Menopause Care with Dr. Rajita Patil

Perimenopause, also called the menopause transition, is a period prior to menopause where a person may experience irregular or skipped periods. This can last from 2-10 years. During this time, people experience hormone changes that can cause symptoms like hot flashes, sleep and mood disturbance. 

Early menopause is defined by menopause occurring between the ages of 40 and 45. However, certain health conditions, surgeries, or medications may induce menopause even earlier in some people. It is important to discuss this timing with your provider because earlier menopause is linked to a higher risk for chronic medical conditions like osteoporosis and cardiovascular disease. Hormone replacement therapy may be strongly recommended to help decreased these risks, as well as address earlier and more severe menopausal symptoms. 

Everyone experiences menopause differently, but common symptoms include hot flashes, vaginal dryness, mood and sleep disturbance. Other symptoms may include changes in cognition and sexual health. The length of time and the severity of the symptoms varies for each person. Some factors that can impact a person’s experience in menopause include race and ethnicity, general health status, social and economic status, and age. For example, studies have shown that Black and Hispanic people may have a longer duration and more severe symptoms compared to Whites and Asians. 

A hot flash is a sudden and intense sensation of heat in your face, neck and chest, and may be accompanied by sweating, reddening of the skin, chills, and a rapid heartbeat. They can cause panic or anxiety for some people. Night sweats are hot flashes that happen while you are sleeping and can affect the quality of your sleep. Hot flashes or vasomotor symptoms (VMS) are experienced by 80% of those going through menopause. Over 50% of people with VMS in the US remain untreated. For some, symptoms may be transitory but for others, hot flashes can last over 10 years and well beyond the perimenopause and early menopause period.  

There is evidence that hot flashes, especially if severe and frequent, are linked to an increased risk of cardiovascular disease and other chronic diseases like osteoporosis.  For this reason, it is important to talk with your menopause provider to address your symptoms. 

The earlier the better! We recommend talking with your doctor when you start to have symptoms or irregular and/or skipped periods. This commonly occurs in a person’s late 40s but can occur as early as 40 and as late as 55. There are large fluctuations of hormones during perimenopause and early menopause which include a drop in estrogen level that can impact all the major organs in your body short and long-term.  For this reason, it is important to seek attention to not only address the burdensome symptoms of perimenopause, but also to use this as an opportunity to address your long-term health so you can ensure living your best life moving forward. 

Yes, The Menopause Society has a list of certified providers. In 2002, The menopause society recognized a need to set essential standards for health providers, thereby assuring high-quality evidence-based care for people going through menopause. To meet this need, The Menopause Society developed a competency examination. Those who pass have demonstrated their expertise in the field and are awarded the credential of MSCP or the Menopause Society Certified Practitioner. At the UCLA Comprehensive Menopause Program, all the core menopause providers are certified.  

Every insurance company is different, but most will typically cover labs that your provider deems necessary to fully evaluate your health. 

Sleep and menopause are closely related to each other.  The physiological and hormonal changes which occur during menopause have a significant impact on sleep and can lead to insomnia.  Sleep symptoms commonly seen in menopause include difficulty falling asleep, frequent nighttime awakenings, early morning awakenings and difficulty falling back asleep after an awakening.  Hot flashes can occur at night, contributing to this sleep disturbance. There is also an increased risk for primary sleep disorders such as obstructive sleep apnea and restless leg syndrome during the menopause transition. There is evidence that poor sleep over time leads to increased risk of developing chronic medical conditions like obesity, diabetes, and cardiovascular diseases. It is therefore essential for you to prioritize healthy sleep habits and seek medical guidance if sleep disturbances persist. 

Perimenopause is a high-risk time for new, recurrence, or worsening of mood disorders due to hormonal changes and increased psychosocial stress levels at this time in a person’s life. Also, people are at greater risk for mood and anxiety problems if they are experiencing problematic vasomotor symptoms (hot flashes) or insomnia. Menopausal distress disproportionately affects BIPOC and low-income people and they are less likely to seek out help for mental health problems due to barriers at the community, provider, and systems levels.  Seeking out a menopause provider is crucial in treating mood, anxiety, and general menopausal distress as well as hot flashes and sleep disturbance, to improve your quality of life and long-term health in menopause.  

Bone loss occurs most rapidly during the menopause transition.  Decreased estrogen production during the menopause transition leads to a rapid rise in bone breakdown and rapid bone loss. This decline usually starts in your 40s but accelerates in the few years leading up to menopause and lasts up to 10 years afterwards. One in two people going through menopause will suffer an osteoporosis-related fracture in their lifetime.  This means that 50% of will break their hip, spine, wrist, or other bone with a simple fall or twist because of weakened bone.     

For this reason, it is important to ensure you are getting at least 1000mg of calcium (dietary and/or supplementation) and 400 international units (IU) of vitamin D daily, along with regular weight-bearing exercise and avoidance of smoking and excessive alcohol consumption to maximize your bone health. 

Several different treatments exist including hormone therapy, non-hormone therapy, cognitive behavioral therapy, menopause group therapy, lifestyle changes, mind-body relaxation, and pelvic floor physical therapy.  It is important for your menopause provider to understand your health and experience during menopause, and then work with you to develop an individualized treatment plan. 

MHT is best used to treat hot flashes and prevent osteoporosis. There can be other benefits of using MHT including improvement in mood and sleep. It is best to talk with your provider about whether you are a good candidate for starting this treatment as every person comes into menopause with different symptoms, genetics, health status, and lifestyle behaviors. The risks and benefits for use should be individualized so you can make an informed decision on whether this treatment is right for you. 

It is typically recommended that a person take progesterone and estrogen for systemic menopause hormone therapy to alleviate hot flashes. Estrogen is the hormone that helps alleviate the menopausal symptoms. Progesterone is recommended to prevent overgrowth in the uterus while using estrogen therapy. For those without a uterus, estrogen is the only hormone needed. 

Vaginal estrogen therapy is the primary treatment for vaginal atrophy related symptoms like vaginal dryness, recurrent UTI, pain with sexual intercourse. This is NOT the same as systemic menopause hormone therapy and does not carry the same risks. Most of the medication is delivered locally in the vagina with minimal systemic absorption. Systemic hormone therapy is used for treatment of hot flashes. Hormone therapy may help with vaginal dryness, but many will need both vaginal and systemic estrogen.