My Doctor Online The Permanente Medical Group

Changes in Midlife

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Menopause is a unique journey for each woman. You might sail through it, barely aware of changes in your menstrual cycles. Or it's possible that you'll have to deal with frequent symptoms. Though every woman is different, the following is an outline of changes you might experience at certain ages.

Mid-30s to Mid-40s:

• Your chance of getting pregnant decreases (but pregnancy is still possible).
• Your menstrual bleeding patterns may change. Your periods may get lighter or heavier, and your cycles may get longer or shorter.
• You may experience mood changes, worsening premenstrual syndrome (PMS), hot flashes, and sleeplessness.

Mid-40s to Late 40s:

• Your menstrual periods may become irregular with more or less bleeding, skipped periods, or periods closer together.
• You might experience symptoms including hot flashes, sleeplessness, anxiety, forgetfulness, difficulty concentrating, headaches, dizziness, heart palpitations, breast discomfort, frequent urination or inability to hold urine, fatigue, weight gain, decreased sex drive, or vaginal dryness. Other PMS-like symptoms may also occur, such as mood swings, irritability, or bloating.

Late 40s to Mid-50s:

• Menopause symptoms begin to decrease although there's a chance that you will experience some symptoms indefinitely.
• You might experience emotional swings.
• As you age, you are at greater risk for heart disease and certain types of cancer.
• As estrogen decreases, you become at greater risk for osteoporosis, or thinning bones. During peri- and postmenopause, calcium is lost from bones at a greater rate than the bones can replace it. Almost 20 percent of total bone loss will occur in the first few years after menopause.

Some surgical procedures can bring on symptoms of early menopause, like certain types of hysterectomies or procedures where the ovaries are removed. Some cancer treatments also have this effect. We will discuss the possible effects of early menopause.

Health Risks for Women in Midlife

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After you experience menopause, you are at greater risk for important health conditions, including the following:

• Osteoporosis is a condition that causes your bones to weaken and easily break or fracture. Half of all women over the age of 60 will experience a fracture to their hip, wrist, spine, or other bone due to osteoporosis. Bone loss is greatest within the first 5 to 7 years after menopause.
• Heart disease occurs when the blood vessels in the heart become clogged. The risk of a woman developing heart disease increases with age. There are ways you can begin reducing your risk of heart disease now. 
• Breast cancer is the most common form of cancer in women, and the risk of developing it increases with age. Therefore, it is important to be regularly screened for breast cancer.
• Colorectal cancer starts in the large intestine (colon) and the rectum. This kind of cancer usually develops slowly, sometimes over many years. Most colorectal cancer begins with small groups of cells called polyps. If you have regular screening for colorectal cancer, we can find these polyps and remove them, preventing cancer.

Lifestyle Changes

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The transition to menopause can vary tremendously from one woman to the next. What you experience in the few years prior to menopause may be different from what you experience once your menstrual cycle has stopped. The key to managing these changes is understanding that they are a normal part of this phase of your life and that there are often simple and effective ways to manage them.

• Stay healthy. Eating right and being active can minimize some of your menopausal symptoms and can help you adapt to these changes in your life.
• Get screened regularly. Keeping up with important health screenings is more important than ever. After you experience menopause, you are at greater risk for important health conditions like heart disease, osteoporosis, and certain types of cancer. And remember your Pap tests - they are as important as ever. 
• Take time for yourself. Mental health can also play a role in helping you though this time of transition. Taking care of yourself means taking time for yourself, relaxing, managing stress, making the time to do the things you enjoy, including daily exercise. Look for support by connecting with other women who may be going through a similar process.

A well-managed and healthy perimenopause and menopause can be a wonderful time of transition and new freedom. We look forward to working with you to make this a very satisfying and fulfilling time in your life.

Symptoms and Solutions

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Perimenopausal symptoms occur because of fluctuations in the hormones (estrogen and progesterone) that your body produces. You will probably find that the transition to menopause is a gradual one.

Every woman experiences the symptoms of menopause differently. You might have few to no symptoms other than losing your monthly menstrual cycle. However, the onset of menopause might trigger a variety of other symptoms, such as:

• Irregular bleeding 
• Hot flashes 
• Vaginal dryness
• Insomnia
• Mood changes
• Incontinence
• Changes in sexual interest

Finding solutions to lessen your symptoms may take time. Maintaining a healthy, active lifestyle is always recommended, but it's particularly helpful in treating some of the symptoms of menopause.

Hormone replacement therapy (HRT) is also available, although it is not the best choice for all women. We can discuss the risks and benefits, if you are interested.

We do not recommend tests to determine your level of hormones, because there is no evidence to suggest that the findings are useful.

Treatments

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You may be one of the lucky women who sail through menopause without much difficulty. However, it's possible that you may experience severe symptoms which are not relieved by changes in your behavior and routines. If this is the case for you, treatment by hormone replacement therapy or by alternative medicines might be an option for you.

Hormone Replacement Therapy

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We recommend that only women with severe menopause symptoms that seriously affect their quality of life take hormones.

Background

Before 2001, hormone therapy was commonly recommended to treat the symptoms of menopause. Then new research from the Women's Health Initiative (WHI) revealed that postmenopausal women who took specific hormones for longer than 5 years had a greater risk of certain health problems like breast cancer, stroke, pulmonary emboli, and cardiac effects. Because of this, both patients and physicians have looked for alternative therapies. We recommend that hormones be taken only by women with menopausal symptoms that seriously affect their quality of life. And if so, only at the lowest effective doses and for the shortest period of time. We would be happy to discuss whether or not hormones might be a good choice for you.

About hormone therapy

If you choose to use hormones to treat your symptoms, we can come up with a plan that is right for you. Your prescription will most likely include both:

• Estrogen to treat your symptoms of menopause.
• Progesterone to balance the estrogen and prevent any precancerous or cancerous changes to the lining of your uterus.

Ideally, you should take hormones in the lowest dose and for the shortest time needed to manage your symptoms. If you stop HRT and your symptoms return, you can slowly decrease the amount of your dose over time. Together, we can develop an approach to managing your menopausal symptoms which is best for you, and help you to taper off hormone therapy at the appropriate time.

Complementary and Alternative Therapies

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Whether or not you decide to take hormone therapy, you can take steps to help lessen discomfort and improve your health during menopause. Although scientists are just beginning to document the benefits of mind-body and herbal approaches, there are some methods you can try to see if they help relieve your menopausal symptoms and improve your sense of well-being:

• Choose healthy foods. A balanced diet can ensure you feel good and are providing your body with the nutrients it needs.
• Be active. Aim for an active lifestyle. A regular routine of physical activity can give you more energy, keep you healthy, and help lessen your symptoms.
• Care for your mental and emotional health. There are many healthy and enjoyable ways to reduce stress and care for your mental and emotional health.
• Consider herbs and dietary supplements. It sometimes seems like there is a new suggestion every week for over-the-counter herbs, supplements, and techniques to control menopausal symptoms. Knowing which supplements are beneficial and which are unproven is an important first step.

Your Care with Me

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If you are concerned by the symptoms you experience leading up to or during menopause, please contact me. Let me know the type of symptoms you are having, how long you've had them, and when they occur.

If we know your symptoms are caused by menopause, we will discuss options for your treatment.

• We can discuss home treatment or lifestyle changes that may reduce or eliminate your symptoms. To learn more, I encourage you to take advantage of my online resources to help you understand and manage your menopause symptoms.
• If we’ve tried to relieve your symptoms without the use of hormones and were unsuccessful, we can consider using hormone therapy or other medicinal therapies to manage disruptive symptoms of menopause.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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