Dearest: My guest tonight is Mary Jane Minkin, M.D. Ob/Gyn, professor and co-author of What Every Woman Needs to Know About Menopause and "The Yale Guide To Women's Reproductive Health: From Menarche to Menopause." Dr. Minkin is a board-certified obstetrician/gynecologist in private practice in New Haven, Conn., and a clinical professor of obstetrics and gynecology at Yale University School of Medicine. Dr. Minkin is a recipient of the Irving Friedman Award, given by Yale School of Medicine's Department of Obstetrics and Gynecology for excellence in clinical abilities and patient care, and has twice been awarded the Resident's Teaching Award for best community attending physician. Dr. Minkin is lead author or coauthor of articles in numerous peer-reviewed journals and also gives lectures to menopause support groups and writes a monthly column, "Healthy Woman," for Prevention magazine. It's a pleasure to welcome you to Power Surge, Dr. Minkin. Mary Jane Minkin M.D.: Well, thank you for asking me to be with you. Dearest: In the ten years since creating Power Surge, I've watched menopause go from almost a taboo subject to one that's openly discussed on talk shows, in magazines and newspapers and even at cocktail parties. Do you attribute this to the outspokenness of the baby boomer generation, the advent of the Internet, or a combination of many factors? Mary Jane Minkin M.D.: I think it's mostly the outspokenness of the boomer generation. I think a lot of this started before most people because internet savvy and that I think that the women of the boomer generation took control of childbirth and that they weren't going to just sit around waiting for menopause, and started asking a lot of questions. Dearest: Even though this is a menopause community, I found a Q & A in your new book, "The Yale Guide To Women's Reproductive Health" interesting about whether women can take SSRIs (anti-depressants) if they're pregnant. Your answer was, "Most anti-depressants currently in use, called SSRIs, are reasonably safe during pregnancy." You further say, "Several studies show that severely depressed women do better taking the medication than not taking them. SSRI's include Prozac and Zoloft." I was under the impression that we have no real long-term studies on SSRIs, so how safe do we really know they are? Mary Jane Minkin M.D.: This issues of pregnancy are different because of the safety of the women and the child. There are several studies that show that women who are depressed have trouble mothering and caring for their children. If you take care of the depression, women bond better with their children. SSRIs are very effective and safe as far as medical complications. The other thing from a medical point of view, they're hard to overdose on. To be honest, Prozac was approved in the late 80s. In the last 15 years these drugs seem to be safe. People on SSRIs for 15 years seem to be doing relatively well. Depression is a bad disease, and the SSRIs help. Jodi: I am 45 and have been experiencing anxiety for 5 years, been misdiagnosed with just anxiety. Now that I'm in full menopause, having not had a period for almost a year, I am totally sick, like a walking zombie. No energy. All my tests so far say everything is fine, just in menopause, what can I do to feel better? I'm pale and just plain ICKY and, have a 7 year old, I'm a single mom. Mary Jane Minkin M.D.: Enough to make you stressed and anxious. You're getting close to full menopause. In general, I find that the earlier women go through meno, the more symptoms they may have. Be sure you exercise with a good exercise regimen. With a 7 year old, you probably have little time for yourself. Try to carve out time for yourself and your needs. Those are the most important things. Certainly, de-stressing the best you can. As far as menopausal symptoms, the usual things such as soy and cohosh. If you get to the point that you've tried all that, then you need medical intervention. Drugs such as SSRIs may be helpful. Drugs like Effexor have good results for your symptoms. Xanax is more as needed basis. Xanax can be habit forming if taken all the time. Effexor has both SSRI and NSRI. Some of the drugs have mixed effects, but the Effexor can help with meno symptoms and is not be habit forming. Also HRT may help you, not for the rest of your life, but can help now. These are all options to consider. Dearest: What type of hormones are you referring to when you say hormone therapy? Mary Jane Minkin M.D.: There are some studies that show that women with depression in menopause may not respond to a typical medication without a little estrogen. Basically, it depends on the patient's preference. Typical estrogen and progesterone intervention. Compounded hormones are fine. One of the first decisions is transdermal approach or by standard pills. For progesterone, if the patient prefers a cyclical or daily regimen to try to minimize the chances of getting a period. Some patients have taken PremPro and felt better than on other HRT. A lower dose is better if possible. The lowest possible dose is the best. That is one of the good fallouts from the WHI (Women's Health Iniative). Healthymeno: How do you feel about natural foods such as Soy to combat the effects of menopause at the beginning and throughout the rest of our lives. And how does exercise help us? Mary Jane Minkin M.D.: I recommend soy to everyone. I think it's great. I know that there's some concern among the breast cancer people, but I think that data is sketchy and out of date. The breast studies were 2 studies in Chicago, not an elegant study, where they took cancer cells and poured soy over them. I feel bad for my breast cancer patients who are told by their oncologists that soy is not good. There are some interesting studies that soy exposure during the teen years may prevent breast cancer when we get older. So soy is good for all ages. I encourage all ages to consume soy, including my children. Soy also has the endorsement of the federal bodies. tiddyti: What are the necessary supplements to take for menopause? Mary Jane Minkin M.D.: I think that the thing that's most important is the calcium intake. It depends if you're taking estrogen or not. If you're not on hormonal supplements, you should get 1,500 mg of calcium, divided. Taking it over the course of the day is much better than taking it all at once. Vitamin D is another thing. If you drink milk, you can get it from milk or other dairy. You can get it from the sun, but dairy is best. That's about all I recommend for everyone. Omega 3 oils are good. People probably don't get enough fish in their diets. Vitamin E is probably not as good as we thought it was. The data on preventing heart attack is a little iffy. It can spike your blood pressure and so you wonder what else it can be doing. Sometimes the cure can be worse than the disease. TearDropp1: I'm 39 and my cycle now runs every two months. I have dizziness approximately 4-7 days before cycle begins. Then I'm ok until next cycle. Have had MRI, blood test, ear, nose and throat, etc. The otolaryngologist says not Meniere's but Dr. thinks it is. Is it possible it was underlying and premenopause has kicked it in? Mary Jane Minkin M.D.: A good question. It's a possibility. One thing I'd think about is fluid retention. Even though they say it's not Meniere's, it is fluid related and diuretics can help. One of the older cures for PMS was a diuretic. It can be argued that it works and you might ask about Spironolactone as a drug before your period. That's one thing I would think about trying, the first thing. It's a drug, a diuretic for PMS. Julianna: Can thyroid (hyper or hypo) effect hypoglycemia or does it effect it the other way around? I have hypoglycemia, but my thyroid tests say normal, but my metabolism is fast, which never used to be (digest food within 18 hours and can't gain weight) I'm 41 and peri on natural HRT. Mary Jane Minkin M.D.: That's interesting. So many of my patients complain the opposite, that they can't lose. You might want to do more extensive thyroid testing. It's more unusual, but you might need to use fancier thyroid tests such as T3. That's the first thing I would think of. Thyroid is very suspicious. You might want to see an endocrinologist to get fancier tests. With hypoglycemia, you may be trying to avoid carbs. You might be getting less calories and fatty foods than you used to, a lot of protein. I think you need a good endocrinologist, then. Jacque1121: I'm taking Paxil CR 25 mg. Is that a good dose? What is a good natural HRT? Mary Jane Minkin M.D.: That's not a high dose. The CR is continuous release. That's a good SSRI, anti depressant. Of all the SSRIs, that has the highest chance of weight gain. Remeron is a biggie for weight gain. Paxil is a good SSRI, and has anti-anxiety properties as well. For natural HRT, if you mean plant-derived, Estrace comes from South American yams. Cenestin is plant-derived. For patches, there are plant-derived. Prometrium is also natural. Biest, triest are fine, too. The only problem with naturally compounded hormones, you have to be careful of the source. Many insurers may not cover these products. PeggyMM: I'm 47, been using progesterone cream transdermally for about 2 years. I feel fine most of the time. I'm just having periods twice a month, otherwise, no menopausal symptoms. Is there anything to be done about the twice a month periods, or should I just live with it and count my blessings? Mary Jane Minkin M.D.: It could be connected to the progesterone you're using. You can stop using the cream for a month and see what happens. Dearest: Did you have the twice a month periods before starting OTC progesterone cream? PeggyMM: No, this has happened only in the last 3-4 months. Mary Jane Minkin M.D.: The progesterone creams won't suppress ovarian action and you may have unusual periods. Birth control pills will suppress your own native action and control your periods. If you stop using the cream for a month or two, you may be able to figure out the cause. PeggyMM: I started the progesterone because I was feeling tired and anxious. It has really helped with those symptoms. Mary Jane Minkin M.D.: Birth control pills could help with those symptoms, too. There are several birth control pills pills I use. If a patient has many symptoms, I use Mercet, with a placebo week. The placebo week has only estrogen. That's a good pill for people with symptoms the week off. My new favorite pill is Yasmin. The progestin is derived from Spironolactone. This drug came from Germany. Spironolactone is the diuretic that I mentioned earlier and it acts like progesterone. This molecule, Drospirenone, is modified so it acts like progesterone with a diuretic property. For people with bloating, PMS, or problems with birth control pills, this new pill will help correct some of that. Chemically, it's very interesting. Jane749: Is there anything specifically good to deal with night sweats? Mary Jane Minkin M.D.: That's another good question. About the same things as for hot flashes. Soy will work, cohosh has some good properties. Flaxseed is a weak plant estrogen. Vitamin E can help some, too. Evening primrose has been very good for many women. It works for a number of women. If it works for you, terrific. It has a very good safety profile. Dearest: Also, check out the recommendations page on the web site at www.power-surge.com/recommend.htm for all these remedies :) Jane749: I'm 54 and have just begun this new life stage. Can I trust the OTC products? Mary Jane Minkin M.D.: It depends on the brand. Check out the company. Soy in food form is better than pills. Soy extracts are reasonable. Check for standardized products. Those are pretty well regulated. Things like Estroven. Amanda52: Welcome Dr. I appreciate your views on medications, Effexor and HRT have helped me so much. I still have anxiety, but so much better. My question is, why is my anxiety so much worse in the morning? I have heard this is common in menopause. Mary Jane Minkin M.D.: One thought - is it related to your cortisol? Cortisol is higher in the morning and afternoon. Check if it's in the normal range. Exercise is a good thing, in the morning, when you're revved up. Amanda52: What is it? Mary Jane Minkin M.D.: Cortisol is our own steroid hormone, made by the adrenal glands and it regulates the body activities. Twinkle: Good evening, nice to have you with us. Is it common/normal to have a period after just going on HRT? I haven't had a period in over a year, but do now. Mary Jane Minkin M.D.: Extremely common. However, despite the fact that it's usually of no concern, most doctors will do a test to be sure that everything is normal, such as vaginal ultrasound. Carla: I'm 52 been on Estraderm 0.05mg patch for 10 years. I have recently weaned off them taking 6wks. to accomplish and am experiencing hot flashes night sweats and vaginal dryness. My hair is thinning (it has been for last 10 years and I know that is a side effect of hormone but it has gotten worse) and eyebrows and lashes as well, am taking Synthroid for 4 years. Do I need to get back on the patch or sweat it out? How important, is it for a woman to have ESTROGEN? Am I in perimenopause since I became surgically in menopause 10 years ago when I had a complete hysterectomy? Thanks! Mary Jane Minkin M.D.: First of all, you're probably postmenopausal but you can still have symptoms at any point. If you want to try the non-medications we mentioned earlier, those are reasonable. If you want to go back on a patch, there are lower doses. Things like Climera are lower and you might be able to do just as well on a lower dose. ALLHEARToo: I'm 54 this month and I have heavy bleeding. Everyone tells me to get a hysterectomy and get something done. But I have Sjögren's Syndrome and I'm afraid it might take me down even more. I'm anemic also. I take iron and a lot of other supplements. Mary Jane Minkin M.D.: Another good question. I think you're smart to think more about the hysterectomy. Hormonal manipulation would be reasonable, if you're not a smoker. The Merina IUD is a little IUD coated with progesterone and is used for heavy bleeding. People initially have a little bleeding, but after 4-6 months, none. Another option is the endometrial ablation, the hot water balloon, or freezing, all less invasive than the hysterectomy. Dearest: Dr. Minkin, what is considered the average age for a woman to become meno/posmenopausal? Mary Jane Minkin M.D.: The average is 51.4 years. That's quoted in the US, but there's a wide variety. Dearest: Dr. Minkin, thank you for joining us to answer so many of our questions about women's health and menopause. I strongly recommend everyone read Dr. Mary Jane Minkin's books, What Every Woman Needs to Know About Menopause and "The Yale Guide To Women's Reproductive Health: From Menarche to Menopause." Mary Jane Minkin M.D.: Thank you so much for having me. 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. 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