Expert advice about menopause

Topics include:

Hormone Replacement Therapy (HRT)
Which has the higher risk for breast cancer: progesterone or estrogen replacement therapy?    The Women's Health Initiative may guide us somewhat in answering this question. In this study the women who took conjugated equine estrogen + medroxyprogesterone (PremPro) had a slight increased risk in breast cancer after about 4 years and thus the study was stopped prematurely.

The women who did not have a uterus and hence only took conjugated equine estrogen (Premarin) did not have an increase in beast cancer at that same interval. That part of the study was stopped at 7 years, not because of increase of breast cancer but because of increase in stroke. —Marilyn Darr, MD

Does HRT help decrease the risk of bone loss?   Yes, when estrogen is decreased after menopause, the rate of bone loss increases. Estrogen helps to decrease this rate of loss. —Marilyn Darr, MD
Could going off HRT give you temporary hot flashes as a result of withdrawals?   Going off estrogen replacement therapy could leave you with hot flashes depending upon how long you have been on it. Many women go off in the first 1 to 2 years without problem. Unfortunately about 5% can have hot flashes up to age 70 or so. —Marilyn Darr, MD
My doctor cut my HRT dose in half to wean me off. What should I expect?   Depending upon how long you have been on HRT, you may have no problems with return of hot flashes, or you may experience an increase in hot flashes and other menopausal symptoms. Every woman is different. Please check with your healthcare provider if symptoms become unmanageable. —Marilyn Darr, MD
Can you explain a little more about estradiol? It was recently prescribed to me but I'm not sure about it.   Estradiol is the major natural hormone made by the ovaries. It is often prescribed to women with hot flashes and night sweats that impact quality of life. It is safe and effective. A slight increase risk in breast cancer is seen after 4 to 5 years of use. —Marilyn Darr, MD

Mental Health
What can we do about dementia?   Dementia is loss of cognitive brain activity. The risk of dementia increases with age. There is evidence that regular physical activity, a Mediterranean diet, participation in leisure activity (reading, playing board games, playing musical instruments, dancing, etc.) can all decrease risk. Do not look for a pill. Do lifestyle changes. —Marilyn Darr

Do headaches tend to increase with menopause?   Some women experience headaches at the time of their period. These are referred to as menstrual migraines. These are migraine headaches that cluster around the onset of each menstrual period. In many women, these headaches worsen in frequency and intensity during the menopausal transition. —Marilyn Darr, MD

Is there a test to determine if you are premenopausal?   Premenopausal or perimenopausal transition is a clinical diagnosis. There are hormone levels such as FSH, but this test is not reliable. Check with your healthcare provider, who may be able to clinically determine if you are perimenopausal based on period irregularity and symptoms such as hot flashes, night sweats and vaginal dryness. —Marilyn Darr, MD

My periods are erratic, some with heavy flow and painful, some light and quick. What's going on with that?   Depending on your age, you may be experiencing perimenopause. This is a time when periods can change because your ovaries do not always produce an egg; therefore the hormone progesterone is not produced and periods may become erratic. It would be important for you to see your healthcare provider to determine the exact cause of these menstrual changes. —Marilyn Darr, MD

Pregnancy Risk 
I'm 52 with regular periods. No birth control. What are the odds of getting pregnant?   If you are having regular periods, you could still get pregnant because you still may be ovulating (releasing an egg into the uterus). It would be important to visit your healthcare provider to help determine your options. —Marilyn Darr, MD

Restless Leg Syndrome
Is restless leg syndrome something that you will always have, or can it go away after time?   Symptoms flunctuate and tend to worsen with age. There is a genetic component in those with primary restless leg syndrome (RLS). It is, however, important to rule out secondary causes of RLS such as iron deficiency anemia and renal disease. Please contact your healthcare provider for diagnosis and treatment options. RLS is manageable. —Marilyn Darr, MD


How do you feel about taking over-the-counter sleeping aids to help you sleep?  

I am not a fan of over-the-counter sleep aids. Most use diphenhydramine, which is actually an antihistimine used for allergies. The time it lasts may be 9 hours, which can leave a person groggy the next day, and may not be that effective in providing a restful sleep.

Side effects could include dry mouth and urinary retention. There is a potential for drug-to-drug interaction with other medications you are taking.

Please always check with your healthcare provider if you are unable to sleep. You may have an actual cause of this that needs to be diagnosed. Also, always tell your healthcare provider if you are taking over-the-counter medications or herbal medications for whatever reason. —Marilyn Darr, MD

Will sleeping pills get you into REM sleep?   The total amount and composition of sleep change throughout life. With aging, the total amount of sleep shortens: Delta sleep (stages 3 and 4), the deepest and most refreshing kind of sleep, diminishes with age. Early stage 1, the lightest sleep, increases with age. There is little decline in REM sleep throughout a person's lifetime. I will ask our pharmacist about sleeping pills. —Marilyn Darr, MD
How many times a night should I be awakened with hot flashes?   

Whatever you are experiencing for hot flashes and awakenings is normal for you. Every woman experiences menopausal symptoms differently. If your sleep is disturbed by the hot flashes, estrogen therapy can help if you have no contraindications to it. Please check with your healthcare provider. Sleep is very important to your overall health and well-being. —Marilyn Darr, MD


Vaginal Lichen Sclerosis
Is vaginal lichen sclerosis common in menopause? How do you return to sexual activity after this diagnosis?  

Lichen sclerosis is an uncommon condition but does affect women after menopause. Most often it affects skin of the vulva. Symptoms include itching, tenderness or in severe cases blistering or ulcers and painful intercourse may occur.

Lichen sclerosis appears as white patches around the labia area and anus. The cause is unknown. It is not contagious and cannot be spread by intercourse. Definitive diagnosis is made by a skin biopsy.

If you are diagnosed with lichen sclerosis, it is important to have followup with your provider on a yearly basis. Complications include narrowing of the vaginal opening which can affect intercourse. Women with lichen sclerosis are at an increased risk of developing squamous cell cancer of the vulva. —Marilyn Darr, MD

Are there treatments other than steroids?   Treatment that has the most evidence behind it is superpotent corticosteroids such as clobetasol ointment daily (and sparingly) at night for 6-12 weeks and then 1 to 3 times per week for maintenance. Again, it is important to follow up on a regular basis with your healthcare provider to monitor this condition. —Marilyn Darr, MD