Women's Health and Menopause

Marcia Jones was online to discuss your questions about women's health and the various stages of menopause and how it can affect your body, your emotions, and your libido.

A transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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washingtonpost.com: We would like to welcome Marcia Jones, PhD to our discussion today on menopause and women's health. Dr. Jones.

Marcia Jones and Theresa Eichenwald M.D.: Thanks for having us. This is a big issue for a lot of the "baby boomer" generation

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Warrenton, Va.: Is there any prescription medication, other than high doses of a simple pain reliever such Ibuprofen, that one can take for very painful menstrual cramps (i.e., dysmenorrheal)? What percentage of women have these severe cramps, both before and during menopause? Thank you.

Marcia Jones and Theresa Eichenwald:Actually during menopause you shouldn't be having cramps. If you are not having periods you shouldn't be having the cramps. You should actually check this out with your Ob-gyn. Ibuprofen is great for menstrual cramps. It doesn't even need to be high doses.

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Fairfax, Va.: My mother (56) is having a terrible time with menopause right now. She has horrendous night sweats. However, if the night sweats do not come (which seems to vary hormonally) her blood pressure skyrockets to 160-180/100+. She is on many different medications for her blood pressure and on phosamax for bone degeneration, but refuses to go on hormone replacement therapy because she has three female cousins who after going on the therapy developed breast cancer, one of whom just passed away this weekend. My mother and I are both only daughters so we have no other history to look at but her cousins. I guess my question is since I am her only daughter - is this what I have to look forward to in about 20 years? (I'm 33 now)

Marcia Jones and Theresa Eichenwald:The high blood pressure may be unrelated to the menopausal symptoms your mom is having. You should be sure that your Dr. gets that under control. The fosamax will help keep her bones from becoming fragile. The two things we worry about in menopausal women is heart and bones because estrogen plays such a large role in maintaining a healthy heart and cardio system and healthy bones. If you can control these issues without HRT, all the better. It sounds like you are on the right path with avoiding the HRT using alternatives. Adding some fitness to her schedule (simple walking) and eating right can help keep her cardio system healthy

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washingtonpost.com: One menopause book is for dummies, one is for idiots and another written by...a man! Which one is best for you? Read Words to the Wise.

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Mini hot flashes: After speaking with my doctor several years ago, I discontinued Prempro due to adverse publicity. However, I now have mini hot flashes, which are very annoying: face and neck feel hot, and I'm taking my sweater off and on many times a day.
I've been taking black cohash about a month now but it has not helped. Any suggestions? Thanks.

Marcia Jones and Theresa Eichenwald:Many women choose to use herbal therapies such as primrose oil and soy products. The problem is we don't know dosage, we don't know side effects. There's not too much research. It's worth weighing the pro's and con's of the alternatives. Sometimes the risk is worth the benefit of HRT. The other types of medical issues in your family should also guide your decision.

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Pittsburgh, Pa.: I am 45 years old. In 2002, I had my right ovary and tube removed due to endometriosis, and since then, my libido has gone in the toilet!; A few months after the surgery, I took myself off birth control pills, and immediately starting having menopausal symptoms, the worst of which was hot flashes and night sweats. When I was evaluated by my doctor, he said that while I was not in menopause, I was most likely in per menopause, and suggested that I go back on the pill. I did, and the symptoms went away, except for night sweats during the week that I have my period. So, I would like to accomplish the following:

Get my libido back.
Stop taking the pill.

What to do???

Marcia Jones and Theresa Eichenwald:You're probably not concerned with pregnancy at this point, right? Sometimes the hormone creams work to restore libido.... they're great because they stop symptoms and help with the libido. Keeping fit with exercise and right eating always helps libido. Some people have used testosterone, but it's pretty scary. Cholesterol can go off the chart, blood pressure.. then there's the facial hair, which really isn't too sexy. Weigh the pros and cons of the HRT considering your other health issues and those of your family.

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Fairfax, Va.: Menopause terrifies me. I was writing this huge essay to submit as a question, but here's the bottom line. Can sex be satisfying to you and your partner even after menopause? It may seem like a dumb question but it's important to me. I always thought HRT would be a choice as I got older, but now that I'm here, it's no longer an option. Thanks for covering this topic. I think a lot of women suffer silently.

Marcia Jones and Theresa Eichenwald:Well, you may be interested to know that even though menopausal women do not engage in sex as frequently as they used to, their satisfaction level is as great after menopause... you'll continue to experience orgasms. If your partner is a woman then everything we talked about low dose hormone cream, exercise, eating right, herbal therapies may be helpful. If your partner is male there are many medications that work well.. you've seen the ads on the TV during football games.

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San Antonio, Tex.: Is there any mention in your book about women who go through menopause symptomless? Certainly, not all women go through menopause in the same way, at the same time, or in the same manner or degree. I have never had migraines, night sweats, or hot flashes--just a simple cessation of menses. It puzzles me to talk to other women who experience these physical--and sometimes troubling--manifestations of menopause and all the things they ingest to counteract them.

Of course, I have a very rare genetic disorder of the endocrine system-FHH. Again, does your book address those with none of these typical menopause physical complaints, or better yet, the underlying cause of why a small percentage of women like me go through this "change of life" relatively unbothered or unperturbed?

Marcia Jones and Theresa Eichenwald:Like you, I'm lucky not to have had a lot of adverse symptoms. Also, I never had PMS or big problems with my periods... everyone is different. However, there may be a second wave during your 70's. It's not often, but Dr. E has seen it in her practice.

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Columbia Md.: I have zero libido. I mean ZERO libido. Should I be
concerned? Not in a relationship, so really, it's kind
of a good thing but I get a nagging feeling
something ain't right. 48 years old, showing some
symptoms.

Marcia Jones and Theresa Eichenwald:Libido is more than just body chemistry (at least after 18 years of age). It has to do with things around you, the nice dinner conversations, the meal, the wine / apple juice, the twinkle in the eye. So if you're not seeing someone, there may not be anything wrong with you. Stop worrying and go meet some people.

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Durham N.C.: Please talk about maintaining a healthy, active sex life: libido and lubrication.

(I remember how but I have forgotten why.)

Marcia Jones and Theresa Eichenwald:Well, if you've been reading some of the other responses you've seen that maintaining a healthy libido includes keeping your body fit and healthy, surrounding your self with someone you love. On a practical level, you may need hormone creams that contain low level hormones, vaginal moisturizers, and vaginal lubricants. You want to distinguish between the moisturizer and the lubricant. Moisturizers are used throughout the week and not necessarily during intercourse, lubricants are used during intercourse.

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Washington D.C.: What are the effective treatments for irregular bleeding?

Marcia Jones and Theresa Eichenwald:there are many reasons for this. This is one of those you really need to take to your gynecologist.

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Lincoln, Neb.: My sister-in-law died of ovarian cancer at age 48 in 2000. She went through menopause at age 38. Is there any connection between early menopause and ovarian cancer? Thank you.

Marcia Jones and Theresa Eichenwald:I'm sorry about your sister-in-law. There is no connection between ovarian cancer and early menopause that we know of.

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Great Falls, Va.: I have had diabetes for 43 years, and I am 46 years old. According to my doctor I have been going through menopause for the last 4 or 5 years. He says estrogen replacement is too risky for diabetics due to the risk of a heart disease in diabetics. My question is: What can A diabetic do for estrogene replacement without risking their health?

Marcia Jones and Theresa Eichenwald:You're right it is too risky. Are you having some specific symptoms. The alternatives to HRT are quite specific to the problems you're facing. Of course the biggest issues are keeping your heart, veins, and bones healthy after menopause.

These are big health issues for women. We really haven't talked much about these issues in this chat, but these are the real areas where women may experience major health issues.

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Potsdam, N.Y.: Is there an over-the-counter test now to determine if you are per menopausal and how accurate is it?

Marcia Jones and Theresa Eichenwald:I'm not aware of any over the counter test because the estuarial (active estrogen) is measured through the blood. So you would have to go to a medical lab. You can tell if you're perimenopausal in general, if your periods become irregular, if you experience some of the common symptoms such as mental fog, flashes, etc.

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Washington D.C.: My transition into menopause has been very easy. I've been extremely fortunate to not have night sweats, hot flashes, mood swings, just a cessation of my period. I do have have the little aching from time to time in my left ovary as if I'm ovulating.

Marcia Jones and Theresa Eichenwald:Good for you. This should encourage women who are dreading menopause. It's really just natures way of letting women go into reproductive retirement. Periods are way over-rated :)

Marcia Jones and Theresa Eichenwald:By the way, that little ache is probably not from ovulating since ovulation generally ceases after menopause.

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Ann Arbor, Mich.: Thank you for taking our questions!; My best friend is 47 and has significant fibroids. She doesn't want a hysterectomy, but now she's developed migraines as what appears to be a PMS effect. Could it all be related? Could it be a symptom of the hormone fluctuation of perimenopause?

Marcia Jones and Theresa Eichenwald:Many women describe their menopause symptoms as PMS-like.
If she experienced severe headaches during the first few days of her period, then she may have more during per menopause. Headaches during the first days of your period mean you're sensitive to low levels of estrogen... typical at that time of your cycle and during menopause.

Nearly one-third of women have fibroids by the time they are 50. They tend to get bigger as you approach menopause but stay the same size after menopause. If they are causing pain or bleeding be sure to keep an eye on them with her doctor. The short answer is yes they could be related.

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Crofton, Md.: I am 45 and began having thyroid problems (cysts) about 2 years ago. I also began having some of the symptoms of per menopause. Are thyroid problems common at this time of life?

Marcia Jones and Theresa Eichenwald:thyroid problems and menopause symptoms can be quite similar. As you probably know, thyroid screening can help detect thyroid problems.

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Washington D.C.: Weight Gain and Menopause!; I have been reading various recommendations on ways to limit or avoid weight gain during menopause and one of the recommendations is for a diet lower in "bad" carbs but increased protein and healthy fats. Do you have any recommendations for healthy eating plans that work with menopausal metabolisms?

Marcia Jones and Theresa Eichenwald:Yes, we recommend a balanced diet. The most important part is to have 5 to 9 servings of fruits and vegetables each day.

The biggest issue really is that during and after menopause, your body fat gets redistributed. As one comedian put it, everything starts moving to the middle. This can make you think you've gained weight when really it's just moved in from another neighborhood. Hormones even control how we're shaped.

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Washington D.C.: WHAT AGE DOES MENOPAUSE STARTS? I THINK I HAVE NITE SWEATS AND HOT FLASHES WHEN IT IS TIME FOR MY CYCLE. HAVING YOUR TUBES TIED AT 25 YEARS OF AGE, AND NOW 38, CAN I BE IN THE PRE STAGE OF MENOPAUSE ?

Marcia Jones and Theresa Eichenwald:Most women start menopause between the ages of 35 and 50. Menopause simply means the end of periods. Perimenopause that period when you're still having periods but your hormones are changing, can start as much as 10 years before menopause! Perimenopause is the period in which you'll experience the symptoms even though you're having periods.

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Cleveland, Ohio: Do certain medications (e.g. statins) affect menopause symptoms (especially hot flashes)?

Marcia Jones and Theresa Eichenwald:Statins do not affect your symptoms

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washingtonpost.com: Unfortunately, that is all the time we have for today. We would like to thank Marcia Jones PhD and Thresa Eichenwald, M.D. for joining us today for our chat on menopause and women's health.

Marcia Jones and Theresa Eichenwald:Thanks for the opportunity. We've enjoyed it and hope we helped some folks out there. Sorry if we didn't get to your question.

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