In our July 23rd post, Dr. Julia Frank said something profound in relation to the options available to treat menopause-related depression, ?Some women will respond better to one [treatment] than another, but that has to be determined on an individual basis?it isn?t predictable from large studies.? This idea is something we need to hear again and again especially when the media blasts a headline claiming the medical advice we?ve believed in is now the very thing that puts us at risk of something possibly worse than the condition we?re treating. Eventually, these conflicting reports begin merging with other dramatic claims into one, colossal doomsday prophesy, and we feel our health options counting down, like a Mayan Calendar, and December 21, 2012 is right around the corner! But wait. Maybe it?s not that dramatic. Maybe there is a path through the confusion. We live in a time when access to information is at an all time high, but making sense of it is the real challenge.
Today, we talk to Dr. Barry Verkauf, professor in the University of South Florida Department of Obstetrics and Gynecology and director of the USF Menopause Center, who offers his advice on treatment strategies, finding the right doctor, the 5 menopause fundamentals, and steaming up your bedroom in a good way.
1. Q:? What inspired you to open up the USF Menopause Clinic on the Tampa General Hospital campus? What has the response been like?
A: The largest cohort of women ever (the Baby Boomer generation) are now are entering midlife and experiencing the perimenopausal and postmenopausal years. Many of them are confused as to what the best way to deal with the symptoms and stresses of menopause and need guidance. Moreover, as women live increasingly longer and the?emphasis in medicine is on prevention rather than intervention, we want those additional years that women live to be of the best quality that they can be. The response has been excellent.
2. Q:? Not everyone lives near a menopause clinic ? we definitely need more of those. Why is it important to find a doctor that specializes in perimenopause and menopause? Can you give women some tips on how to find a specialist in their neighborhood?
A: Doctors who specialize in a particular area generally have more interests, more in-depth knowledge, and more commitment to their area of specialty. They are often in the best position to give the best information. To try to find a doctor near you who specializes in menopausal medicine, try calling the nearest medical school if you live in a community that has one. You can also try the Websites of the organizations who have members specializing in menopausal medicine associated with them:? The North American Menopause Society; The American Society of Reproductive Medicine and the American College of Obstetricians and Gynecologists.
3. Q:? The news media has been flooded with a new spin on the 2002 results of the WHI Study. Women found these ?sound bites? biting them in the you know what! What is a woman to do? With all of these confusing headlines, how do women figure out what is best for them?
A: While it is important to educate oneself, putting the abundant information available in appropriate perspective is best done by a specialist in the area. Find a competent Obstetrician/Gynecologist or a specialist in menopausal medicine.
4. Q:? If a woman is experiencing sleeplessness, hot flashes and memory loss but does not feel comfortable with hormone therapy, what would you recommend that she try to reduce these symptoms?
A: For women who are uncomfortable using hormone therapy, the SNRIs Effexor and Pristiq seem to be the next-best choice. While not as effective as estrogen in relieving symptoms, they are the best available alternatives at present. Gabapentin is sometimes used as a backup therapy as well. For some women, the use of nutricuticals such as ginseng, primrose oil, and black cohosh seem to be somewhat helpful (though there is a lack of scientific evidence proving their efficacy), and some have said that acupuncture is helpful. All of this is after taking care of the fundamentals of dealing with the menopause:
1)??? Regular exercise
2)??? Dress in layers
3)??? Avoid spicy hot foods
4)??? Avoid hot drinks
5)??? Keep things in perspective.
5. Q:? Many women find that their libidos crash. Do you have a crash course answer???
A:? I know of no ?crash course answer? for ?crashing? libido. From a rational point of view, one has to treat and correct the underlying unpleasantness (menopausal symptoms and stresses that are almost inevitable at this time of life). Trying to make sex revolve around a date like when you were young and planning for it with a special evening seems to be helpful as well. Discussing the issue with one?s partner is always necessary and helpful. While there is no FDA approval for them, drugs such as testosterone and Flibanserin are sometimes used for women with hypoactive sexual desire disorder. Discuss the situation with your doctor. Referral to a sex therapist is sometimes necessary.
Thank you, Dr. Verkauf!
My conversation with Dr. Verkauf reminded me of something I found online recently, a thorough but thought-provoking scientific study related to the 2002 findings of the Women?s Health Initiative. (And by thorough, I mean thick with data. For the brave of heart, there is a link to it below.) This paper compares ?patterns of HRT use before and after the WHI in women newly diagnosed with menopause.?
According to the recent, follow-up study:
| Comparing 2 research groups, the percentage of women who: | Before WHI | After WHI |
| Initiated hormone therapy after symptom diagnosis | 56.9% | 31.3% |
| Initiated combination HRT | 21.9% | 7.2% |
| Initiated non-HRT | 42% | 66.1% |
| Use of SSRIs | 15.2% | 22.3% |
| Use of SNRIs | 1.6% | 7.2% |
| Use of tranquilizers | 9.5% | 15.8% |
The positive interpretation, and what I believe, is that women are ready to act decisively when presented with information that affects their health. Maybe that explains why the number of women who discontinue therapy is the same pre- and post-WHI (46%). The cautionary interpretation may be in how we react when we see or hear the results of a new study. If we react before getting all of the facts, we may find ourselves later on conducting a backyard search for the baby we threw out with the bathwater. Not that we needed a scientific study to realize this, but one of the main findings of the pre- and post-WHI report was this:
?This study?s findings suggest that women seeking treatment for menopausal symptom relief and women?s health professionals continue to work together to find the appropriate balance between therapy use and adherence to therapy use guidelines.?
I guess it?s reassuring when scientists generate reams of data that confirm what common sense told us all along. Before initiating, changing, or discontinuing any treatment, always ? Educate yourself. Talk to your doctor. And don?t forget to talk to your partner. After a libido-squelching discussion of the best way to treat your night sweats, brainstorm a list of libido-lifting ?activities? that will keep the fun kind of heat turned up in the bedroom.
Remember, reaching out is IN. Suffering in silence is OUT!
Tell me: What is your opinion on the use of antidepressants as an alternative to HRT to treat menopausal symptoms especially in women with no symptoms of depression or anxiety?
For more information on Dr. Barry Verkauf, USF Menopause Clinic, and the WHI study, check out these links:
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