What your mother didn’t tell you!

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It turns out that the majority of women experience mid-life and beyond with many unanswered questions about their changing bodies. To help disseminate much needed information on the topics of perimenopause, menopause and postmenopause, The Miriam Hospital Women’s Association recently hosted two expert physicians from Lifespan’s Menopause Consultation Program, Dr. Mary Catherine DeRosa and Dr. Teri Pearlstein. 

 

Gynecologist Mary Catherine DeRosa is director of the Menopause Consultation Program at Lifespan Physician Group-Obstetrics and Gynecology. She is a clinical assistant professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University. Her areas of interest include menopause, sexuality and bone health.

Psychiatrist Teri Pearlstein is director of Women’s Behavioral Medicine at the Women’s Medicine Collaborative. She is a professor of psychiatry and human behavior and professor of medicine at Alpert Medical School. Her clinical interests include depression and anxiety disorders relating to the menstrual cycle, pregnancy, postpartum and menopause.

For many women, questions about their changing health begin quite simply with “am I there yet?” The clinical definition of perimenopause is monthly menstruation coming seven or more days late. This change can start as early as age 40, but for some not until their late 50s. For many, early symptoms include hot flashes, night sweats, brain fog, anxiety and depression.

DeRosa discussed traditional hormonal therapies as well as non-hormonal medications, herbals, and hypnosis and explained that relief often can be found through simple lifestyle modifications such as exercise, weight loss and dietary changes. Seventy percent of women experience hot flashes, which on average continue for seven to 10 years. Unfortunately, a majority of women go untreated due to confusion about treatment options, which are many and should be discussed with a health care provider.

With anxiety and depression commonly experienced during menopause, Pearlstein explained that it can be hard to distinguish between symptoms typical of perimenopause like irritability, low libido and low energy and more serious signs of depression like feelings of worthlessness and thoughts of suicide. While menopausal transition is a window of vulnerability for the development of such depressive symptoms, most women who experience a major depressive episode (MDE) have experienced one  previously. Thus, it is not common for women to experience their first MDE during this transition.

Stressful life events can be risk factors for the onset of depression during this time. As with hot flashes, exercise can help, as can herbal and dietary supplements. In some cases antidepressants should be considered since they have been shown to have positive effects on menopause symptoms that include sleep, libido, and hot flashes.

Many in attendance at the program were alarmed to hear that women begin losing bone mass in their mid-30s. In the perimenopausal and early menopausal years, a woman can lose up to 5% of bone mass each year.

Osteoporosis affects 10 million Americans. One in two women over age 50 will have an osteoporotic fracture in her lifetime. DeRosa outlined important steps that can be taken to care for bones in the menopause transition:

                         1,200 mg of Calcium daily (most of which can be obtained through diet)

                         600-800 IUs of Vitamin D daily and depending on your exposure to the sun perhaps as much as 1,000 IUs daily

                         Weight-bearing and core- strengthening exercise

                         No smoking

                         Limited alcohol consumption

                         Consider Bone Density testing

The women at the program learned a great deal about menopause, treatment options, and supportive services available to make this transition easier.

The Miriam Hospital Women’s Association Programming Committee, responsible for organizing this program, includes Barbara Brown, Sherry Cohen, Caryl Freedman, Neile Hartman, Robin Kauffman, Eleanore Koo, Marianne Litwin, Marilyn Myrow, and Cynthia Schwartz, along with Association President Susan Guerra and Department Assistant Vickie Scott.

NEILE HARTMAN is on The Miriam Hospital Women’s Association Programming Committee. For additional information about membership or other questions about The Miriam Hospital Women’s Association, contact Vickie Scott at 401-793-2520 or Vickie.Scott@lifespan.org.