Joining us today to talk about menopause 101 is Dr. Lindsay Michel, a gynecologist at the Women’s Health institute at Maimonides Medical Center. This is Maimo Med Talk. I’m your host, Deborah Howell.

Welcome, Dr. Michel. So nice to have you on with us today.

Dr. Lindsey Michel: Oh, thank you so much for having me. Happy to be here.

Deborah Howell: Our pleasure. So I’m really curious about why you got into this particular area of medicine. What was the big draw?

Dr. Lindsey Michel: I think for me, just going into OB-GYN, it really was the ability to provide primary care for women and as well as surgical care. And I found that OB-GYN did have something unique in that you had continuity of care with women throughout all phases of their lives from early in their menstrual cycles to their reproductive health, and then ultimately in menopause. So I found it as a unique opportunity to be able to take care of women in all phases of their life.

Deborah Howell: Oh, and the word continuity. You know, it’s music to the ears of a patient where, you know, they’re going to be there for you. And they’re going to know you when you’re young and hopefully they’ll still be there when you’re old. Love it.

Dr. Lindsey Michel: Exactly.

Deborah Howell: All right. Let’s get into the nuts and bolts of menopause 101. Can you give us a working definition and then an overview of this phase of life?

Dr. Lindsey Michel: Yeah. So menopause is a phase of life. It’s a normal transition in every woman’s life and it’s marked by a natural decline in a woman’s reproductive hormones. It’s essentially marked by the end of menstrual cycles. Interestingly, it is diagnosed actually retrospectively. So it’s not actually diagnosed until you have 12 months without a normal menstrual cycle.

Typically, women experience menopause between 40 and 58. Although the average age is about 51 years old. But this can vary depending on your genetics and oftentimes women’s will shadow the same end of their menstrual cycles as with women in their family.

Deborah Howell: That’s very interesting. I did not realize that. Could you give us an example of that?

Dr. Lindsey Michel: So, for example, if your mother went through menopause at 57 and your sister went through menopause at 55, then I normally tell patients that they’re more likely to experience menopause at a later age than someone who has family members that experience menopause a little bit earlier. I would say the one caveat is, you know, there are some women that may experience menopause earlier than 40. And those are typically women that suffer from a condition called premature ovarian failure, or in women who may have had their ovaries surgically removed and been induced into a surgical menopause or women who may have experienced chemoradiation because that will do some damage to the ovaries and can cause you to go into menopause sooner than our typical 51 years old.

Deborah Howell: Sure. And what are some of the symptoms that patients experience during menopause?

Dr. Lindsey Michel: So patients can experience tons of different symptoms. The most common that they’ll see and the initial changes that they’ll see is cycle irregularity. So we know that normal menstrual cycles can vary anywhere between 21 to 35 days and lasts less than eight days. But you’ll find as you’re getting closer to menopause and what we call our perimenopausal transition, in those years leading up to menopause, you might find that your cycle become a little bit more prolonged or you might even miss a cycle. So I would say most commonly that’s the major symptom that women will experience. Other symptoms that are very common and probably the second most common are what we call vasomotor symptoms or as people more commonly understand as hot flashes or night sweats.

Deborah Howell: Oh, the lovely night sweats.

Dr. Lindsey Michel: Yes. They’re not fun for anyone.

Deborah Howell: No. Not you, not your partner, not your cat.

Dr. Lindsey Michel: Exactly. You know, and it’s hard to describe a night sweat for anyone. But what I typically tell people is when you experience a hot flash, it’s typically like flushing in the face and you can experience it mostly in your upper body, in your face, your neck, your chest. And it can last anywhere from one to five minutes. And then, as your body tries to reregulate after having a hot flash, then you might start to experience some chills or things of that nature to calm yourself down. And then, essentially night sweats is those same hot flashes just occurring during sleep.

Deborah Howell: Yep. And always have an extra T-shirt or, you know, pajamas next to the bed because, you know, you’re going to go through a couple of sets.

Dr. Lindsey Michel: Exactly. You know, thirdly, some other common symptoms that you might experience are what we call our genitourinary symptoms. And those are symptoms related to changes that occur in the vulvovaginal area, so within the vagina and with the vulva. So as we experience in our body, we see thinning of the skin when we get older and through menopause. And so we start to see more dryness in that area, so patients can experience some itching or burning near the vulva or in the vagina. It can also lead them to have increased risks or recurrent urinary tract infections or experience more discomfort or dryness with essentially sexual activity. So that way, I’d say it’s the third most common thing that we’ll see with symptoms during this transition.

Deborah Howell: We’d run the gamut, but there might be some more symptoms that you haven’t touched on.

Dr. Lindsey Michel: Yeah, we have a couple more. Yeah. So, a few more symptoms are just general changes in overall mood. You can feel more anxiety, more depression, more anxious during this time. we can see some women have some memory impairment. Also, some women will experience insomnia, more difficulty with sleep. And then, like I said, general body changes that women may experience in addition to the thinning or the dryness of the skin, you might see some hair loss. Most commonly, we see that in the back of the scalp. But you can also see increased hair growth on the face, so that’s a change as well. And then generally, women might experience some weight gain, not necessarily due to to menopause, but it can sometimes be due to those changes in our reproductive hormones as well as changes in how our body distributes our fat. We see a little bit more fat in the belly area, so that’s often something that women can experience during this time.

Deborah Howell: What’s not to love?

Dr. Lindsey Michel: I know. Lots of changes and, most of them, not that fun.

Deborah Howell: Losing hair where you want it and gaining hair where you don’t want it, on your face.

Dr. Lindsey Michel: Exactly.

Deborah Howell: Okay. So these are all the normal symptoms. When is it time to see a physician?

Dr. Lindsey Michel: So I would say, you know, it’s really important for women to really continue to have their annual checkups with their physician. And that way, you know, they can address any of their concerns that they might be having about changes in their bodies and see if the physician can let them know whether this is normal or abnormal. With that annual exam, it can also evaluate these menstrual cycles. Now, cycle irregularity, as I mentioned previously, is a very normal thing to happen. However, if we start to see that a patient may have more increased cycles or heavier cycles, that’s something that requires more workup and should not be attributed to just menopause.

Lastly, I would say, you know, if a patient’s experiencing any of these menopausal symptoms that are disruptive to their daily life, a physician would be a great opportunity to address those issues and offer some treatment options.

Deborah Howell: Now, when you say physician, are you saying you really should have a gynecologist?

Dr. Lindsey Michel: Yeah. I would say a gynecologist in particular, or you can find any type of menopausal expert.

Deborah Howell: Okay. Now, the good part, making your patients going through all these menopausal changes feel a whole lot better. What are some of the treatment options?

Dr. Lindsey Michel: Yeah, I think there’s tons of different treatment options and we really have to tailor our treatment options to the patient’s symptoms. So as we’ve just discussed, there are tons of different symptoms that a patient may experience, and a lot of them can begin with changes in lifestyle and behavior. So as you had mentioned, you know, those who experienced those night sweats, having those clean change of T-shirts, sleeping with a fan, simple changes that you can make to make yourself more comfortable when you do have those hot flashes. Or with insomnia, making sure that we’re attuned with having good sleep hygiene, you know, making sure we’re keeping electronics out of the room, only using the bed for sex and for sleep. making sure we’re having a good sleep schedule and avoiding things that can disrupt our sleep, whether that be exercising late at night, eating late at night, you know, having caffeine or alcohol that can also our sleep patterns.

For our vasomotor symptoms, we talked about some of the options for just making us feel better with the hot flashes. There’s less data on whether there are some herbal options that can help us with those treatments. Some women swear by their black cohosh and their dong quai and their ginseng. There’s mixed research on the benefits of those things. But I say, if you do find that you have some benefit from those things, I support the use of that. But it’s just very important to let your doctor know, so we can be attuned to that and make sure there’s no interactions with any other medications that you’re being prescribed.

Deborah Howell: That’s a perfect point because, you know, a lot of us take a lot of supplements and not all of them may very well with some of our medications.

Dr. Lindsey Michel: Right. Exactly. But, you know, you have various different women who have different desires and, you know, wanting to do the most for their symptoms or say, “Oh, maybe I want to try something a little bit more natural before progressing to something like hormonal therapy.” I always tell women who are having vaginal symptoms, a lot of that dryness, itchiness, burning, can be resolved with vaginal moisturizers.

We add the vaginal moisturizer so that we can maintain moisture and improve some of those symptoms. So I do find that is something that another option that women can have, and not necessarily have to progress to hormonal therapy. However, if none of those things work, we can always do something like hormonal therapy.

Deborah Howell: Which can be as simple as applying a tiny little patch to your belly.

Dr. Lindsey Michel: Exactly. There’s various different options for our hormonal therapy for women in menopause. And I think, there’s been different phases of having a good reputation with getting hormonal therapy versus a bad one. But I think in select patients, it can be very beneficial. And if it relieves a woman from all of these symptoms and it’s used for a very short period of time, we don’t often see detrimental effects.

Deborah Howell: Anything else you would like to add to our conversation or let us know maybe what sets my Maimonides apart from the rest?

Dr. Lindsey Michel: Yeah. As you mentioned, I do work in the Women’s Health institute at Maimonides. And I think it’s a unique place in that we have multiple subspecialties within the division of OB-GYN that can treat women there. And so we can work collaboratively to make sure that all of the women’s needs are addressed all in one location. So I think that’s really what sets us apart, to have that opportunity for women to see everyone in one location and have that collaborative care.

Additionally, I think if women want or have more questions about menopause, I encourage them to look into more patient education. I think education is power. And so, a great resource is actually the North American Menopause Society at menopause.org. And that can provide more information about menopause, the transitions, what’s normal, what’s not normal, and as well as a locator for menopausal providers.

Deborah Howell: Once again, that’s menopause.org.

Dr. Lindsey Michel: That’s correct.

Deborah Howell: Okay. Well, Dr. Michel, it’s been such a pleasure to have you on with us today. Thank you so much for your time and for all you do for our patients and for supporting women’s health.

Dr. Lindsey Michel: I appreciate being here. Thanks so much for having me.

Deborah Howell: And to make an appointment with the Women’s Health institute at Maimonides Medical Center, please call 718-283-9044. For general information, visit maimo.org. That’s M-A-I-M-O.org. This has been Maimo Med Talk. I’m your host, Deborah Howell. Stay well, and thanks for listening.