Taking Charge of Menopause with Lynne Steinman, M.D. and Robert Dosh, M.D.

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

The co-authors of The Taking Charge of Menopause Workbook, Dr Lynne Steinman and Dr Robert Dosh will be joined by Dr Ceceila Hann for a discussion about menopause.

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 the Women's Health Place on WebMD Live. Our guest speakers joining us this evening are Lynne Steinman, PhD, and Robert Dosh, Ph.D., co-authors of The Taking Charge of Menopause Workbook, and obstetrician/gynecologist Cecelia Hann, MD.

Lynne A Steinman, Ph.D., is a licensed clinical psychologist in private practice, specializing in stress management and anxiety, mood disorders, chronic illness and fibromyalgia, women's issues (including menopause ), dementia, and caregiving. She is on the board of directors of Psychological Success Associates, Inc.

Robert M. Dosh, Ph.D., is licensed both as a psychologist and a marriage, family, and child counselor. He is in private practice specializing in the assessment and treatment of attention deficit hyperactive disorder in adults and children and Tourette's syndrome disorder. Dr. Dosh is on the board of directors of Psychological Success Associates, Inc., based in Santa Clarita, California.

Cecelia M. Hann, MD, is a board-certified, licensed obstetrician/gynecologist and member of the executive committee at the Henry Mayo Newhall Memorial Hospital in Santa Clarita, California. 

Dr. Steinman and Dr. Dosh, could you begin by giving our members some background...what prompted you to write the Taking Charge of Menopause Workbook?

Dr. Steinman: We realized that the baby boomer generation has redefined every biological, social , and psychological transition they've encountered, from sexuality to career to childrearing. Traditionally, we knew that menopause was associated with many negative expectations and perceptions. We also knew that as the baby boomers approached menopause, they would want to become empowered so they could play an active role in taking charge of this transition. As a result, we developed the idea of a workbook that would give them the info they needed to make informed decisions throughout the process.

Moderator: Short Term Effects: One of the short-term effects of Menopause is heavy bleeding. Do you have any suggestions for things that can lesson this effect?

Dr. Hann: The heavy bleeding can be caused by various reasons. Finding the reason is probably more important in treatment. If it's a physical problem, like having a fibroid tumor, it generally does not respond to hormonal therapies. However, if it is caused by a hormonal imbalance, progesterone therapies work really well. Medications such as Naprosyn, in high doses, may work well to curb the bleeding. Watching for anemia is really important in this age group. As always, check any suggestions with your doctor before pursuing them.

Moderator: Are there any factors that can help one manage hot flashes?

Dr. Hann: There are herbal remedies, such as soy and black cohosh. Taken regularly, these may help with hot flashes. Getting rid of caffeine, alcohol also helps. Low dose estrogen also works really well. The emphasis is on "low."

Moderator: What are hot flashes?

Dr. Hann: Hot flashes are the warm feelings that come over your body when estrogen levels drop. It's noted around menopause, and can be induced by stress. It's hard to miss it when you have one!

plath11976_WebMD: Are there any herbal remedies that have same the effect as estrogen?

Dr. Hann: If you mean "natural" estrogens, derived from plants, the answer is "yes." There are estrogen products from soy plants, as well as Mexican yams. These products are widely available in non-pharmaceutical grades at health food stores.

LadyByrd_WebMD: If you have heavy bleeding with clots, could this possibly mean menopause is not far off?

Dr. Hann: Heavy bleeding with clots is really not related to menopause, itself. With menopause, bleeding actually tapers off. Periods become fewer, in amount and duration. Anything outside of that requires evaluation to determine the cause.

Moderator: What suggestions do you have for women struggling with memory loss?

Dr. Steinman: First of all, if you feel your memory loss is abnormal, it is important to have it evaluated. That way, you can determine whether there is any medical process that is abnormal or requires treatment. If nothing out of the ordinary is found, the most important first step is to relax! Certain changes in memory are normal with age, and most are not related to Alzheimer's disease. The more anxiety we experience with regard to forgetfulness, the more interference we create for our memory! There are also some tips to help optimize your memory. For example, use input from a variety of sources to reinforce learning. Read the info to be remembered, write it down, and repeat it out loud. Another tip involves reviewing new info immediately, since research suggests that most forgetting occurs in the first few minutes. So, the next time you are introduced to someone, use their name in your next sentence. Estrogen may help memory, and may help in the slowing of the onset of Alzheimer's disease.

plath11976_WebMD: Is it safe to take estrogen after having a hysterectomy (ovaries still intact)? That is along with having endo.

Dr. Hann: After hysterectomy for endometriosis, one has to be careful in using estrogen. It can bring the endometriosis back, because the ovaries can harbor it.

LadyByrd_WebMD: Do changes in hormones cause blemishes again like when we were teenagers?

Dr. Hann: Skin changes during menopause is very common, including dry skin, blemishes, more moles, uneven skin tone, are more common. Also, malignant and non-malignant skin conditions can be more common.

Flooz_WebMD: What about all the talk about soy products included in daily supplements?

Dr. Hann: Soy products can work in reducing hot flashes. It may be a placebo effect, or a perception. It may also promote a feeling of well-being. We don't have any scientific data to prove these effects at this time.

Moderator: Lifestyle: Many of us are all too familiar with the physical effects of menopause. What lifestyle changes can have a positive impact on one emotionally during menopausal years?

Dr. Steinman: If there were just one change to suggest, I would have to say it would be exercise. I doubt there is much I can say that people don't know about its beneficial effects. Some of the chemical changes that occur with exercise affect brain chemistry in ways that help improve mood and stress tolerance. Exercise can also enrich your sex life and, of course, can help with heart and bone health. Make sure you get the "OK" from your health care providers prior to starting a program. Also, make sure to make it realistic, convenient, and enjoyable.

Dr. Hann: Other lifestyle changes are diet changes - low carbs, low fat, high protein (in moderation), smaller portions, less caffeine, less alcohol and, of course, no cigarettes!

Flooz_WebMD: At age 47, I still don't know what symptoms to look for to know if I am going through menopause. I feel normal up to this point. Still taking the pill.

Dr. Hann: Even if you're on the pill, when you start menopause, there will be some changes. First, you might notice hot flashes. Insomnia, vaginal dryness, mood swings. Of course, you may start late, and/or may have minimal changes that you will notice. Very lucky, if that's the case!

Moderator: Sex: Let's talk now about sex after menopause... In The Menopause Workbook, you have a page titled: A Prescription for a Good Sex Life. Could you tell us about this?

Dr. Dosh: During menopause, there are changes that will occur in sex life. It's not something to fear. However, it does require communication between partners and some adjustments in your lovemaking. You will perhaps need to take into consideration vaginal dryness, change in sexual desire (either more or less) More frequent sexual activity may help optimize lubrication ability. The old saying, "Use it or lose it" applies here.

Dr. Hann: There are testosterone creams and testosterone tablets available on the market, by prescription. DHEA in low doses also can help. FOREPLAY IS THE KEY!!! AND LOTS OF IMAGINATION AND FUN HELPS!!!

Dr. Steinman: Many people are surprised to learn that some women actually experience an increase in sex drive at this time.

Moderator: Mood: Does menopause cause depression?

Dr. Steinman: It used to be thought that the two went hand in hand. In fact, there was even a term, "Involutional Melancholia" to describe depression at this time in life. However, there is no evidence that menopause causes an increase in "clinical" or "major" depression. It is important to remember that there is a big difference between a depressed mood and the illness of clinical depression. Many women do report an increase in depressed or anxious moods, especially in perimenopause. It is important to remember that some of these symptoms, such as irritability and fatigue, may be caused by sleeplessness from hot flashes. Also, there may be a number of life changes or stressors at this time of life that may be associated with depressed mood, such as relationship changes, or illness in self or others, or $ problems. Some women who are prone to clinical depression may be at higher risk for a recurrence at this time in life, especially if they have had mood disturbances associated with hormonal changes. Do keep in mind, however, that the rates for clinical depression in women are highest between ages 25 and 44.

LadyByrd_WebMD: What would be the earliest age and the latest age to start menopause?

Dr. Hann: The actual menopause, on average starts between age 48 to 52. However, quite a few women go thru menopause before 40. Often, it is very hard on them. They aren't really prepared for such early menopause. Likewise, some women can still be menstruating well into their 50s, even late 50s. That is unusual.

Moderator: What treatments are recommended for depression in menopausal women?

Dr. Steinman: Hormone treatment may be helpful. There are estrogen receptors in the brain, and there is likely a complex relationship between estrogen and the level of certain neurotransmitters associated with mood. For women with depressed and anxious MOODS, I would suggest starting with items such as exercise, relaxation techniques, and increase in pleasurable activities, social support, and perhaps psychotherapy, depending on level of severity. For a true clinical depression, the research suggests a combination of psychotherapy and medication to be the most effective treatment.


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Moderator: We hear so much about stress. What suggestions do you have for really dealing with stress and learning how to manage it?

Dr. Steinman: I think there are 3 important aspects to managing stress. They are based on the idea of changing what you can and learning to better accept what you can't. The 1st is to do what you can to try to change the situation. Even small dents in a problem can have a positive impact. The second is to try to change your reaction to situations so that you're coping as positively as possible. The third is to try to optimize your tolerance and preparedness for stress, e.g., thru exercise, meditation, etc. Humor always helps, too. Find a good joke every day!

Moderator: Mid life can be a very difficult time for couples to communicate. What suggestions do you have for menopausal women?

Dr. Dosh: It's important to talk to your partner about what you're experiencing, about your concerns, and specify what support and help you need from them. It's also important to know that many men know very little about menopause. If your partner is open to it, teach them what you know. It's also important to not misread a man's quietness or lack of response as a lack of caring. Often, if a man doesn't know what to say, or what to do to fix it. they remain quiet.

Moderator: Mid life can be a very difficult time for couples to communicate. What suggestions do you have for partners (men) of women going through menopause?

Dr. Dosh: It's again important for the man to ask his partner as much as he can about what she's experiencing, and what support she needs from him. He should also express any concerns he has about how the menopause may be affecting their lovemaking. Remember to listen.

Moderator: We are almost out of time, in closing would each of you share your final thoughts and suggestions for women so that they can take charge of their menopause?

Dr. Hann: This is really a time of opportunity. for women to improve their lifestyle, look forward to great health if they invest some time in exercise, reasonable diet, calcium, regular checkups and giving themselves permission to enjoy life. That will carry them through.

Dr. Dosh: It's important to remember that men also go through changes at this time and approximately 15% go through male menopause or andropause. For men, this is primarily psychological due to their difficulty adjusting to the changes at this point in their life. There is also help for men available and this may require therapy or hormonal therapies.

Dr. Steinman: Baby boomers are changing the way we do menopause - we can create a new, positive way of looking on it that we can pass onto our daughters. Menopause is actually a time in many cultures when women are revered for their wisdom. I think we should try to incorporate that in ourselves, increasing our self-esteem and self-acceptance.

Moderator: Our time has come to an end. I would like to thank our guest speakers Lynne Steinman, PhD, and Robert Dosh, PhD, co-authors of The Taking Charge of Menopause Workbook, and obstetrician/gynecologist Cecelia Hann, MD. for joining us this evening. It has been a pleasure having you all here. Take care everyone and be healthy.

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