Questions and answers with Dr. Michael Goodman

1. How do I know if I am (peri-) menopausal?
“Menopause” is the time of a woman’s final menstrual period. Of course, the only way to know if it is your “final” is to see if any more follow. By definition, 12 months without menses, in the presence of other “menopausal symptoms” equals menopause.

Perimenopause is that time around or just before the final menses. It is frequently punctuated by symptoms including but not necessarily limited to: Hot flashes/night sweats, poor sleep quality, mood and memory dysfunction, vaginal dryness, heart palpitations, joint stiffness, “crawly skin,” depression, etc.

Menopause is a normal, functional passage of life. There are many lifestyle, nutritional, botanical, herbal and pharmaceutical ways to ease the passage.

2. Is there something “natural” that I can do?
Nowadays, “natural” is little more than an advertising gimmick, designed to “reel you in” to buying some probably untested nutritional supplement of uncertain medicinal or therapeutic benefit.

By definition, “natural” means “native to plant or animal.” By this definition, Premarin, derived from pregnant mare’s urine, is “natural.” Know what you are taking (and whether it interacts with other supplements and pharmaceuticals you are ingesting).

That said, there are several things to try. Pick and choose with the aid of your healthcare practitioner:

* Bioidentical hormones, such as estriol, estradiol, progesterone, testosterone, DHEA. These are all synthesized from a plant source (soy or wild yam) to exactly mimic the molecule found in the body.
* Lifestyle changes are certainly natural! Try improving diet (increasing fresh fruits/veggies; decreasing meat, fats, convenience foods) and exercise!
* Vitamins, herbs, botanicals, which include but are not limited to soy isoflavones, black cohosh, chased berry, vitamin E, calcium, etc.

3. My sex drive is in the toilet. What can I do?
All sorts of things conspire to diminish libido in (peri-) menopausal women. It is hard to feel sexy if you are hot-flashing all over the place. Or if your vagina is dry and lovemaking is painful. Been married a long time? A few teenagers always in and out of the house? And what about your testosterone? Well before your estrogen levels fluctuate and then take a giant plunge, testosterone slowly but steadily declines, with frequent effects on energy, sex drive, perseverance, etc.

So, what can you do? Get your menopausal symptoms under control. Get to sleeping better. Work with your mate and perhaps a therapist on ways to rekindle you and your mate’s sexual connection, and definitely work with your healthcare practitioner to check on and improve your testosterone levels with transdermal or oral therapy.

4. I am miserable with hot flashes, moodiness and very poor sleep. What can I do?
Many books have been written to answer this. Here is an outline:
* Estrogens, either synthesized (ethinyl estradiol; conjugated estrogens; etc.) or a bioidentical (estriol; estradiol) can be delivered either orally or (better!) transdermally via patches, creams and lotions or (more rarely) via injection. Bioidentical progesterone, delivered via cream, lotion or capsules, can help with these symptoms. Bioidentical testosterone, usually given either as a transdermal gel or lotion eorks wonderfully along with estrogen to mitigate symptoms.

* Vitamins, supplements, and plant-sourced botanicals. Both those with “estrogen-like effects” (phytoestrogens) and those which are used for their helpful calming and psychological effects.
— Soy and other legume-derived isoflavones help some women’s hot flashes, especially when combined with other measures listed below.
— Black cohosh, chased berry (Vitex) and evening primrose oil have all been of help to some women.
— Mega-dose B vitamins and high-dose (800-1200 mg) vitamin E can help with hot flashes.

* Non-hormonal pharmaceuticals.
— Hot flashes: The anti-depressant Effexor and the anti-seizure/anti-depressant medication gabepentin, are quite effective in relieving nighttime flashes (daytime too, to some extent).
— Moodiness/depression/anxiety: Xanax and Ativan, in low doses, is great for anxiety/”panic”. (Both can aid in sleep also). Mood stabilizers/anti-depressants such as Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Wellbutrin, etc. may be quite helpful.
— Insomnia. Sonata lasts +/- four hours and is good for women with difficulty getting to sleep or middle-night awakening. Ambien lasts 6-7 hours. 5-hydroxytryptophan also works here. These medications are best used short-term until the problems causing the insomnia are brought under control.

* Lifestyle changes: Avoid “triggers.” Most women suffering from hot flashes are aware of situations such as heat, caffeine, spicy foods, stress, etc., that trigger their flashes.
— Exercise! Probably the single most important thing increasing quality of life in midlife women is exercise. A total of 30-40 minutes of strenuous “sweaty” exercise will go a long way towards clearing your mind, uplifting your mood and chasing away hot flashes. (As it releases endorphins, which increase the serotonin in your brain, exercise has appropriately been called “nature’s Prozac.”)
— Stress reduction: Peri-menopausal symptoms themselves are stressful. Stress reduction help such as meditation, paced respiration and muscle group tension/relaxation techniques are imperative, especially at bedtime.

—For many more FAQs and answers to your menopause and sexual health questions, go to www.DrMichaelGoodman.com

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