All things menopause

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For National Menopausal Awareness month, a registered nurse explains how you will know you are in menopause and what to expect during that time period.

Episode Transcript

Mary Leigh Meyer: Howdy, everybody. Welcome to Sounds Like Health! My name is Mary Leigh Meyer.

Sam Craft: And I’m her co-host, Sam Craft.

Mary Leigh Meyer: And we’re here with Dr. Sharon Dormire. She’s with us from the Texas A&M College of Nursing. Welcome to the show!

Sharon Dormire: Thank you so much. It’s good to be here.

Mary Leigh Meyer: And it’s good to have you. You are our resident menopause researcher. You’ve had a lot of grants and done a lot of work with menopause, so that’s what we’re going to talk about today.

Sam Craft: I’m interested and intrigued by this topic because I’m obviously a male and do not have… I do have hot flashes to an extent…

Mary Leigh Meyer: Oh, my god, what?

Sam Craft: … but not like in normal menopause ways, I guess.

Mary Leigh Meyer: And it’s going to be an interesting one, because it’s not something that a lot of people speak about. I feel like there’s almost a stigma around it, but it’s less of a stigma about menopause but more of a stigma about aging and getting older.

Sam Craft: I think a lot of people just assume—and me being a man—I also just assumed that menopause only happens to older women. It’s, for lack of a better term, like a rite of passage in womanhood, or some stupid thing like that. So it would be interesting to hear what really the medical aspect of it is today.

Sharon Dormire: Okay. Menopause is somewhat of a newer phenomenon in our society because in the 1800’s women lived to their late 30’s, early 40’s, but ovarian function continues till 35, between 35 and 52, basically. That’s when menopause typically occurs. So it’s a later-in-life phenomenon and when the life expectancy wasn’t long, women didn’t have menopause. Now, there’s lots of people through history who lived longer than that, that’s for sure. So, I don’t want to say everyone didn’t make it, but the average life expectancy. But eggs, and the whole menstrual cycle are set up to be kind of finite.

It works until approximately age 35 and from then on in it starts declining significantly. And what happens as it’s declining, the whole menstrual cycle is a brain function piece, and the brain releases hormones to say, “I need an ovary to get mature. Release an egg. Get ready for fertilization.”

Sam Craft: “You’ve done this for so long. What’s happening?”

Sharon Dormire: Yeah, what’s wrong? And when it’s not responding, it’s not getting the feedback from the menstrual cycle, it keeps putting out more and this whole imbalance of the hormones happens. So one of the first signs when you’re getting close to menopause is actually heavy bleeding because of the hormone imbalance. Some women have struggle tremendously with trying to control their menstrual bleeding, and it becomes irregular, as well. It may or may not be ovulatory. A lot of times you have babies born in that time, and twinning, because the ovaries are pumping out. And so, when you have someone who’s in their late 30’s and had twins, it’s physiological.

Mary Leigh Meyer: Oh, wow!

Sharon Dormire: I know. What a surprise!

Sam Craft: Yeah, I know.

Sharon Dormire: “I thought I was menopausal!” The irregularity lengthens, and you just stop having periods, you’re not sure what’s going on. And there’s some others things that show up like irritability, but that’s hormone imbalance. But what defines menopause is one full year without a menstrual period. So once you reach that, it’s a retrospective thing. You say, “I was menopausal at age 52” when you’re 53, and you haven’t had a period for a year.

Sam Craft: So, what about, again, me being a male and this is my concern as far as my household goes, what are emotions like in this time of hormones going crazy? Is it always like some women are just standard baseline level? Do some get angrier or emotional? Maybe emotional is a better word.

Sharon Dormire: Emotional is probably a good word. And it’s not everyone because everyone reacts to their hormones differently. If I could use my mom as a model, she’s no longer alive, so I think I can say what she was like. When she was going through this she would be laughing and crying at the same time. She would be having both emotions going on.

Mary Leigh Meyer: Been there.

Sharon Dormire: She’d be crying about something but then start to laugh, or she’d be laughing and start to cry. But it really is mostly some irritability more than anything, which a lot of women relate to premenstrual-wise anyway. So it was just that hormone piece that they feel.

Mary Leigh Meyer: Is there a big difference in those emotions from the PMS—pre-menstrual emotions—feelings and this menopausal emotional change or are they somewhat similar?

Sharon Dormire: Pretty much similar. Pretty similar. I think women who haven’t had it, though, might experience that emotional challenge and then their partner’s like, “What’s wrong with you? You’re crying over a commercial.” It’s just strange things that pop up. So, it’s a little different. It doesn’t mean it’s real negative. It’s just…

Sam Craft: It’s just different.

Sharon Dormire: Strong difference. Yes. Strong changes in your emotions. And when you talked about age, age typically is pretty tight around age 52-ish, the average age for women in the United States. But if a woman has problems, polycystic ovaries, maybe has a hysterectomy, if there’s anything that upsets the hormone balance, she’ll be menopausal early. So if she has a hysterectomy that includes her ovaries, she’s menopausal even if it happens at age 29. And the hormones are really important, actually, in your cardiac health, in your cognitive health. It makes a difference to longevity.

Sam Craft: So just not knowing, my question here, is there anything emotionally or mentally that could trigger menopause early in life? Like PTSD of some sort or something along those lines?

Sharon Dormire: No, because it’s such a hormonal-based piece and that’s the whole basis of it. Emotions affect menstrual cycles for women but not puts you into menopause.

Mary Leigh Meyer: And what about those women who are on birth controls that may make them not have a period or make them have irregular periods? How do they know? Do they still get the stereotypical menopausal symptoms of hot flashes and all of that jazz?

Sharon Dormire: That’s really an excellent question. And it takes my thinking right away to some early research that was done back in in the 70’s when birth control pills were first really introduced widely. They started to wonder what are the consequences of being on the pill and not ovulating and all of those pieces. They started a study that continues today. It was called the National Nurses’ Health Study. They chose nurses as the population because nurses are pretty good at record keeping and know what medicines they’re on and when their bodies have changed and so they’re good reporters.

In addition, the population of nurses is pretty representative across socioeconomic groups and so that’s why they recruited young women, at that time, and they started following them, and they stayed with them, which then led to menopause. They got information about menopause and their experience with menopause. And that study found that women who started hormone therapy at menopause had better cognitive health and better cardiac health than women who did not.

That led to the Women’s Health Initiative, which you may or may not be familiar with. That was running during the 90’s into 2002, but pieces of it continued after that. At 2002, the study was stopped because they had, I think, 8,000 in each group, nationwide, 8,000 women who had been given hormone therapy or given placebo, and the hormone therapy group had eight more breast cancers than the placebo group out of 8,000 and they decided to stop this study. In retrospect, that was an error and it created public health panic. People didn’t have the right information.

But the truth is, the issue was in the Women’s Health Initiative, the average age of women in that study was 62 to 63. They were approximately 10 years without estrogen, and so you’re adding it back and they didn’t have estrogen receptors. The estrogen receptors were gone at the cellular level. So that’s really the problem with that study. But yet it’s one people still harken back to.

I know when I personally go… I moved here three years ago and when I went to my physician, my OB-GYN physician, he wanted to talk about why you’re still on hormone therapy. Maybe we should release it. And so I told him my perspective on it and he said, “You know what you’re talking about. I’m done.” Because he understood what I was saying. And so I think there’s a lot more to look at, but the key seems to be that women have continuous estrogen as opposed to a long break.

Sam Craft: What are some of the normal or most common misunderstanding or misconceptions with menopause?

Sharon Dormire: Very good question. One of them is that women feel like they will start growing hair on their face. They feel like their voice will change. They’re fearing an increase of testosterone, really. But they’re feeling they’ll be more masculine because of it. And that’s not the case at all. And the whole thing that you were really saying is on women it’s an age discrimination piece. With men, when you see graying of the hair at the temples, you say that’s debonair, “Doesn’t he look handsome?” Women color their hair forever, case in point myself, because if you’re gray-haired or if you’re menopausal, you’re old. Nobody says you look wise, they say, “She looks old.”

Sam Craft: Society can be a terrible thing.

Mary Leigh Meyer: You don’t really notice that looking at different celebrities.

Sharon Dormire: Right, right.

Sam Craft: I hear all the time “menopausal.” I think to a man the most common symptom to me besides the hormones going crazy is hot flashes. So what is a hot flash? What is happening?

Sharon Dormire: What’s really happening is the blood vessels everywhere, but mostly subcutaneous, open. The vasodilator opens just like if you were doing a hard run, only you’re sitting perfectly still doing something, and you start this immense sweating. You can have some increased heart rate and changes in the respirations, but mostly it’s the skin temperature, the sweating, the heat. I still get them and sometimes I have to pick up my hair in the back because your whole neck will be wet or your whole shirt will get wet in a very short time.

Sam Craft: How are they brought on? Is it just a chemical thing? Can stress bring them on? How long do they last after menopause is over?

Sharon Dormire: Very good question. What brings them on? Why women have hot flashes is actually the basis of my research because it’s not known. It’s really not well-defined. We know that it’s somehow related to estrogen and the estrogen decline, but it’s not an absolute relationship because only 80 percent of the women who are going through menopause have hot flashes. Now, those 80 percent are very uncomfortable and that’s generally when…

Sam Craft: Wow. I didn’t realize it was just… I thought it was everybody experienced that. But everybody experiences it a different way.

Mary Leigh Meyer: I feel like that’s the symptom that most people find difficult to manage.

Sharon Dormire: It’s actually what brings women to health care in this age group. Which is kind of sad. They often have their babies and then make sure the children go get care and then when they’re reaching into the menopausal age, it’s the hot flashes that make them go for care. Which is a good thing because it would be nice to have them getting care regularly and making sure their reproductive systems and bodies are safe. But they may not be going to anybody, so it’s good to bring them in in that respect. That’s a good thing that the hot flashes are doing, but it is hot flashes that are the biggest thing.

Sam Craft: It’s like a warning sign, the biggest one everybody sees.

Sharon Dormire: And the men know about it because you can wake up and half the bed is soaking wet…

Sam Craft: That’s wild.

Sharon Dormire: … and she’s gone out to the couch to sleep because she had to change her clothes and her location. It’s really heavy sweating.

Mary Leigh Meyer: Yeah. I shared a cubicle with a woman, hi, Theresa, I love you, who would turn her fan on all the time and then the heater. We were just going on that roller coaster of hot to cold.

Sam Craft: That’s bizarre.

Mary Leigh Meyer: There was not much she could do about it…

Sam Craft: I can’t imagine my body just going bipolar like that in temperature all the time.

Sharon Dormire: Well, that’s where my research gets very interesting because we started looking at what’s the issue with blood sugar and why is it happening relevant to blood sugar. And so in my postdoctoral study I did a really exciting study and I brought women in the hospital, kept them fasting. One day they got glucose infusion, one day they got normal saline infusion. The women didn’t know what they were getting when and we were monitoring their blood sugar every 15 minutes and their hot flashes electronically and all of that.

And the women, indeed, had, this was a small group study but it was repeated measures. I think we had, yes, we had 12 women and when the blood glucose was below 110, so I’m not talking hypoglycemia, I’m just talking postprandial or after you eat, they had 63 hot flashes. When I elevated their blood sugar, there were three total in a four hour time frame.

Mary Leigh Meyer: Oh, that’s correlation. Is that the right word?

Sharon Dormire: Yes. And I’ve done repeated studies after that. Well, now the technology’s changed so I can let women wear monitors and live their life for five days and bring them back and see the data. And so it’s still showing.

Sam Craft: But I bet you get a lot better reading because then you really can tell if it’s normal situations or stressful or whatever, if their heartbeat goes up. You can correlate a lot more things to that then what you used to could.

Sharon Dormire: I like that it’s not experimental. It’s not me doing something to them. It’s in your daily life when are your hot flashes occurring and why. And it is holding that when their blood sugars are lower they’re having the hot flashes. And the reason for that is glucose is transported into the brain by glucose transporter one. That’s how it gets in there. The brain doesn’t store blood sugar, it doesn’t store fat. It has about two-minute supply at any moment. But when you get busy working or something, it needs to get in there faster.

And what the body does is upregulates, produces more glucose transporter one. The key is estrogen stimulates that upregulation. So estrogen makes up regulation of glucose transporter one. It makes this whole process more efficient. Well, if I’m stressed or if I’m trying to do a presentation or whatever, and I have lower estrogen level, it’s not as fast at bringing the glucose in and so the body says, “Well, we can beat that. Let’s vasodilate the vessels and flood the brain with blood and hopefully extra glucose.

Sam Craft: So, this whole process we just talked about just now, why doesn’t that happen in men?

Sharon Dormire: Awesome question.

Sam Craft: Because we don’t have the female parts obviously, but that stuff we have, right?

Sharon Dormire: Yes.

Mary Leigh Meyer: A brain, yes.

Sam Craft: Touché.

Sharon Dormire: Yes, they do. But the neat part, actually interesting part to me is all through life from fetal development until a man dies, estrogen level in the brain is higher than in women because testosterone is changed, aromatized, whatever word works for you, it changes to estradiol in the brain. So testosterone levels and your estrogen level is actually higher in the brain. The only time that men have hot flashes naturally is if they lose their testes by injury, trauma, cancer. If there’s a reason that they have that withdrawal, they have hot flashes just like a woman.

Sam Craft: That’s interesting.

Mary Leigh Meyer: And how long do hot flashes normally last? You defined menopause as no period for 12 months, but you could have symptoms before and you can have symptoms after. What does that timeline look like? Is menopause a moment in time or is it…

Sam Craft: … a process.

Mary Leigh Meyer: … like the general life event that’s happening?

Sharon Dormire: It’s defined as being that moment when your menstrual periods stopped, but then a woman is post-menopausal after we’re able to say, “Yes, your ovaries have completely stopped and you’re not going to have any more cycles.”

Sam Craft: So, is that the year process, that’s post?

Sharon Dormire: Yes.

Sam Craft: Okay.

Sharon Dormire: And you’re posts forever after that.

Sam Craft: Okay, yeah.

Sharon Dormire: But the time that your hot flashes would last is typically two years. So that year where you’re going through menopause plus one, two to three years. Many women last a lot longer and there is no way to predict who’s going to be longer and who’s not. Some women have very few hot flashes, some women have many.

Mary Leigh Meyer: And how long do hot flashes normally last?

Sharon Dormire: Themselves, each individual flash?

Mary Leigh Meyer: Mm-hmm.

Sharon Dormire: The hot flashes can be just like 50 seconds to 5, 10 minutes.

Mary Leigh Meyer: Oh, goodness.

Sharon Dormire: It just depends on how uncomfortable it is. What’s interesting to me in a study I conducted… Well, I did three studies last summer and I did my recruiting through Texas A&M. I just sent out to staff and faculty an invitation. I was flooded with responses. It kind of goes back to that we don’t talk about the menopause much. They were so thankful, I have to say their word is thankful. They’d come in and get into the study and they’d thank me for doing this and they wanted more information. And they stayed with me through all three studies because they were so committed. And I just was kind of touched by that because it says how much their marginalized. People don’t talk to them and tell them what’s going on. That’s kind of sad.

Mary Leigh Meyer: And I bet it’s a frustrating process, too, irregular periods, hot flashes here and there and you can’t really do much about it. But there are some different therapies, hormonal therapies. Is that correct?

Sharon Dormire: Yes. You can use natural substances, which the evidence is not really as strong as people convey. You can use certainly hormone replacement therapy. And hormone therapy, what you take, it depends on if you have a uterus or not. If your uterus is in place, you must take an estrogen-progesterone combination because the progesterone protects the uterus. If you don’t have a uterus, you can take just estrogen. And it can be in lots of forms. It doesn’t have to be a pill. It can be a vaginal cream. It can be a patch, like a smoking patch. There’s lots of ways you can get it. It can be helpful. There’s information also, I should be natural in this, and say that there’s some information that regular exercise makes a difference, too, and helps people.

Sam Craft: In what terms? As far as getting through menopause?

Sharon Dormire: Treating the hot flashes, but to me that’s probably helping maintain your blood sugar pretty evenly and making a difference in that way.

Mary Leigh Meyer: That’s true. Or you can’t tell if you’re in a hot flash or you’re just trying to run.

Sharon Dormire: There you go.

Sam Craft: It’s a hundred degrees outside. It’s every day.

Sharon Dormire: Yes. I don’t know that I’d want to run in today’s temperatures.

Sam Craft: No, thank you.

Mary Leigh Meyer: And you mentioned hysterectomies. My mom had a hysterectomy back in the day. Can you tell everybody what a hysterectomy is and why you mentioned that in terms of menopause?

Sharon Dormire: Hysterectomy is surgical removal of the uterus, usually the fallopian tubes and sometimes the ovaries, as well. If it’s all of those pieces, it’s called a total hysterectomy. And then if it’s just sub-pieces, like if you have a young woman and you don’t have to take her ovaries out, you shouldn’t be doing that. But if the ovaries are damaged or there’s a problem or there’s some reason to take them, then that’s different. There’s lots and lots of reasons that a woman could have a hysterectomy. Could have tumors that are bleeding excessively when the period comes. Could have endometriosis, which is very painful. Over proliferation of the lining of the uterus. It could have tumors of any kind. There’s all kinds of reasons that it could happen.

It doesn’t all have to be abdominal, meaning a surgical incision in your abdomen. That used to be the primary way, but you can also do vaginal hysterectomy. There’s lots of ways to do the surgery laparoscopically, even, now. So we have more options to us now.

Mary Leigh Meyer: And then what happens when that is removed?

Sharon Dormire: It depends on the age of the woman if you’re going to do hormone therapy or not. So if it’s a younger woman, you’re definitely going to do hormone therapy. If it’s an older woman, you might not choose to do that because she might not need that at this point. But there’s a lot of practices that if the woman is younger, like less than 50, they start hormone therapy basically in the recovery room. They’ll start using a patch and stuff because the woman who has a hysterectomy and her ovaries removed will start having hot flashes immediately and they’re pretty dramatic. Her’s are worse than a natural menopause so you want to prevent that and keep her a little bit more comfortable. But every person’s body is different.

Mary Leigh Meyer: And that’s why it’s so important for everyone to have these conversations with their health care providers because everything’s so dependent and it sounds like these symptoms are so, I want to use the word arbitrary, but that’s not the right word they’re so…

Sharon Dormire: It’s random.

Mary Leigh Meyer: They might happen, they might not happen.

Sharon Dormire: It’s random.

Mary Leigh Meyer: Sometimes they’ll happen a lot, sometimes they won’t happen. You might have a period, but then you might not have one for eight months and then you’d get one for the next four months. It sounds confusing, like a confusing process.

Sharon Dormire: It is. And that’s why openness and information is important. And if I can say one thing that I think women should do is to make an effort to be informed. There’s lots of good places to get such information, but one that I have to speak called North American Menopause Society, NAMS, and the access to that is easy. The website is menopause.org and they have a plethora of good patient-focused information that you don’t pay for it. You can access it as a patient.

And then reproductive endocrinologists also have very good information. So I recommend that you avoid social media sources and Internet searches that are just random because it’s not evidence-based and people are trying to sell products most of the time instead of information so that you can make a good, healthy decision for you.

Mary Leigh Meyer: Oh, I think that’s a good wrapping point. Is there anything else you want to be sure our listeners know?

Sharon Dormire: No, I think I’m good. Thanks!

Mary Leigh Meyer: Okay. Well, thank you for coming on the show, Sharon. I think I learned a lot.

Sam Craft: Yes, a lot learned. Hand raised.

Sharon Dormire: Well, that’s good. And I hope it’s helpful to many.

Mary Leigh Meyer: Oh, I know it is.

Sharon Dormire: Awesome.

Mary Leigh Meyer: And thank you all for listening. This has been another episode of Sounds Like Health.