[music plays] [no dialogue] >>Lori Banks: Today on Being Well we are answering all of your questions about menopause.

APNs Leslie Taggart and Nicole Wochner from Sarah Bush Lincoln Health System will be here to talk about the stages of menopause and the symptoms that come along with it.

We'll learn more about what medications are available to help control symptoms such as hot flashes, and if hormone replacement therapy might be an option for you.

Stay tuned for this informative edition of Being Well.

[music plays] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony's Memorial Hospital, delivering healthcare close to home.

From advanced surgical techniques and testing, to convenient care for your family, HSHS St. Anthony's makes a difference each and every day.

St. Anthony's, where you come first.

[no dialogue] Welcome back to Being Well.

I'm Lori Banks.

And today we're talking about a subject that a lot of you and your girlfriends probably talk about, and that is menopause.

And here to answer all of our menopause questions is Leslie Taggart and Nicole Wochner from Sarah Bush.

Ladies, thank you so much for coming back.

>>Nicole Wochner: Thanks for having us.

>>Lori Banks: Alright, well we've got a whole list of questions, some of them generated by, you know, friends and coworkers of mine.

So, let's get started with just what is menopause and how do you know if you're in it?

>>Nicole Wochner: Menopause is kind of, goes in certain phases.

So, I think the important part of menopause is understanding that there is something called a peri-menopause that starts kind of previous to cycles stopping.

That can be when you start having hot flashes, and when you can start having mood changes and sleep disturbance, and things like that.

Menopause is defined by 12 months of no periods.

So, you're not technically menopausal until you've been a year without cycles.

But those symptoms can start long before the cycles stop.

And so, I think that's where a lot of women get confused.

It's like, well I'm still having my period, but I'm having all these other symptoms.

What's going on?

>>Lori Banks: Yeah, when do your patients, about what age are they hitting that peri-menopausal stage?

>>Leslie Taggart: Well peri-menopause can start even in your 30s.

A lot of the patients' risk factors, and body style and lifestyle habits can affect that.

But anywhere from 30s.

Some women might not start it until well into their 40s.

>>Lori Banks: And then that, so that can last for a few years.

Then menopause can drag on for more than just a year?

Or how does that... [laughing] >>Leslie Taggart: Well we have some patients that'll go like 11 months.

And then all of a sudden their period will come back.

And they're so frustrated because then that 12 month period starts back over again.

It's 12 months of consecutive no menses, so.

>>Lori Banks: Okay, and then once you hit that-- >>Leslie Taggart: Then you're considered menopausal.

>>Lori Banks: Okay, so what about, what is the average age for a woman to be in menopause?

>>Nicole Wochner: In the United States it's 51.

So, ethnicity kind of plays a role in that too.

We know that Hispanic women and African women, African American women to some extent, but more African women have earlier menopause.

And Asian women a bit later.

But kind of the norm/average in the United States is 51.

And a lot of that has to do with our diet here in the U.S., and our lifestyle and things like that too, so.

>>Lori Banks: Let's talk about existing, you know, lifestyle factors, other health factors, diabetes, high blood pressure.

How do those things play into menopause?

>>Leslie Taggart: Well obesity's probably the biggest one.

If you are overweight you will suffer more, with more of those peri-menopausal symptoms.

But lifestyle factors such as tobacco use is huge.

It's earlier onset of peri-menaopause and menopause in general, as well as alcohol has a lot to do with that too.

And exercise, if you don't exercise.

Really just, I mean us healthcare providers preach on it all the time, but it really affects so many things.

But yes, if you are out of shape and don't take care of yourself, you are going to struggle with menopause and peri-menopause more so than someone who does.

>>Lori Banks: So, those symptoms are going to hit you harder.

>>Leslie Taggart: Yeah, they're going to be more exaggerated.

They're going to probably happen earlier, and you're going to struggle with them longer, and they're going to be more intense.

>>Lori Banks: Well actually we were talking this morning about oh, thank goodness it's cool in here, because I was hot this morning.

Hot flashes are very common.

Let's talk about those dreaded hot flashes.

How do you know if you're... Well you know you're having one, but what really defines a true hot flash?

>>Nicole Wochner: It's really just different for every woman.

It's more of a temperature intolerance issue.

So, it's just there's a whole biochemical mechanism behind it, but basically it's just women have a sort of less of a tolerance to small temperature changes.

So, that's what triggers, you know, in your 20s you can go from like a warm room to a cold room, and back to a warm room and really like, yeah it's a little warm.

But for a menopausal or peri-menopausal women that slight temperature change, your body can't compensate for that.

And so, that triggers a hot flash.

And sometimes anxiety can do it as well.

So, I don't think that there's like a standard hot flash.

I think everybody kind of has a different experience with it.

But like you said, if you're having them you will know.

>>Lori Banks: But it's not always perfuse sweating.

It can be you're just really, really warm.

>>Nicole Wochner: Some people say it feels like a fiery furnace, like you're burning up from the inside out.

And some women sweat a lot with it, and other women don't sweat at all.

It's just really different from person to person.

But 75% of American women report having hot flashes during menopause.

So, it's pretty good likelihood that you're going to have some hot flashes as you go through menopause.

>>Lori Banks: Is there anything that you can do, any medication, supplements, anything you can do if you're really suffering and you're like at work, and you are sweating and then you're freezing?

If it's really interrupting your life, is there anything you can prescribe for it?

>>Leslie Taggart: There is actually a new treatment.

It's a low dose of generic, or it's a brand called Brisdelle now, but it's low dose Prozac that, given at low doses than what we would use for anxiety or depression, has been shown to help tremendously with that.

Again we have found that more so just what you wear and, you know, cotton.

Like your grandma would say, "Wear cotton."

And avoid some of those triggers that you know, like stress and anxiety, that are going to cause that.

Have a fan with you.

Have water.

Those environmental things are you know, not that the medication's not safe.

But those are some much more practical things that you can do.

You'll probably get just as much relief doing that as vs. taking a daily medication.

>>Lori Banks: Or do what I did, and I started never drying my hair the morning I go to work.

Because, we were talking, and I would just be sweating.

So, that's one solution-- >>Leslie Taggart: Small little changes, yes.

[laughing] >>Lori Banks: Don't use a hairdryer in the morning.

[laughing] If your mother went through menopause at a certain age, can you expect the same result?

>>Nicole Wochner: Yeah, genetics are a pretty huge predictor for menopause.

So, within a couple of years in any direction, most women do follow suit with their moms.

Our generation, it's kind of hard because a lot of women our moms' ages had hysterectomies because of bleeding issues or, you know, other kind of concerns.

And now we have so many treatment options available for dysfunctional bleeding and things like that.

So, we're doing a lot less hysterectomies.

But 20, 30 years ago that was kind of the go-to for treatment of, you know, menstrual irregularity and all of that.

So, a lot of my patients that I say, "Okay let's talk about menopause.

Let's talk about your mom, let's talk about your sisters."

And they're like, "I don't know, my mom had a hysterectomy when she was 30."

So yes, absolutely moms', you know, menopausal course does have some predictor for daughters.

But in a lot of cases we don't have that to go back to, so.

>>Lori Banks: Okay, let's talk about, I wanted to get back to...

I jumped ahead there.

We were talking about symptoms, so hot flashes is one.

What are some other common ones that your patients talk to you about?

>>Leslie Taggart: Well usually some of the earlier ones would be like mood instability or liability, which usually they'll be like, "Oh my kids and husband say I'm a jerk."

So, and lots of times the patient will notice it too.

They don't want to feel like that.

So yeah, mood changes, the temperature intolerance.

A lot of them will report an increase in weight or inability to lose weight, that they normally could work hard and lose those two pounds, where they are doing all the normal stuff, exercising and eating right, and just not losing weight.

As well as extra weight in the mid-section right around the abdomen is really common.

Loss of hair, but then also gaining facial hair.

So, you're losing it from your head but finding it on your chin.

>>Lori Banks: Super!

>>Leslie Taggart: Yes!

And then later, osteoporosis goes into that, declining estrogen levels.

So, that one comes into play with that.

But those are some of the more common issues.

>>Lori Banks: And are a lot of... That's just related to the changes in hormones: the weight gain and the facial hair?

>>Leslie Taggart: Yeah, and you think about when we are pubescent and starting with this whole maturation process, the estrogen is naturally inclining.

But now we're on the opposite end of the bell curve.

We're coming down slowly.

So, when you were crazy because you were a teenager, the same thing happens when you're coming out of that.

Those hormones are just reversing.

>>Nicole Wochner: It's really similar.

Yeah, absolutely.

>>Lori Banks: So, for women who, let's talk about if you had children or not had children.

Does that have any impact on menopause?

No, really?

>>Nicole Wochner: I mean I guess there is some theory that maybe a little bit of that plays into it.

But no, not really.

>>Leslie Taggart: There's been lots of research trying to find a connection there, and there's just not been a solid study to say yes or no, one way or another.

>>Nicole Wochner: And even over the course of the last, you know, 50.

60 years doing retrospective studies, the average age of menopause really hasn't changed.

So, you know, we look at a lot of sort of new research on like BPA and carcinogens, and things we're exposing ourselves to that probably are not ideal.

But as far as, you know, estrogenic activity and things like that, and how that affects menopause, we haven't really seen a shift with that.

So, obviously there's, you know, that's a dot-dot-dot, more to come.

But yeah, so far we don't have any necessary-- Other than smoking and lifestyle factors, there really ins't a whole lot that plays into changing.

>>Lori Banks: So, the fact that you may have been on birth control for several years has no impact.

>>Leslie Taggart: Or even like if you started your period a lot sooner than the girlfriends in your class, that has not shown to show much difference.

It's really like we said, diet, exercise and other lifestyle, yeah.

And genetics, they're huge.

And your genes, they're something you can't change about that.

>>Lori Banks: So, this was a question that came up around the office.

Is there any kind of blood test or something, hormone test that you can do to decide if you're menopausal?

Especially for a woman that's had maybe an endometrial ablation, who doesn't have a period.

How do you even know if you're...?

>>Nicole Wochner: We really just go by symptoms.

There's not like a blood test for like a predictor of like you're getting close.

Once your menopausal, we can kind of determine that with blood level.

But as far as the peri-menopause, there's no sort of gauge for that.

So like, especially for women who've had an ablation or women who've had a hysterectomy and still have their ovaries, it's really more looking at the hot flashes, looking at the mood changes, looking at the sleep disturbances and all of that, and just kind of treating it more clinically.

I have that conversation with patients a lot.

You know, I can draw your blood, but ultimately these symptoms that you're talking to me about are what we need to address.

So, whether your blood work looks perfect or whether it looks borderline, we still need to address what's going on with your symptoms.

So, I don't-- >>Leslie Taggart: And even as you're going through or close to menopause, that FSH level is what we check, that changes significantly day to day, even if you're, you know, very close to menopause.

So, really a lot of people just want that proof, they want it.

>>Nicole Wochner: They want that number.

>>Leslie Taggart: But yes, yes.

But I kind of think it's kind of a waste of your money.

I mean I'll do it if you want to, but it doesn't provide much clinical information for me.

>>Lori Banks: Okay, you talked about sleep disturbances.

Is that common for peri-menopausal, menopausal women?

>>Nicole Wochner: Yes.

>>Lori Banks: So, what's kind of behind that and what can they do about it?

>>Nicole Wochner: It's another, you know, estradiol, estrogen shift that triggers, you know, sleep disturbance.

And it's more of a sleep pattern disturbance.

So, women can typically fall asleep okay, but it's more frequent waking during the night.

Some of that has to do with night sweats.

The hot flashes that you have during the day are happening at night as well.

So, whether you perceive them completely or not, they're enough to disrupt your sleep pattern so you don't get really deep, restful sleep.

And then you know, the littlest things will wake you up.

>>Leslie Taggart: As well as the bladder comes into that too.

Decline in estrogen can affect your bladder, so you're having to go to the bathroom more, there's more incontinence issues.

And that, if you're having to get up to go to the bathroom, most people will have a harder time going back to sleep immediately.

So, that can add to that.

>>Lori Banks: Just as we age, do you just don't get in that as deep of sleep as we used to?

>>Leslie Taggart: For different, yes, different sections of your life.

Like when you're with a new baby, and then again with this.

But eventually as you, as the dust settles and your hormones level off, you will get back to where you can get a good night's sleep again.

>>Lori Banks: So, let's get back to, we talked about some of the emotional instability.

What kind of advice do you have for... you said you do have patients who kind of realize I'm acting a little crazy or very, you know, easily set off.

What advice can you give to them to kind of manage their way through that part of it?

>>Leslie Taggart: Well, and some of those medications we talked about for hot flashes, they're called SSRIs, they are actually used for treatment for some of that mood liability.

And again, given at low doses we find that we can treat multiple symptoms with those medications.

And because they're not given at higher doses, we don't have some of the side effects, whereas like if you were taking sometimes double or quadruple that for anxiety or depression.

It's enough to help take the edge off a little bit because that's, a lot of my patients will say, "I just feel edgy, I just feel like the slightest thing can just set me off."

Or "I just want to snap at my kids when they do normal things or my husband irritates me so easily."

So, and this is all very, very normal.

And if everyone in your home understands that, that helps too to be like I'm not trying to be mean to you.

Sometimes Mom just says things that come flying out.

My filter's going away a little bit.

And again all that will settle down too once you get through that peri-menopause.

That's not how you're going to be forever too.

So, a lot of people don't take anything, and they'll just use other coping mechanisms: exercise, going for a walk for 30 minutes a day just to blow off some steam really helps.

>>Lori Banks: Okay, you had mentioned that you do see changes in your hair, and your skin and your nails.

What's kind of going on, other than oh, I have wrinkles that I didn't have before?

>>Leslie Taggart: Well testosterone changes as well during that, so that can affect some of that facial hair.

And again it's all coming back to the estradiol, estrogen thing, where you'll notice a lot of older ladies that their hair is just so much thinner.

And that has a lot to do with that.

So, if you're just conscious of that, maybe not wash your hair as often.

Because, usually when you wash your hair, that's when a lot of your hair is going to come out.

Or be more gentle with brushing, that kind of thing.

You can take a multivitamin, just a daily multivitamin can help with that.

Some of my patients really like the hair, skin and nail vitamin.

And there's nothing that will hurt you with that.

But yeah, just being conscious of that.

And again drinking more water and just helping with your diet will help with a lot of that.

>>Nicole Wochner: Yeah, estrogen's kind of the hormone that keeps your skin sort of soft, and you know, increases elasticity so you don't have as many wrinkle issues and things like that.

So, since that's declining, you kind of have to compensate for that with like more water and the other sort of dietary things you can do to help with the elasticity of your skin.

>>Lori Banks: I wanted to save this question because we need some time to talk about it, and that is like hormone replacement therapy.

Because, we're losing estrogen and it's a good thing for lots of reasons.

But yet it has this downside of causing heart issues.

So, we're going to spend some time talking about that, about hormone replacement therapy.

>>Nicole Wochner: I think I can speak for both of us, we both prescribe hormone replacement.

You know, we have a lot of studies.

There were some studies that came out, you know, around 2002, 2003, WHI that sort of scared us about hormones, scared the American public, scared providers, kind of everyone about hormones and risks, and all of that.

And so, I think that sort of reshaped kind of how we look at hormones and how we look at dosing.

And so, you know, we've continued on with those studies, and what we're finding is that for women who take a low dose of hormones for a short amount of time, and by short amount we mean, you know, around five years, and women who are in that peri-menopause to early menopause period, there really aren't significant risk factors that go along with that for the average woman.

Now obviously there's women who aren't candidates for hormone: women who've had breast cancer, women who've had endometrial cancer, women who've had, you know, serious heart disease risk factors and things like that.

But for the average woman who is for the most part healthy and doesn't have any sort of underlying disease conditions, it's really pretty safe.

And it does have a lot of benefit outside of even just treating your hot flashes.

So, I think you know, I spend a lot of my time counseling, sort of like reshaping our view of hormones.

Because, we do kind of like, ooh, hormones are bad.

>>Lori Banks: Yeah, well it is scary.

I mean you hear about estrogen sensitive breast cancer, tumors, and heart disease.

Kind of makes you not want to take them at all.

So, how do you determine if a patient is a good candidate?

You know, if they're having, "Oh I'm kind of hot once a day."

I mean what kind of determines...?

>>Leslie Taggart: Severity of symptoms is probably the number one thing.

Again if you're saying I'm just having a couple hot flashes, then obviously we're not going to jump.

I'm not going to say it's a big gun medication, but it's not something we're just going to throw at everybody.

We try and counsel the patients on, like we've talked about so many times, the lifestyle modifications.

Diet and exercise truly does so much.

You can control a lot of your symptoms with that alone, and not take a single pill.

But yeah, your age has a lot to do with that, if you're a smoker, if you're overweight, your parents' history with heart disease, again with breast cancer.

And if you're good about screening with mammograms, I mean we want you to do that at age 40.

That all kind of helps stay on top of it.

Not that we give that as, well as long as you're doing that we're good to go kind of thing.

But yeah, severity of symptoms is probably the number one thing, and then we kind of calculate that along with lifestyle modifications or patient history that that particular patient has.

>>Lori Banks: So, what hormone, when you're giving hormones, is it estrogen replacement, is that what you're giving them?

>>Nicole Wochner: For women who have a uterus, so women who haven't had a hysterectomy, we do a combination of estrogen and progestin because it has a protective affect for your uterus.

For a woman who has a uterus who's taking what we call unopposed estrogen, estrogen only, which you can do over the counter with Estroven and things like that.

So, you do have to be careful with that.

You put yourself at increased risk for thickening the lining in your uterus, and that increases your risk for endometrial cancer.

So, it's actually really pretty dangerous.

So, we do give progestin to kind of combat that.

There's actually a newer medication on the market now as well that has a combination of estrogen and then ASRM, which is a little bit of a different sort of combination that does the same thing as far as protecting the uterus, but sort of in a little bit different way than the progestin and some of the risks that can go along with that.

So, I think we're living in a time that sort of is ever evolving.

You know, even just since I've been in practice, which has only been for 13 years, we have so many new options for hormone replacement.

And we're sort of constantly on a quest to find the lowest, safest dose.

And so, I think we're just, you know, making it safer for women who are... Because, it's a quality of life issue.

And I think for a woman who's suffering with hot flashes and suffering with other menopausal symptoms, we need to have something that's safe, that we know is going to manage the symptoms without putting people at a lot of risk.

So, the good news is that's, you know, I think there's more to come on that.

So, yay.

>>Lori Banks: Yay, yay for all of us.

Alright, let's talk about sex, sex drive.

What kind of changes happen, you know, in that menopausal state?

>>Leslie Taggart: Libido changes are common.

I have had it both ways.

I've had some patients are like saying my libido's gone, I have absolutely no interest.

Other patients report that their sex life is improving.

But a common complaint is pain with intercourse or bleeding with intercourse.

And because of that decrease in estrogen, like Nicole was talking about how our skin in our face changes, so does skin everywhere else.

So, there is a natural drying of not just the external vulva, the external genitals, but inside the vagina itself.

So, that's what can cause some irritation and pain with intercourse, especially like with initial penetration.

That's when, most of our patients say that's, when we first start, that's when I'm most uncomfortable.

And that can be a big deterrent with libido.

If it hurts, you're not going to want to do it.

So, there's, Nicole and I encourage patients to use olive oil, as crazy as that sounds, as...

It's a plant based product, so there's no chemicals in it, just as a natural lubricant for day to day.

I mean you think about using lotion on your skin.

You can use that day to day in the vagina or on the outside, the vulva, but also as lubricant for intercourse as well, too.

It doesn't, for tissue that's already irritated, putting more chemicals on it like the over the counter KY's and all that other, yes, yes, that is like liquid fire.

So, for someone that's already having problems, that's only going to compound that.

So, we find that olive oil is a great therapy for that.

>>Nicole Wochner: Vitamin E. I mean everybody has their favorite oil these days, I feel like.

>>Leslie Taggart: As long as they're plant based like that, and not necessarily a petroleum based product that has so much junk in it, that helps a lot.

>>Lori Banks: I thought I've seen ads for like an estrogen cream that can help too.

>>Leslie Taggart: Yes, it's very controversial because they're actually advertising and using the word "sex" on TV, which is kind of iffy.

But yes, there are.

The two main ones right now are Premarin and Estrace cream.

And those are awesome.

We usually have no problem with prescribing those because they're mostly a local based medication.

So, it only goes where we put it.

There's some minimal part that can go in the bloodstream, but for the most part it just goes in the vagina.

And given four to six weeks, most of my patients report great improvement with just day to day uncomfortable irritation, but as well as with intercourse too.

>>Lori Banks: Okay, I think we've got about two minutes left.

I just want you guys to sort of walk us through what do you tell your patients, what advice do you give.

Because, all women are going to go through this.

You can't really avoid it.

So, how can we make it as positive or as comfortable as possible?

What should we do?

>>Nicole Wochner: I think just healthy lifestyle, kind of being proactive with it and knowing that's going to happen, sort of already have those sort of lifestyle things in place.

Exercising and eating healthy, and avoiding smoking.

And the things that we talk about for just general health are going to help with menopause.

I tell people all day long, I think we paint this picture of like ugly, ugly menopause, it's awful.

And it doesn't have to be that.

I think a lot of it is sort of how you go into it.

Yes, it's going to happen.

Yes, your'e probably going to have hot flashes.

For some women, absolutely it's awful.

And that's what we're here for.

But I think if you can go into it knowing that it's going to happen, it's going to be for a relatively short amount of time, and then it's going to taper off, it makes it a lot more manageable than thinking this evil, looming menopause is here to stay.

>>Leslie Taggart: And think of it as a positive thing.

A lot of people kind of suffer with this, like now I can't have children.

It's that end of an era for them, which is very consuming for us as mothers.

That's so much who you are.

But think of that as celebrating, you know, like I can focus on me more now.

And think of it as a positive thing, and not so much of a doomsday, like it's coming, so.

[laughing] >>Lori Banks: Ladies, thank you so much for coming on the show and giving us just a great, you know, open, honest, frank conversation about menopause.

I think you've answered a lot of questions for our viewers.

>>Leslie Taggart: Thank you.

>>Nicole Wochner: Thanks for having us.

>>Lori Banks: Absolutely.

Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active, managing stress, and regular checkups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general and laparoscopic surgery.

More information online, or at 347-2255.

>>Singing Voices: Rediscover Paris.

>>Lori Banks: Our patient care and investments in medical technology show our ongoing commitment to the communities of East Central Illinois.

Paris Community Hospital Family Medical Center.

HSHS St. Anthony's Memorial Hospital, delivering healthcare close to home.

From advanced surgical techniques and testing, to convenient care for your family, HSHS St. Anthony's makes a difference each and every day.

St. Anthony's, where you come first.

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