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MenoPause Blog

  • Should I treat my hot flashes or wait them out?

    by Margery Gass | Dec 16, 2014

    It is really your choice. If your hot flashes are not bothering you that much, you may want to just wait them out. Hot flashes generally become milder and less frequent as time goes on, and for most women they totally disappear. However, there are some women who have a long experience with hot flashes for several years, maybe longer, and then an occasional hot flash forever. The challenge is that no one can predict how long your hot flashes will persist. Hormone therapy provides very effective treatment for hot flashes, but it is not always a permanent cure. About forty percent of women have a return of their hot flashes when they stop treatment—somewhat like a second menopause when the estrogen level drops again.

    There are a number of low-risk coping strategies and lifestyle changes that may be helpful to you for managing hot flashes, but if hot flashes remain very disruptive then prescription therapy can be considered. Prescription hormone therapy (HT) approved by the US Food and Drug Administration (FDA) and by Health Canada include systemic estrogen therapy (ET) and estrogen-progestogen therapy (EPT; for women with a uterus). Some of these treatments have been around for 70 years. A newer FDA-approved hormone product, for women with a uterus, combines estrogen with bazedoxifene instead of a progestogen. Bazedoxifene is an estrogen agonist/antagonist, which means that it works like estrogen in some tissues while inhibiting estrogen activity in others. In this case, it helps to protect the uterus from cancer. There are reasons why some women should not use HT and the list includes such things as a history of estrogen-related cancers such as breast cancer, a history of liver disease, blood clots in the legs or lungs, cardiovascular disease, and stroke. A review of your health history with your healthcare provider is an important first step.

    For women who prefer not to take hormones or cannot take them for other health reasons, nonhormonal drugs approved to treat depression, called selective serotonin-reuptake inhibitors (SSRIs), have been found to be effective in treating hot flashes in women who don’t have depression. The only SSRI the FDA has approved thus far for treating hot flashes is paroxetine 7.5 mg. It was shown to improve hot flashes and offers women a new choice. Discuss with your healthcare provider all of these options to see which ones are appropriate for you. 

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  • Are headaches related to menopause?

    by Margery Gass | Nov 23, 2014
    Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around their menstrual periods (so-called menstrual migraines) or when taking oral contraceptives. Hormonal headaches typically stop when menopause is reached and hormone levels are consistently low. Most headaches do not require treatment or can be treated with nonprescription pain medications. Some headaches, however, can be serious. More serious headaches, including migraines, may require prescription drugs; however, care should be taken to monitor the use of these drugs. If a headache is unusually painful or different from those you have had before, seek medical help promptly.
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  • Approaching menopause? Don’t forget about birth control

    by Margery Gass | Nov 06, 2014
    If you’re having hot flashes and other menopause symptoms but still getting your period now and then, there is a slight chance you could become pregnant, unless you have already taken care of that. If not, and if you would like to avoid pregnancy, birth control is recommended until one year after your last period. Many options are available for midlife women:

    • Birth control pills, patches, or rings—added benefits include more regular cycles with perhaps lighter bleeding, perhaps fewer hot flashes and a reduced risk of cancer of the uterus and ovaries. Note that these methods are not recommended for women who are smokers over age 35, have high blood pressure, migraines or who have had a blood clot in their legs or lungs. 
    • Progestin-alone pills, implants and injections—a potential option for those who smoke, have certain cancers,  high blood pressure, diabetes (without kidney, retina, or neurologic complications), history of blood clots, or obesity. These conditions should be discussed with your healthcare provider.
    • Barrier methods (condoms, diaphragm, spermicide)—condoms are the only method than provides some protection from HIV and other sexually transmitted infections. Note that these methods depend upon one of the two partners using the method with intercourse every single time.
    • Intrauterine devices with or without hormones—safe, highly effective, convenient, and long-term.
    • Sterilization (Tubal ligation, fallopian tube inserts, or vasectomy for men)—very effective and permanent methods, but require a surgical procedure.
    • Note that the last two methods, as well as progestin implants, require procedures that produce long-lasting contraception. They are highly effective, but they are more costly up front and in the short term. If you are quite close to menopause, they may not be worth the cost and the necessity of undergoing a procedure. 
    For all of these methods be sure to review the pros and cons with your healthcare provider in order to be sure the method is a good choice for you.
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  • MenoPro, a free app for women

    by Margery Gass | Oct 17, 2014

    Are you bothered by menopause symptoms and wondering what to do about it? Try our free MenoPro app available in the iTunes store. You can also read about it here.


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  • Are memory problems related to menopause?

    by Margery Gass | Oct 09, 2014
    Memory and other cognitive abilities change throughout life. Difficulty concentrating and remembering are common complaints during perimenopause and the years right after menopause. Some data imply that even though there is a trend for memory to be worse during the menopause transition, memory after the transition is as good as it was before. Memory problems may be more related to normal cognitive aging, mood, and other factors than to menopause or the menopause transition. Maintaining an extensive social network, remaining physically and mentally active, consuming a healthy diet, not smoking, and consuming alcohol in moderation may all help prevent memory loss. Atherosclerosis (hardening of the arteries) may also contribute to mental decline. Aim for normal cholesterol, normal weight, and normal blood pressure to help protect your brain. Women who are concerned about declining cognitive performance are advised to consult with their healthcare providers.
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  • Is there a relationship between menopause and cancer?

    by Margery Gass | Oct 08, 2014
    No, menopause itself doesn’t increase the risk of cancer. Cancers are more common as people age, however. Most cancers occur in people age 55 and older. The cancer most women are concerned about is breast cancer and whether hormone therapy increases the risk. Women with a uterus, who need to use a progestogen in addition to an estrogen, have some increased breast cancer risk after3 to 5 years of taking these hormones. Women who have had a hysterectomy who can use estrogen alone show no increased risk after 7 years. Keep in mind that many other things affect breast cancer risk, including your genes, your weight, and your lifestyle. Hormone therapy can also play a role in uterine cancer. If you have a uterus and don’t take, or don’t take enough, progestogen with it, that can increase the risk. If you have any menstrual-like bleeding after menopause, see your healthcare provider about it. The risk of colon cancer, the most common cause of cancer death in both women and men, increases with age, and combined hormone therapy may lower the risk for women. But for this cancer, too, many other things affect your risk, including genetics, weight, and lifestyle. If you are at average risk, you should have a colonoscopy every 10 years starting at age 50.
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  • Invitation to women with low desire and sexual dysfunction

    by Margery Gass | Sep 23, 2014

    The time has come. This is your opportunity to discuss your concerns and to share your thoughts on the need for treatment with the United States Food and Drug Administration (FDA). There have been many products brought to market over the last 15 years for male sexual dysfunction, but we still have nothing for women.

    The most common female sexual dysfunction is female sexual interest/arousal disorder, often referred to as “low desire” or “low libido.” The FDA wants to hear from women who have this condition. How does it affect your life? What is the most distressing aspect of it? Has anything helped?

    On October 27, 2014, the FDA is holding a Patient-Focused Drug Development public meeting on Female Sexual Dysfunction in Silver Springs, Maryland. You can apply to appear in person or submit your comments online. Webcast participants will also have an opportunity to provide input through webcast comments. A panel of patients and patient advocates will present comments to start the dialogue, followed by a facilitated discussion with all patients and patient representatives in the audience. I will be there in person in the audience to hear your comments, and I will also be participating on the scientific panel the following day.

    All parts of the event are free but you must register online and by October 20, 2014. For event details and to learn more visit Eventbrite: Patient-Focused Drug Development Public Meeting and Scientific Workshop on Female Sexual Dysfunction event page.

    For more information, refer to the FDA meeting website.

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  • How can I find a menopause specialist?

    by Margery Gass | Sep 18, 2014

    The North American Menopause Society maintains a search feature on this Web site for those women in the United States or Canada who are searching for physicians and other healthcare providers interested in helping them manage their health through menopause and beyond. Those who have passed a competency examination leading to the prestigious credential of NAMS Menopause Practitioner are noted in the displayed results.

    Find a Menopause Clinician now

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MenoPause: the blog!

Posts to our Blog are written by NAMS staff members and Dr. Margery Gass. All posts are reviewed and edited by Dr. Gass. We strive to bring you the most recent and interesting information about various aspect of menopause and midlife health. We accept no advertising for our website. We want you to have accurate, unbiased, evidence-based information. 

Margery L.S. Gass, MD, NCMP
NAMS Executive Director

An internationally recognized leader in the field of menopause, Dr. Gass became Executive Director of The North American Menopause Society in 2010. Dr. Gass has been an investigator on numerous research projects, including serving as a principal investigator for the Women’s Health Initiative, and has published and presented on a wide range of topics related to menopause, including osteoporosis, sexual dysfunction, and hormone therapy.

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