Menopause Support
The menopausal transition is an opportunity for women to refocus attention & energy on their health & wellbeing. For some, this can mean making lifestyle changes to improve their day-to-day quality of life & prevent chronic disease. For others, hormonally-mediated symptoms may motivate them to search for relief through the use of hormone replacement therapy (HRT) or other therapies.
Navigating the immense quantity of information from internet, medical providers, & friends can be understandably overwhelming; all women can benefit from the individualized education, counseling & evidenced-based therapies only a menopause specialist can provide.
Services Provided
Education & counseling on menopausal transition including up-to-date health-related research focusing on women over 40 in a relaxed atmosphere with plenty of time for questions.
Individualized, age-appropriate screening recommendations and proactive preventive care based on an assessment of personal & family medical history and evaluation/management of current complaints, including:
Diet & lifestyle assessment & counseling in accordance with the basic tenets of “Health at Every Size”.
For those that meet clinical criteria, medications may be an option for obesity
Screening for & treatment of other conditions which can co-exist with, mimic or exacerbate menopausal symptoms:
vaginal & urinary tract symptoms, genitourinary syndrome of menopause
breast & bone health,
thyroid disease, blood sugar, cholesterol issues,
nutritional deficiencies,
issues related to fertility & contraception.
FDA-approved ‘bioidentical’ menopausal hormone therapy & testosterone
Referrals to other health care providers & specialists as needed.
Recommended to have a PCP to seek regular care for any acute illness and/or needs that are not listed above; I can coordinate with PCP.
HELPFUL IF YOU BRING/SEND ALL RECENT TEST RESULTS & CURRENT MEDICATIONS/SUPPLEMENTS TO YOUR FIRST APPOINTMENT.
Menopause Frequently Asked Questions
Are my symptoms related to menopause?
Do I need hormones?
Why do I need to see a menopause specialist?
Do you prescribe bio-identical compounded medications?
Are there non-hormonal treatment options available?
Aren’t hormones dangerous? Can I use menopausal hormone therapy after breast cancer?
What lab work or testing will I need?
Are my symptoms related to menopause?
Menopause is not like a light switch, where one moment you are pre-menopausal and the next you are post-menopausal. Unfortunately, it is quite the opposite: erratic hormone production fluctuates from day to day and month to month, thereby causing changeable and varied symptoms. Menopause is the spontaneous, permanent ending of menstruation, and is literally one day, typically the day that is one year after the last menstrual period, usually around age 50, but can be anywhere between age 40-60. Symptoms may begin up to 15 years before the final menses & may last for several years after. Many factors may impact this transition, from genetics to lifestyle habits. However, some may enter into menopause through surgery or medication.
Special consideration should be given to issues related to fertility. Pregnancy can occur even in presence of menopausal symptoms & menstrual irregularity into mid-40’s. Others may have difficulty achieving/maintaining pregnancy in absence of these symptoms at any age. Contraception and/or fertility-preserving strategies should be a part of every woman’s assessment & plan during perimenopause.
When one suspects perimenopausal symptoms, it is an excellent time to have a complete medical examination by a qualified health professional. Diagnosis of perimenopause can usually be made by reviewing a woman’s medical/menstrual history in addition to specific symptoms and treatment recommendations can be made accordingly.
Do I need hormones?
Not all women need HRT. This decision should be based on a detailed conversation or series of conversations between a woman and her physician. Therapies with less associated risk, like diet and lifestyle, should be tried first. Screening for other conditions that can cause similar symptoms, like hypothyroidism, should be excluded. A considered assessment of a woman’s potential benefits vs. risks should be conducted. While risks are possible with any use of HRT, symptoms can negatively impact a woman’s day-to-day quality of life, affecting relationships with family and friends and performance at work & the degree to which this happens may outweigh these potential risks. Medical organizations devoted to the care of women agree that there is no question that HRT has an important role in managing symptoms for healthy women in menopause transition. What we’ve learned so far about the benefits and risks comes from large groups of women, but each woman is unique. The question is whether it is the right choice for YOU. Only after you and your doctor have a thorough discussion about your individual risks, benefits, and preferences can you make a decision that’s right for you.
Why do I need to see a menopause specialist?
Maybe you don’t. Not everyone needs treatment for menopausal symptoms. This is not rocket science or magic, menopause is a stage of life and, like menstruation & pregnancy, is not a disease that requires treatment. However, like menstruation & pregnancy, some have symptoms associated with menopause that can be managed to improve overall comfort & quality of life. A menopause specialist can provide individualized risk assessment & evidenced-based treatment of menopause-related symptoms, including osteoporosis, anxiety, depression, insomnia, cardiovascular disease, diabetes, migraines, contraception & sexual dysfunction.
Do you prescribe bio-identical compounded medications?
There is a lot of confusion regarding bio-identical HRT. In brief, hormones may be synthetic or bio-identical. “Bio-identical” refers to hormones that are chemically identical to those made by a woman’s body. There are studies that suggest bio-identical hormones seem to be somewhat safer than synthetic, but they are not risk-free.
Bio-identical hormones may be custom-compounded or prepared by pharmaceutical companies. Many years ago, patients and physicians chose compounded preparations because conventional bio-identical options were scarce. Today, several pharmaceutical companies offer FDA-approved bio-identical HRT in an array of doses/formulations. Compounded hormones may be necessary when there is not an equivalent FDA-approved option (i.e. testosterone) or when a woman has an allergy to a component of a commercially-produced product. Compounded products are often not covered by insurance and are not supervised as closely as the FDA-approved products and there is no evidence that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies; typically they are much more expensive. As such, the FDA-approved products are a great choice for most women.
Are there non-hormonal treatment options available?
There are non-hormonal options for women who prefer to avoid HRT or in whom the risks outweigh potential benefits, such as some breast cancer survivors. There are several studies confirming the positive impact of diet, exercise, acupuncture, stress management and lifestyle changes for women with mild symptoms & should be first-line therapy. Vitamin and herbal supplements may be helpful in some women, but research is mixed & some are expensive; appropriate dosing & use of high-quality products is necessary to know if these may be effective. Finally, there are non-hormonal medications that may do double-duty in decreasing menopausal symptoms while treating other conditions, such as depression, insomnia, & anxiety. My goal is to help manage menopausal symptoms without needing a bag full of medications OR supplements by utilizing targeted therapies that are supported by research.
Aren’t hormones dangerous?
There are several benefits to using hormones including decreasing the typical menopausal symptoms such as hot flashes, night sweats, insomnia, mood issues, “brain fog”, urinary symptoms, vaginal dryness and painful intercourse, preventing bone fractures later in life, lowering risk of heart disease & diabetes if started early.
However, despite claims, there is no such thing as “risk-free” HRT for menopause when used systemically to achieve these benefits. EXCEPT: vaginal estradiol which everyone can use risk-free
Generally, HRT may be an acceptable option for women up to age 65 or within 10 years of menopause and healthy older women who continue to be bothered by menopausal symptoms. This goes for women who have had breast cancer (see Resources on right of page). Individualization is key in decision to use HRT. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors. New studies are frequently published, so this topic is constantly in flux.
Many are told that they must stop HRT by 60-65, but NAMS released a position statement in 2015 indicating many women will continue to experience menopausal symptoms that negatively impact their quality of life well past this age and may benefit from continued HRT. These decisions are nuanced & must take into account several factors that are best considered with the help of a menopausal specialist.
What lab work or testing will I need?
For most, hormone tests are not helpful because levels change throughout the menstrual cycle. A single hormone level can be misleading since production does not fall at a steady rate, but varies greatly during perimenopause and cannot predict or confirm menopause. Normal hormone levels in presence of menopausal symptoms does not eliminate the likelihood that one is perimenopausal. Also, if a woman is currently taking hormones, hormone testing will not be valid. Testing may be helpful with, complaints of sexual dysfunction, fertility problems or when periods stop at an early age. Some lab tests can identify other causes of symptoms that mimic or worsen symptoms of perimenopause, such as thyroid disease or vitamin deficiencies, & diseases that can increase during perimenopause, such as cardiovascular disease and diabetes. Though often recommended, salivary/urine hormone levels are not accurate & should not be used to evaluate or treat menopausal symptoms. Treatments should never be prescribed to treat hormone levels, but only to decrease symptoms & therefore levels are unnecessary to determine or adjust dosing. For more info on the lack of support for hormone testing in menopause, read this excellent explainer by Dr. Jen Gunter
Menopause Book Club
Last Fridays 10-11am Virtual
The Menopause Society Certified Practitioner (MSCP) since 2012.
Menopause Learning & Resources
2/2023 NYT an audio version of the article “How Women Have Been Misled About Menopause”
7/2023 NYT podcast: “Menopause is Having a Moment”
HRT & WHI Podcast - Revisiting the WHI
Hormone Replacement Therapy (HRT) and Menopause an interview with the authors of the fantastic book “Estrogen Matters”
“Menopause Manifesto” by Jen Gunter
Excellent short read/listen on menopause research update
The Menopause Society is an excellent resource for high-quality information. Here is a great recent article from the Menopause journal on the ways the Women’s Health Initiative study was misconstrued. And International Menopause Society has great videos.
Women’s Sexual Health: Prosayla from International Society for the Study of Womens Sexual Health
Testosterone for Women Consensus Statement
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LGBTQIA+ menopause resources
The Advocate video blog
Still have questions? Feel free to email me: info@drleighlewis.com