Dearest: My guests tonight are the co-authors of the new book, "100 Questions and Answers About Menopause" -- a book that addresses the "nuts and bolts" regarding menopause.
Ivy M. Alexander, Ph.D., C-ANP, is a nurse practitioner specializing in women's health and a professor of nursing at Yale University School of Nursing Director of the Adult, Family, Gerontological and Women's Health Primary Care Specialty. She is also a practicing clinician in the internal medicine department of the Yale University Health Services. She has practiced as a nurse practitioner in internal medicine with a focus on women's health since 1992. Her primary interest is menopause and midlife health issues.
Karla Knight, RN, MSN, is a nurse and healthcare writer. She has been a nurse for 28 years. Since 1997, she has been a writer for Nursing Spectrum, a national RN-led communications company and division of the Gannett Company, Inc. Her many articles have appeared online as well as in print media.
Their book, "100 Questions and Answers About Menopause" addresses menopause as well as other midlife health risks such as osteoporosis, diabetes, heart disease and breast cancer. While some women sail through menopause, others experience a whole range of symptoms. "100 Questions & Answers About Menopause" offers the help you need to understand menopause symptoms, treatment options, including lifestyle changes, alternative therapies, prescription medications and more. The book discusses difficult issues surrounding the HRT controversy and natural hormones.
A very warm welcome to Power Surge, Ivy and Karla. We're informal here, so I hope it's okay if we address you by your first names.
Karla Knight, RN: That's fine, thank you.
Ivy Alexander, Ph.D.: Definitely - it is a pleasure to be here!
Dearest: Can you explain exactly what a "nurse practitioner" is and what her responsibilities encompass? Also, do nurse practitioners generally work alongside a physician, or is it common for them to practice alone?
Ivy Alexander, Ph.D.: Nurse Practitioners have advanced training, usually a master's degree. They can eitehr work in a practice with other NPs, or with MDs, or midwives, etc. The exact scope of practice differs by state, but in all state except one NPs can prescribe medications. In every state NPs see patients, diagnose illnesses or problems, and help patients manage those problems.
Dearest: A follow-up on that question ... Over the 11 years I've been running Power Surge, I've noticed a shift of women going from the traditional gynecologist to nurse practitioners and naturopaths. Most women express frustration over doctors who don't listen to them, or minimize their symptoms and only seem to prescribe medications they don't feel they need for their menopausal complaints. Can you please address these issues?
Ivy Alexander, Ph.D.: This is a great question. For my PhD, I did a study asking women about their experience in primary care even though I didn't ask them to compare NPs and MDs, they had a lot to say about how NPs were caring, and that many of the MDs they had worked with were less approchable - I did an interview with Fox News in Florida right after that sutdy was completed, and they interviewed women on the street - everyone said they preferred to see NPs!
Karla Knight, RN: There can be difficult people to communicate with in any profession and it's important to find someone who can take care of you and listen. Not with reference to their professional degrees.
moondance: I had a period (heavy) in January -- a scant one shortly after in February and none since, but for the past 3 years, I seem very anxious, worse now. I can't commit myself to anything. Is this part of peri-menopause? I can't focus on or remember anything.
Ivy Alexander, Ph.D.: It sounds like perimenopause, especially the changes in your periods, but some of the symptoms you describe can be due to other problems (like thyroid abnormalities, etc.), so it is important to check them out and see if you are having patterns or not many women do experience anxiety and changes in mood as part of their menopause symptoms.
allanmary: My gyn says it's safe to continue my low dose Climera .25 patch with Prometrium every 3 months for 10 days. Is there any new research that says this is not a safe method? I have been on this method for 7 years and cannot get off as the hot flahses are brutal. Am in good health, no bad habits, 55 and thin. My gyn says it is okay as it is so low dose. Also, can I take the prometrium 100 capsules vaginally?
Ivy Alexander, Ph.D.: The regimen that you describe is being used more and more commonly. The bigger issue is how long is it safe for a woman to remain on hormones. Unfortunately, we don't have a specific answer. We mostly we try to help women wean off or stay on the lowest dose possible and it is individualized to the woman. Hormones ar not okay for everyone, but they are very helpful for some. The WHI data showed us that it is pretty safe to stay on HRT for 5 years, but those women were older, and if you have been on HT since you went into post-menopause the results may not apply to you.
Dearest: WHI = Women's Health Initiative
kates: I am 44 and I believe I've been periomenopausal since age 35. Hot flashes began 1-1/2 years ago. My periods are getting shorter. I cannot tolerate anything that's on the market for my sysmptoms. Will I be okay going through this "au natural"?
Karla Knight, RN: Perimenopause can last from 8-10 years. When menstrual periods start to change, it's an indicator that there are several natural lifestyle changes that women can do to help reduce symptoms that you might find helpful. For example, daily exercise helps to reduce hot flashes and improve sleep, deep breathing exercises like those done for yoga helps to reduce stress and hot flashes.
Maria: I am 48 years old and at the age of 42 i went through an early menopause within 1 year and 1 half it was all over with periods. Now that i am 48 I wanted to know if I will still be feeling symptoms of menopause. I get anxiety attacks and headaches.
Ivy Alexander, Ph.D.: Most women have the most severe symptoms during the 5-7 years after menopasue, but some studies show that other women have symptoms for 20+ years after menopause. Most of the research has looked at hot flashes, but anxiety and headaches are very common as well.
Maria: Thank you.
cozett: I was told today I have a large cyst on both ovaries. Must take out ovaries, tubes, in next two weeks. Also, have option of uterus. I must make a choice by tomorrow. I'm 59 and have had no periods for 2-3 years. What should I do? The simple or total hysterectomy? She does NOT suspect cancer. I do have fallen bladder. I LOVE my NP as well as my doctor, but they are leaving it up to me.
Karla Knight, RN: It's wonderful that they are leaving it up to you. If you have not had a period for 2-3 years, your uterus is not doing a lot of activity -- not serving any particular purpose at this point. However, it does take up some space in the abdominal cavity and it would be interesting to hear what the surgeon thinks about your fallen bladder if the uterus is removed. You should also think about the extended surgery that would be required to remove your uterus.
angel0508: I didn't have any symptoms until I was postmenopausal for 2 years. They hit me all at once. I have had them for 2 years on & off. Is it true they are worst at the beginning and the end? Mine tapered off and now they are back. Is this a sign I am almost done?
Ivy Alexander, Ph.D.: It's hard to say. Did you have surgery that caused your menopause?
angel0508: No. I am 59.
Ivy Alexander, Ph.D.: Some women go through menopause like nothing has happened, while others have mild or severe symptoms. Still others have little symptoms at the beginning, probably due to the estrogen stores that are in their bodies and later develop more signficiant symptoms - it is very individual. Most of the symptoms are the worst at the bginning and wane over time, but the problem is we don't know how long that time will be until after the fact.
CW1: I am one year out from my last period (age 53), am a breast cancer survivor (DCIS - 2 years ago) and am having trouble with vaginal dryness / discomfort. My ob/gyn recommends using estrogen ointment or pill in the vagina, but cautions that I should check with my oncologist. Any thoughts?
Karla Knight, RN: Have you tried non-hormonal vaginal moisturizers?
CW1: Such as?
Karla Knight, RN: Such as Replens, K-Y long acting moisturizer. Vitamin E oil is another.
Dearest: You can actually insert a vitamin E capsule intravaginally. See this article which contains a great deal of information about treating vaginal dryness.
Ivy Alexander, Ph.D.: Regarding vitamin e - it is the oil that is safe to use in the vagina - you need to be extremely careful about using a capsule because the capsule material can be irritating.
Dearest: My article recommends using the oil inside the capsule, too. It goes without saying that being careful when inserting a vitamine E capsule is important (just as it is with tampons, applicators for vaginal medications/lubricants, et al.)
CW1: My ob/gyn said that only the extrogen would treat the cause, others take care of symptoms? Have you had any bc survivors that use estrogen this way?
Karla Knight, RN: Estrogen will replenish the superficial cells of the vagina, so the ob-gyn is right. The others will only reduce the dryness to make you more comfortable. It is a good idea to check with your oncologist but many clinicians treat vaginal dryness with local vaginal estrogen in breast cancer survivors.
CW1: Thank you!
darlacheeks: In addition to soy, what can we do to reduce the symptoms of having hot flashes? I'm an oven all the time and exercising gets me beet red and burning up. I don't want to do something that will make my periods worse as I flood with them. I’m 43 and I take soy caps (for hot flashes) and progestin cream (my hair loss from surgery).
Ivy Alexander, Ph.D.: You can do several things - one is to keep up the exercise, even though it makes you really hot while oyu are at it , it will reduce hot falshes at other time. Also, drinking more water can help, as can deep breathing exercsies (especially when a hot flash starts) wearing light, breathable clothes help a lot, and avoiding tops with high necks is a good idea, too. Also, try not to wear synthetic fabrics becasue they make temperature control and sweating worse.
darlacheeks: I live in AZ so it's really hot here. Thanks!
knowledgeispower: Please describe the ways a period can change in perimenopause. I am 44.
Karla Knight, RN: Periods can get longer, shorter, bleeding can be heavier or lighter. Cramps can be worse or better and premenstrual headaches are usually worse during perimenopause, but can get better after menopause.
JenniferNe: I take synthyroid for my thyroid when is the best time to take estratest HS? Can Estratest cause Acne?
Ivy Alexander, Ph.D.: Estratest can cause acne because it has testosterone in it along with the estrogen. It is importnat to take the synthroid alone (eg, not with any other medicines or vitaimins) so you need to space them out.
Thyroid medications are usualy taken first thin in the morning on an empty stomach. The estratest HS is usually taken at bedtime, you should have at least one full hour after the thyroid medicine before you take anything else.
chillybon: I'm having extremely cold flashes more so than hot - my thyroid checked out okay by my GYN - should I go to a Endocrinologist? My thermostat is so off. I'm 51.8 years and haven't had a period since Sept 04 - also do you insert the Vitatmin E capsule before or something like once a day? I have been diagonosed with Atypical Hyperplasia last September so I can't take any hormones either.
Ivy Alexander, Ph.D.: After a hot flash you have a reduction in core body temperature, so many women experience more cold spells than they do hot flashes, it is individual.
chillybon: Sometimes I'm just cold.
Ivy Alexander, Ph.D.: If the thyroid checked out okay, the endocrinologist might not have much to add unless they have expertise in menopause management.
chillybon: I may not have to have a hot flash and the coldness affects different parts of my body.
Ivy Alexander, Ph.D.: The vitamin e oil is what we recommend - you can puncture the capsule and squeese it out onto your finger, then use your finger to rub the oil into the vaginal tissues.
cfreundt: I just turned 40 and have been going through perimenopause for about 4 years now. I'm wondering if your breast cup size can increase due to PM. I've gone up 2 cup sizes in 4 years with only a 5 lb weight gain.
Ivy Alexander, Ph.D.: Many women do have breast changes during peri-menopause. It is common to have swelling at differnt times but an overall increase in brest size can happen too - it is importan to keep up with regualr self-breast exams, clinicin exams, and mammograms to monitor the tissue changes most women who take hormone will have some increase in brest tissue.
cfreundt: I've not taken any hormones or anything for that matter.
Dearest: Ivy or Karla, many women develop allergies and respiratory problems (coughing, wheezing) during their menopausal years. Does this have anything to do with the fact that histamine levels are affected by hormone levels?
Ivy Alexander, Ph.D.: Histamine levels are affected by hormones. This is why some women have worse asthma on hormone therapy and it also makes changes in asthma during peri-meno common - the changes in hormone levels that are common in perimenopause will affect breathing and often cause wheezing in women who had previous asthma. It can also cause wheezing in women who nevenr had it before.
sandyleggs: I've had heavy periods for 2 yrs (I use super plus tampons 2 tied together, about 70 or more of them), hot flashes started 1 week, trigylcerides shot up over 500 in a week, went from 120 to 150 in two years, being treated for iron deficiency. For the first time today I began a search on what to help me. Also today I had first vaginal ultrasound. There were white lines and round black holes. I know what the white lines are but what COULD BE the black holes? Eggs? By the way, besides iron, I avoid pills. P.D. Thanks for being here!
Ivy Alexander, Ph.D.: Thanks. It's fun to be here!
Ivy Alexander, Ph.D.: Sounds like you might have some cysts on the ovaries - they can be totally innocent, but it is very hard to say without seeing the films. Heavy bleeding is common in peri-meno and fibroids can make the bleeding changes worse. Hopefully, you will start to slow down soon!
sandyleggs: I found one website only that had pic of ultrashound -- the black holes were eggs.
Ivy Alexander, Ph.D.: Yes, black holes can also be eggs. It is hard to determine without knowing how old you are or where you are in your cycle.
bacibear: I had surgery two weeks ago. Now in surgical menopause. I've been dealing with night sweats, crying jags, anxiety.. The doctor says no hormones. What can i do to help me through this? I have gotten a homeopathic remedy from a midwife called oophorinum. Can't find any info about it on the internet. Do you have any knowledge of this?
Ivy Alexander, Ph.D.: I am not familiar with this remedy - why are you unable to use any hormones?
bacibear: Doctor says because of endometriosis.
Ivy Alexander, Ph.D.: I see - have you tried any of hte alternatives, such as vitamin E (by mouth), calcium and magnesium? Lifestyle changes like exercise, deep breathing?
bacibear: I am taking black cohosh only a few days so it's too soon to know if it is helping.
Ivy Alexander, Ph.D.: Great. Several studies show that black cohosh is very helpful. It is second most helpful to estrogen, but can take some time to work, good luch!
spitfire: I'm 51 and haven't had a period for over 2 years. How do I know when I'm safe from becoming pregnant?
Dearest: If you're one of the five winners, be sure to E.mail me at Dearest@aol.com with: your full name, address, telephone number and your username at the chat tonight. Please allow 4-6 weeks for delivery.
Karla Knight, RN: The general rule is if you have gone 12 months without a period, you can be fairly certain that you will not become pregnant.
spitfire: Is there a test you can take?
Karla Knight, RN: A test for exactly what?
spitfire: To see if you are safe from getting pregnant
Karla Knight, RN: FSH used to be considered a measure of whether you were postmenopausal. But now it 's believed that you can even for six months have FSH levels that would indicate that you are safe from pregnancy -- but then your estrogen levels can suddenly increase and you can ovulate. So, being without a period for 12 months is a better guide.
mmeg52: What are your thoughts on bioidentical hormones -- patches vs cream vs orals etc?
Ivy Alexander, Ph.D.: Bioidentical hormones are those that are manufactured in the same form as what the body naturally makes. They have to be taken in much larger doses than the body would normally makee them, because they are modified and metabolized in the body - so even thought they are the same formulation the body changes them so they are useful in tissues.
Creams and patches are metabolized differntly than pills.
mmeg52: For example, Biest vs 17-beta estradiol patch?
Ivy Alexander, Ph.D.: Pills go through the liver fist and require higher doses usually than do patches or creams. In practice, the right answer is the one that works best for the woman - sometimes it is a pill, sometimes a patch, sometiems a cream or gel rubbed on the skin.
angel0508: I am taking Black Cohosh & Chasteberry -- also vitams and Magnesium. Do you feel this is a good combination? I am feeling better now, but i still have anxiety. What would be good for me to take for this?
Ivy Alexander, Ph.D.: That sounds okay. Vitamin B complex often helps with anxiety and stress - you also need to find time to relax, exercise, and give yourself enough time to cope with whatever life is throwing your way.
Dearest: angel, you can also check the Power Surge Recommeendations page.
marlo: HI! 53 and in menopause five years. My hot flashes are subsiding. I still get them, but not so intense. I drink Revival Soy. My question to you is, why do I feel so off-balanced sometimes? Everything is fine as far as blood and thyroid.
Karla Knight, RN: There are some estrogen receptors in the brain that can affect balance and it's also not uncommon to feel a little fuzzy. The good news is these symptoms tend to decrease with time. There isn't a specific treatment, although women who take estrogen tend to have less of those symptoms. The best treatment is "time."
In the interim you need to be careful about falling, change positions slowly. Be careful on stairs. Make sure there are no loose rugs around or cords to trip on. If this off-balance feeling continues, I would go back to my clinician.
JenniferNe: Why do we get fat around our stomach when we hit menopause? I have lost 15 pounds so far but still have a stomach. :(
Karla Knight, RN: At midlife, it's very common to go from the pear shape to the apple shape. It's great that you lost the weight. And it's important to exercise. And maintain a healthy diet.
Dearest: Ivy and Karla, thank you for joining us to answer our many questions about menopause and women's health. I heartily recommend their new book, "100 Questions And Answers About Menopause." It's in a wonderful question and answer format and covers everything you need to know about menopause and related women's health issues.
Karla Knight, RN: Thank you for having us, Dearest.
Dearest: My pleasure. Thanks for coming and for offering such valuable information.
Ivy Alexander, Ph.D.: We had a great time and enjoyed chatting with all of you.
Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994- by Power Surge. All Rights Reserved.