A Woman's Guide to Menopause and Perimenopause

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WebMD Live Events Transcript

If you have questions about menopause or perimenopause, you've come to the right place. Mary Jane Minkin, MD, joined us from the Yale University School of Medicine on April 6, 2005 to answer your questions about hot flashes, HRT, depression, sexuality, healthy lifestyle choices, and more.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live. Our guest today is Mary Jane Minkin, MD, co-author of A Woman's Guide to Menopause and Perimenopause. She is here to answer your questions about menopause and perimenopause.

Welcome to WebMD Live, Dr. Minkin. After all of the discussion about hormone replacement therapy (HRT), I'm surprised to see ads for it again on TV. Can you bring us up to date on HRT?

MINKIN:
One reason we're seeing more information is the fact that part two of the women's health initiative (WHI) came out about a year ago, and that was for women who had had a hysterectomy and who were being given estrogen alone, no progestins.

That study showed actually a reduction in breast cancer in the women taking estrogen. This caused people to rethink the first part of the initiative as well, and a new set of guidelines came out this past fall from the North American Menopause Society (NAMS).

The web site of NAMS is menopause.org, where you can read that the guidelines have changed and indeed, the experts are now stating that if you need estrogen for relief of symptoms, it is quite reasonable to take it, under a health care provider's supervision.

The symptoms they particularly single out are:

• Hot flashes
• Sleep
• Sexuality

Of course there were problems with the WHI design originally, because it was not designed as a study of younger women going through menopause. It was really seeing if estrogen given to older women helps prevent heart disease.

Indeed, in that study, it did not, but for starters, the average age of women starting the WHI was 63. And of course they also only looked at one preparation of estrogen and progestin, namely Prempro. You should, of course, speak with your health care provider if you have any symptoms of menopause.

MODERATOR:
Can you define menopause?

MINKIN:
Technically it's what I call a retrospective diagnosis, because you have to go a full year without a period to officially say you're in menopause. Until that time, you are technically in perimenopause.

Now, women can start getting menopausal symptoms way before they hit their last menstrual period and they can get symptoms for five or sometimes even eight years before they hit true menopause.

These symptoms can include:

• Hot flashes
• Night sweats
• Insomnia
• Irritability
• Vaginal dryness
• Bladder symptoms

All of those can happen way before you hit the final period and go that full year.

MEMBER QUESTION:
I am 45 and still having my period, but I am very irritated at times. Sometimes I am the most irritated with the people I love. Is this normal? Also, almost every night I wake up sweating. Are these all signs of menopause?

MINKIN:
The answer is quite possibly, and the problem is it's impossible to say for sure, because there is no true blood test of perimenopause. However, one thing that one could easily try is either a little estrogen or, and this may sound crazy -- low-dose birth control pills.

If all the symptoms resolve, I would think that these were related to perimenopause. Now of course, some of these symptoms can also be related to PMS, which can occur years before menopause. Again, sometimes birth control pills will help.