Find a Great GYN When Your OB Days Are Done
Baby-making years a fading memory? Heading for menopause (along with a hot flash, or two)? Then it’s time to rethink your OB-GYN—and find a doctor who is less OB and more GYN. Your body is changing, and that means your needs are shifting, too. So, enough about preventing, encouraging, or sustaining a pregnancy! If you’ve gone 12 months without a period (the official definition of menopause), it’s all about decreasing estrogen and the many health issues that can stem from this loss. Look for a gynecologist who can explain and address these concerns. Here’s how.
New Symptoms , Increased Risks
“Menopause is a two-fold issue,” says Mary Jane Minkin, M.D., clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale Medical School in New Haven, CT. First, there are many possible symptoms to manage (which last, on average, anywhere from 3 to 12 years, and in 10% of women, forever), including hot and cold flashes, night sweats, insomnia, and waning libido. But that’s just the half of it: Serious health concerns, such as bone loss and heart issues, can arise, when estrogen levels (which affect many systems in the body, including the brain) plummet.
Hormones Are in Flux, Causing Mood Changes
During perimenopause (the transition leading up to menopause) your hormones fluctuate, says Rebecca Dunsmoor-Su, M.D., medical director for menopause at Swedish Medical Center in Seattle—which can trigger low mood. Women who struggle with depression or anxiety may see an exacerbation, especially if they’ve had a history of premenstrual syndrome (PMS), or its more serious cousin, premenstrual dysphoric disorder (PMDD). “Mood changes can be severe. Women shouldn’t be afraid to seek care,” she adds. The right GYN may suggest meds, including birth control to regulate hormonal fluctuations or antidepressants (prescribed by your GYN or a referred psychiatrist).
Sleepless Nights May Need Treatment
According to the Sleep Foundation, up to 47% of perimenopausal women and 60% of postmenopausal women report insomnia. Dwindling estrogen affects neurotransmitters involved in the sleep-wake cycle. Estrogen loss can also increase your body temp (hello, night sweats!), making things uncomfy. Hormone replacement therapy (HRT, more on that later) can help, but so can changes to your work habits, activity levels, what you’re eating, and even relationships, says Deepali Kashyap, M.D., a gynecologist in Henderson, NV. For some menopausal women, the supplement melatonin helps with Zzzs.
Zero Sex Drive
Among the menopausal women Dr. Kashyap treats, many report zero libido and painful sex due to vaginal dryness. And while these may seem like private matters, you should discuss them with your gynecologist. Both are side effects of decreased estrogen, but they can also be related to some other menopausal issues, such as weight gain and fatigue. “It’s important to feel energetic and have a good sex life,” Dr. Kashyap says. Your GYN can help with advice on hormones and lubricants, and can also examine what else might be going on in your life affecting your sex drive.
Bone Density Issues and Menopause
Bone health is a big concern as you move into your menopausal years. “If you look at the statistics, the most rapid time of bone loss happens within the first four years after menopause,” says Dr. Minkin. So, even though the recommended age for a bone scan is 65, she suggests her patients get a baseline scan once they’re fully menopausal. “If she’s not starting with such great bones to begin with, I want to know, so I can follow her closely.” If you haven’t gotten a baseline scan yet, ask your GYN if one is right for you.
Heart Problems Can Arise
What does your ticker have to do with your female hormones? A lot. Cardiovascular disease is the leading cause of death in U.S. women, with risk increasing in postmenopausal women. “In pre-menopausal women, there’s a stable relationship between estrogen and progesterone,” says Dr. Kashyap. “When that changes, it can lead to heart disease” because estrogen plays a protective role. Lifestyle factors in, too. According to the American Heart Association, only 7.2% of menopausal women get enough physical activity, and less than 20% eat a healthy diet. Your GYN can assess your risk factors to determine if you should see a cardiologist.
Pros and Cons of HRT
HRT can be a controversial topic, so you’ll want a physician who can explain the pros and cons of using it to treat your menopausal symptoms and prevent conditions like bone loss. “Hormone therapy is a safe and effective intervention for women, when done carefully,” says Dr. Dunsmoor-Su. Ask your GYN to explain bioidentical hormones (for example, estradiol and micronized progestin) verses compounds, as well as estrogen-only therapy over a combo treatment. Long-term data from the Women’s Health Initiative found that estrogen-only HRT lowered risks of breast cancer, while a combination hormone treatment increased it.
The Possible Cancer Connection
The risk of getting certain cancers goes up when you go through menopause, so talk to your doctor about the preventative screenings you should be getting. If you go through menopause after age 55, for example, you’re at increased risk for breast (40% higher than someone who went through it at 45, according to research), uterine, and ovarian cancers, likely because you’ve had more exposure to estrogen and more ovulations. Dr. Dunsmoor-Su says menopause is also a prime time to discuss other preventative testing such as cervix and colon screenings.
Find a GYN Who Gets You
According to a study in Menopause, fewer than one and five obstetrics and gynecology residents receive menopause training. With numbers like those, how do you find a great one? Word of mouth could help. If you have friends your age, ask where they go. “But your friends may not be a good judge of knowledge base and training,” Dr. Dunsmoor-Su comments. So, narrow down your list by checking out The North American Menopause Society (NAMS) to search for doctors in your area who are certified menopause practitioners. Or, look to major hospitals for menopause departments and specialists.
Menopause Training: Menopause. (2013.) “Menopause Education: Needs Assessment of American Obstetrics and Gynecology Residents.” pubmed.ncbi.nlm.nih.gov/23632655/
Sleep and Menopause: Sleep Foundation. (2021.) “Menopause and Sleep.” sleepfoundation.org
Bone Health and Menopause: Chronic Diseases and Translational Medicine. (2015.) “Primary Osteoporosis in Postmenopausal Women.” ncbi.nlm.nih.gov/pmc/articles/PMC5643776/
HRT and Breast Cancer: San Antonio Breast Cancer Symposium. (2019.) “Long-term Influence of Estrogen Plus Progesterone and Estrogen Alone Use on Breast Cancer Incidence: The Women’s Health Initiative Randomized Trials. abstractsonline.com/pp8/#!/7946/presentation/2229