begin until 5 years prior to full menopause. The severity and length of a woman’s menopause can often be dictated, to some extent, by family history.
During peri-menopause estrogen levels decline, setting off occasional or isolated menopause-related symptoms like those previously discussed.
Menopause Insomnia
Prior to or after a woman enters menopause, this transition may set off a number of menopausal symptoms may become more frequent and intense for some women. Hot flashes, night sweats and anxiety WILL impact sleep leading to chronic insomnia symptoms.
Post-Menopause Insomnia
Women may develop insomnia as a behavioral pattern ingrained from regular sleep interruptions over the course of their lifetimes—from PMS and pregnancy-related insomnia. Insomnia doesn’t end during post-menopause. Insomnia may be a sign of more serious sleep disorders in a post-menopausal woman. Statistics prove that more women past menopause develop sleep disorders, including restless leg syndrome and sleep apnea, than at any other time in their lives.
Treating Menopause Related Insomnia
At A2M your healthcare provider will evaluate and treat the primary source for insomnia—menopause. Hormone replacement therapy has been shown to drastically relieve some symptoms of menopause, which in turn may alleviate insomnia. Menopausal insomnia may also be treated with life-style changes that include: sleep hygiene, diet, exercise, and other important daily routines.
Many women gain weight during the menopausal transition; however, this is not primarily due to hormone therapy or aging alone. Weight gain per se cannot be attributed to the menopause transition, hormonal milieu changes during menopause is associated with an increase in total body fat and abdominal fat. Weight excess at midlife is not only associated with a heightened risk of cardiovascular, diabetes, osteoarthritis, hypertension, and metabolic disease, but also impacts adversely on health-related quality of life and sexual function. More weight may contribute to more severe hot flashes, depression, urinary tract symptoms, and difficulty sleeping.
Other factors influencing weight include lack of exercise, increase in alcohol and food consumption, loss of muscle mass, cortisol fluctuations, and increased fat storage. Loss of muscle mass contributes to a lower resting metabolic rate which, in-turn, causes lower energy expenditure leading to weight gain. On average, a woman can gain up to two pounds per year after menopause, leading to a 20-pound weight gain over ten years.
However, menopause weight gain isn’t inevitable. The hormonal changes across perimenopause substantially contribute to increased abdominal obesity which leads to additional physical and psychological morbidity. There is strong evidence that hormone replacement therapy (HRT) may partly prevent this menopause-related change in body composition and the associated metabolic sequelae.
Clinicians at Augusta Anti-Aging Medicine employ customized weight management strategies that focus on the individual’s needs to help overcome physiologic and other barriers to weight management with the use of lifestyle approaches with exercise, dietary recommendations, nutraceuticals, addressing methylation disruptors, and pharmaceuticals. We are able to achieve success at A2M with a nonstimulant approach to weight loss to promote a lifetime of success.
Low Sexual Desire or Female Sexual Interest/Arousal Disorder (FSIAD), previously called, Hypoactive sexual desire disorder (HSDD), is the most common sexual dysfunction in women. It has been associated with negative emotional and psychological states, as well as medical conditions including depression. FSIAD is a common sexual disorder that affects 1 in 10 women. It occurs at any age. The Mayo Clinic notes that as many as 40% of women have FSIAD at some point in their lives, according to some studies. 5% to 15% of women have the problem continuously.
Hypoactive sexual desire disorder (HSDD) refers to a woman’s chronic or ongoing lack of interest in sex, to the point that it causes personal distress or problems in her relationships. FSIAD is the combination of two diagnoses: low desire (HSDD) and (Female Sexual Arousal Disorder) inability to achieve arousal or become lubricated with ample stimulation.
It’s normal for women to lose interest in sex from time to time. A woman’s libido can change throughout her life. It might be optimal when she’s feeling good about her relationship or if she’s excited about a new one. It might decline when she’s under emotional stress or dealing with hormonal changes from pregnancy, menopause or other health issues.
FSIAD can be frustrating for a woman and her partner. But it is a treatable condition. Even though it might take time to discover the cause, a woman with FSIAD can return to a satisfying sex life.
There are many ways to treat FSIAD. Treatments for the physical causes are specific to the individual. For example, changes in medications or diabetic control may be necessary. Lifestyle changes to combat stress and fatigue may also be the cause of desire issues..
Some women benefit from counseling or sex therapy. Specialists can help with coping with past sexual trauma, self-esteem issues, or understand relationship issues. A sex therapist can help women improve their ability to openly discuss sexual concerns with partners. They might also introduce ways to make intimacy a bigger priority – and more interesting.
Hormonal Therapies
Some women find estrogen therapy helpful. Estrogen is sex hormone that affects libido, among other functions. It can be administered in many forms (pills, patches, gels, or injections). This type of therapy, called systemic estrogen therapy, helps the brain make its needed chemical connections to increase desire. Local estrogen therapy can be applied through a vaginal cream or ring. This increases blood flow to the vagina and stimulates arousal.
In some cases, you may require a combination of estrogen and progesterone to treat FSIAD.
Testosterone is another hormone that affects the sex drives of both men and women. While the FDA has not approved the use of testosterone therapy in women, off-label prescribing has shown beneficial in the treatment of FSIAD. It is critical that you seek treatment with a healthcare provider who is trained in the management of hormone replacement therapy to avoid unthwarted complications.
At Augusta Anti-Aging Medicine, your healthcare provider is trained in the management of hormone replacement therapy and speaks nationally to train other clinicians on the safe use of hormone replacement therapy and the treatment of desire/arousal issues. Your healthcare provider will work with you to develop a confidential treatment plan that includes a Bio-Psycho-Social approach helping you regain optimal sexual health.
Menopausal status is associated with the risk of symptoms of depression and anxiety. There is a greater likelihood of increased symptoms of depression during perimenopause and symptoms of anxiety during postmenopause. In women without a history of depression or anxiety, the perimenopause and postmenopausal stages are associated with increased risk of greater symptoms of anxiety and depression relative to premenopause.
Menopausal fatigue is often thought to be the result of hormone imbalances. As hormone levels, particularly estrogen, fluctuates, you will notice differences in your energy levels.
These hormonal changes can influence your normal sleep pattern, so that women who had always slept well before the menopause may find that they are struggling to achieve an adequate restful sleep. This is often a cause of fatigue during the day. There are lifestyle causes which could also trigger fatigue. Many menopausal women feel that they are under greater time restraints, and often other menopause symptoms that create stressor and impacting a woman’s stress level resulting in more fatigue.
As you enter the perimenopausal period, your hormone levels rise and fall in unpredictable ways. Eventually, estradiol (estrogen) levels decline until your body stops making them completely. These same hormonal changes causing hot flashes and night sweats can also affect your mood and energy levels, leading to fatigue. Hormonal variations can also make it harder for you to sleep at night, which can leave you feeling tired during the day.
Risk factors for fatigue include:
Even if you’re in your 40s or 50s, fatigue isn’t necessarily due to perimenopause or menopause.
- alcohol and drug use
- anemia
- cancer
- chronic fatigue syndrome
- chronic obstructive pulmonary disease
- depression
- diabetes
- heart disease
- lack of exercise
- medications, such as antidepressants, antihistamines, pain relievers, and heart medicines
- obesity
- poor diet
- sleep apnea and other sleep disorders
- stress
- viral illnesses
- underactive thyroid gland
At Augusta Anti-Aging Medicine, a national certified menopausal practitioner will perform a comprehensive evaluation to determine the cause of your menopausal symptoms and partner with you to develop a customized treatment plan, based on the lasted evidence, to address your menopausal symptoms and help you regain energy and optimal health during menopause.
Many women experience mood swings in perimenopause and menopause. Mood swings are one of the most common symptoms, along with hot flashes and night sweats. Emotional reactions are common in menopause due to overwhelming stressors experienced. If mood changes are abrupt and leave you feeling mostly sad and anxious, it is time to take control of your symptoms and address them.
Not all women will experience mood changes with menopause, but for some it is the first symptom they experience, causing irritable, anxious, or even depressed. They may also have problems with sleep and feel sad and wanting to cry for no reason. These changes in the body, just like your skin problems, low sex drive, or frequent vaginal infections, are due to hormonal changes in the body.
There is a relationship between the amount of estrogen in women’s bodies and the ability to manage hormones of happiness and depression. As a result, low estrogen may lead to stress, tiredness, anxiety, lack of focus, and sudden changes in your mood. If you are generally a moody person, the shifts in your hormones during menopause would only make matters worse. And when symptoms build on top of each other, you might feel like you cannot deal with all of them.
Pelvic organ prolapse is a result from weakness or laxity in the ligaments, fascia, and muscles supporting the pelvic organs. The prevalence of pelvic organ prolapse is difficult to ascertain, and treatment is based on symptoms.
Common contributing factors include:
- Childbirth (particularly vaginal delivery)
- Obesity
- Aging
- Injury (eg, due to pelvic surgery)
- Chronic straining
Less common factors include congenital malformations, increased abdominal pressure (eg, due to ascites, abdominal tumors, or chronic respiratory disorders), sacral nerve disorders, and connective tissue disorders.
Pelvic organ prolapse affects various sites and includes:
- Anterior vaginal wall prolapse
- Posterior vaginal wall prolapse
- Apical prolapse (vaginal vault prolapse)
- Uterine prolapse
Prolapse of the vaginal wall allows surrounding organs to protrude into the vaginal space; commonly used terms include cystoceles (bladder prolapse), urethroceles, enteroceles, and rectoceles (recto-vaginal wall prolapse), depending on the site. A prolapse may occur in multiple sites.
Risk factors for vaginal wall prolapse are:
- Age
- Obesity
- Vaginal delivery
Severity of vaginal wall prolapse can be graded by the Baden-Walker system, which is based on level of protrusion:
- Grade 0: No prolapse
- Grade 1: Halfway to the hymen
- Grade 2 : To the hymen
- Grade 3 : Halfway past the hymen
- Grade 4: Maximal possible
Although the Baden-Walker system is commonly used, it is an older classification system that is not reproducible; thus, professional organizations recommend the Pelvic Organ Prolapse-Quantification (POP-Q) system. The POP-Q system is a more reliable and reproducible classification system that is based on predefined anatomic landmarks:
- Stage 0: No prolapse
- Stage I: Most distal prolapse is more than 1 cm above the hymen
- Stage II: Most distal prolapse is between 1 cm above and 1 cm below the hymen
- Stage III: Most distal prolapse is more than 1 cm below hymen but 2 cm shorter than total vaginal length
- Stage IV: Complete eversion
Symptoms and Signs:
- Pelvic or vaginal fullness, pressure, and a sensation of organs falling out are common. Organs may bulge into the vaginal canal or through the vaginal opening (introitus), particularly during straining or coughing. Dyspareunia can occur.
- Mild cases may not cause symptoms until women become older.
- Stress urinary incontinence can accompany pelvic organ prolapse.
- Enteroceles may cause lower back pain. Rectoceles may cause constipation and incomplete defecation; patients may have to manually press the posterior vaginal wall to defecate.
Recurrent urinary tract infections may be caused by hormonal changes that affect the tissue in the genitourinary tract such as: labia, clitoris, vulva, urethra, and the lower one-third of the bladder can greatly impact a woman’s quality of life. Instead of treating the bacteria with different antibiotic therapies, it is just as important to treat the environment (the vagina) which becomes a perfect medium for bacterial growth during menopause. Without treatment the problem will worsen and the pain may become intensified and affect sexual relations. However, there are treatment options, but first, a comprehensive evaluation is in order to rule out other urological conditions that can cause recurrent UTIs such as, kidney stones, urethral diverticulum, interstitial cystitis (IC), or cancer.
Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic, or long-lasting, condition that causes painful urinary symptoms. Symptoms may vary between individuals. Some people experience mild discomfort, pressure, or tenderness in the pelvic area while others have intense pain in the bladder or suffer with urinary urgency or frequency.
Approximately four million Americans suffer from interstitial cystitis (IC), a recurring uncomfortable or painful condition of the bladder. IC symptoms are similar to a bladder infection, but IC does not respond to antibiotics. Approximately 3 in 8 million women and one in four million men suffer from IC.
IC is diagnosed by ruling out other conditions with similar symptoms. A lifestyle approach with diet, stress control, medications, and in some cases, rescue bladder treatments are utilized. Since IC may result from conditions that cause inflammation in the body, therefore, a lifestyle approach is fundamental in the treatment of this condition. Since severe IC symptoms may affect your quality of life, it is important to seek help for this condition early on.
Symptoms of IC include:
- A feeling of discomfort or pain and pressure in the bladder area – this may get worse as the bladder fills
- Needing to go to the bathroom more often than normal during the day and night – as often as every 10 minutes
- Feeling like you need to urinate right away, even just after you went
- Pain, pressure or tenderness in the pelvic area and/or genitals o Pain during sex
- In some people, IC symptoms come and go; but for others, the problem is constant
What Causes IC?
- No one knows what causes IC.
- IC seems to run in families. Physical or mental stress can worsen the symptoms of IC.
- Smoking can make the symptoms of IC worse.
- Cranberry products can trigger irritation in an IC bladder. Fruits considered to be more IC-friendly include pears, mild sweet apples and blueberries.
How is IC/PBS Treated?
- Diet changes, such as avoiding citrus fruits (oranges, grapefruits, lemons or limes) or spicy foods, and limiting caffeine, carbonated drinks and alcohol can help control symptoms.
- Wear comfortable, loose clothing.
- IC-friendly activities including yoga, Pilates and walking.
- Physical therapy to relax pelvic muscles can help improve IC.
- Train yourself to urinate less often once you have your pain under control.
- Learn ways to control your stress, such as relaxation methods, meditation and massage.
- Explore methods such as acupressure, acupuncture and biofeedback to relieve symptoms.
- Oral prescription medications, nerve stimulation therapy and surgery may also help relieve symptoms of IC.
At this time there is no cure for IC. However, there are many available treatment options to help relieve your symptoms of bladder pain, urgency, and frequency. A combination of treatments is the best approach in managing your IC. Finding your optimal treatment plan may also require a period of trial and error. The following is a list of treatment options for IC, starting with the least invasive treatments and ending with the most invasive treatments. Only when less invasive treatments fail to control your symptoms or improve your quality of life should you and your healthcare provider consider more invasive treatments.
Treatment Options
• Avoiding diet triggers (lifestyle changes) can help to control your IC symptoms (coffee, tea, soda, alcohol, citrus juices, and cranberry juice).
• Timed-urination and not waiting until your bladder tells you (bladder retraining), managing your stress, and developing healthy sleep habits.
• Over-the-counter products such as neutraceuticals, calcium glycerophosphates (Prelief), Pyridium (phenazopyridine) are available without a prescription at drug stores and pharmacies and are helpful for mild to moderate pain.
• Complementary and alternative medicine (CAM) refers to health care systems, practices, and products that are not part of the conventional medicine treatment approaches. CAM therapies most often used to treat IC symptoms include biofeedback, herbal remedies, massage, yoga, and Pilates.
• Physical therapy can treat pelvic floor muscle dysfunction.
• Your Augusta Anti-Aging Medicine healthcare provider will prescribe medication that may include antidepressants, antihistamines, pentosan polysulfate sodium, H2 blockers, and more. You may also be prescribed bladder instillations—medicine your healthcare provider puts directly into your bladder via catheter.
• Removal of Hunner’s ulcers (also known as Hunner’s lesions) can reduce symptoms significantly.
• Cystoscopy with hydrodistention under anesthesia may reduce pain and discomfort in some IC patients, which can last 3 to 6 months. However, not everyone benefits from this procedure, and it may take up to several weeks to notice any symptom improvement.
• Neuromodulators, also known as electrical nerve stimulators, send mild electrical pulses to nerves in the lower back and help manage urinary function. Neuromodulators have been helpful for IC patients who don’t get enough relief from other therapies.
• Cyclosporine (an immunosuppressant) may be used when other treatments haven’t helped enough or you and your provider agree your symptoms justify it.
• Botulinum toxin A (Botox) injections into the bladder muscle are only considered when other treatments haven’t helped enough or you and your doctor agree your symptoms justify it.
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Lectus urna duis convallis convallis tellus id interdum velit. Massa placerat duis ultricies lacus. Consectetur adipiscing elit pellentesque habitant morbi tristique senectus et netus. Volutpat ac tincidunt vitae semper.