Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There has been increasing interest in recent years in
the use of so-called "bioidentical" hormone therapy for perimenopausal women.
Bioidentical hormone preparations are medications that contain hormones that
have the same chemical formula as those made naturally in the body. The hormones
are created in a laboratory by altering compounds derived from
naturally-occurring plant products. Some of these so-called bioidentical hormone
preparations are U.S. FDA-approved and manufactured by drug companies, while
others are made at special pharmacies called compounding pharmacies, which make
the preparations on a case-by-case basis for each patient. These individual
preparations are not regulated by the FDA, because compounded products are not standardized.
Advocates of bioidentical hormone therapy argue that the products, applied as
creams or gels, are absorbed into the body in their active form without the need
for "first pass" metabolism in the liver, and that their use may avoid
potentially dangerous side effects of synthetic hormones used in conventional
hormone therapy. However, studies to establish the long-term safety and
effectiveness of these products have not been carried out.
Other drug treatments
The selective serotonin reuptake inhibitor (SSRI) medications have been shown be effective in
reducing menopausal hot flashes. These drugs are generally used in the treatment
of depression and
anxiety as well as other conditions The SSRI
that has been tested most extensively in the treatment of hot flashes is
venlafaxine (Effexor), although other SSRI drugs may be effective as well.
Clonidine (Catapres) is an anti-hypertensive drug that
can relieve hot flashes in some women. Clonidine is taken either by pill or skin
patch and decreases blood pressure. Side effects of clonidine can include
dry
mouth, constipation, drowsiness, or difficulty sleeping.
Gabapentin (Neurontin), a drug primarily used for the treatment of
seizures,
has also been effective in treating hot flashes.
Megestrol acetate (Megace) is a progestin that is sometimes prescribed over a
short-term to help relieve hot flashes, but this drug is not usually recommended
as a first-line treatment for hot flashes. Serious side effects can occur if the
medication is abruptly discontinued. Megestrol may have the side effect of
weight gain.
Medroxyprogesterone acetate (Depo-Provera) is another progestin
drug and is administered by injection to treat hot flashes. It may lead to
weight gain as well as bone loss.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Hot flashes are experienced by many women, however, not all women undergoing menopause experience hot flashes. A hot flash is a feeling of warmth that spreads over the body. Treatment for hot flashes include hormone replacement therapy and alternative prescription medications such as SSRIs (Effexor, Paxil, Prozac), clonidine (Catapres), megestrol (Megace), and gabapentin (Neurontin). Few alternative treatments for hot flashes (for example phytoestrogens - isoflavones, black cohosh, and vitamin E have been scientifically studied.
A carcinoid tumor is a tumor that develops from enterochromaffin cells. The important characteristic of carcinoid tumors that sets them apart from other gastrointestinal tract tumors, is their potential to cause the carcinoid syndrome. Local symptoms may include abdominal pain, intestinal bleeding, and intestinal obstruction. However, often symptoms of the carcinoid syndrome can be more devastating than the local symptoms. There are many options for the treatment of carcinoid tumors and carcinoid syndrome.
Male menopause refers to the decline in testosterone production in men. As men age, they often experience many of the same symptoms that women experience in menopause. Testosterone replacement therapy may relieve some of these symptoms.
Stress may be considered as any physical, chemical, or emotional factor that causes bodily or mental unrest and that may be a factor in disease causation. An important goal for those under stress is the management of stress in our lives. Elimination of stress is unrealistic, since stress is a part of normal life. We can however, learn to manage stress through techniques such as exercise, relaxation, meditation, time management, and support systems so that we have control over our stress and its effects on our physical and mental health.
Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.
Premature menopause is when a woman goes through menopause before the age of 40 because of genetics, illness, or a medical procedure. Symptoms of premature menopause include irregular or missed periods, mood swings, hot flashes, periods that are heavier or lighter than usual, vaginal dryness, bladder irritability, incontinence, dry skin, eyes or mouth, sleeplessness, and decreased sex drive. Though premature menopause cannot be reversed, the symptoms can be managed with methods similar to those used for natural menopause.
Premature ovarian failure (POS) is the cessation of normal functioning of the ovaries in women under the age of 40. Premature ovarian failure may be caused by follicle depletion or dysfunction. The most common symptom of premature ovarian failure are irregular periods. There is no "treatment" that will restore the ovarian function, but there are treatments that my relieve symptoms.
Surgical menopause happens when a premenopausal woman has her ovaries removed in a surgical procedure called a bilateral oophorectomy. An abrupt menopause follows, with women often experiencing more severe menopausal symptoms than if they were to go through natural menopause. Chemotherapy and pelvic radiation therapy may also cause menopause by damaging the ovaries.
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