“Menopause” – with Dr. Michael Silverstein
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In this episode, Dr. Michael Silverstein explains menopause, including symptoms and treatment options. According to Dr. Silverstein, physiologically, menopause occurs when the ovaries have stopped growing follicles. He says that it’s not that the woman is “running out of eggs,” they simply atrophy. The average age to begin menopause is 52, though this can vary. The major symptoms of menopause include hot flashes, insomnia, vaginal dryness, and mood swings, with symptoms typically beginning in the mid-forties.
Treating Menopause Symptoms
Dr. Silverstein notes that among his patients, hot flashes are “typically the most disabling” symptom. He also says that “all symptoms are easy to treat without hormones, aside from hot flashes.” Most of the symptoms of menopause are caused by lower levels of estrogen, and in the past, all menopausal women were treated with hormone replacement therapy. However, Dr. Silverstein explains that “there’s always been an association with a mild–10%–increase in breast cancer with taking estrogen.” For this reason, he says that the Women’s Health Initiative is now in favor of hormone replacement therapy “in the lowest dose, for the shortest time necessary” and that those taking estrogen should have more frequent mammograms. Dr. Silverstein also says that hormone replacement therapy is “on a case-by-case basis and an ongoing conversation with your gynecologist.”
Decreased bone density is another concern that is caused by lower levels of estrogen. Dr. Silverstein explains that this is why older women fracture bones more frequently or lose height. According to Dr. Silverstein, it’s important for gynecologists to intervene early, and he recommends calcium supplementation and weight-bearing exercise, “which we encourage women at all ages to do.”
Dr. Silverstein explains that among all women, there is a range of zero to a lifetime of menopause symptoms. “If you had to pick a middle area, I would say 3-9 months,” he says. Additionally, Dr. Silverstein finds that it is difficult to predict what an individual is likely to experience as she nears menopause.
Gynecologist as Primary Care Doctor
Dr. Silverstein notes that “at least 75% of my GYN patients don’t have a regular medical doctor,” and that gynecologists often serve as primary care providers. Dr. Fox adds that “some gynecologists are quite comfortable doing primary care, and others are less comfortable.” He urges women to ask themselves “am I getting everything that I need from my gynecologist, or do I need to see another doctor?”
Dr. Silverstein recommends that his patients start having breast ultrasounds and mammograms at 40, colonoscopies at 50, and a Pap smear every three years in addition to their well-woman visit. He also urges patients to have regular bone density checks and any other necessary exams.
Some particular concerns among women in their 40s and above are heavy and more frequent bleeding, which can be signs of endometrial cancer or other medical problems. “The management is often medical and very rarely surgical,” Dr. Silverstein explains. Dr. Fox adds “if caught early, it’s almost universally cured.” In addition, if a woman stops bleeding, then suddenly starts again, Dr. Silverstein explains that “sometimes, if the lining of the uterus breaks down, it exposes blood vessels.” This is treatable, and not necessarily too concerning.