Menopause is defined as the last menstrual period.  It signals the end of reproductive life.  It is the end of ovulation and the end of estrogen production.  The average age of menopause is 51.4.  Perimenopuase on the other hand is the years leading up to menopause - usually 4 to 8 years prior to menopause.  The average age of the perimenopause is 47.5 and is thought to be the years of "hormone imbalance".

There are some 43 symptoms of menopause, including hot flashes, night sweats, increased moods, and irregular periods, leading to no period.

But, also very common are weight gain, low libido or sex drive, inability to sleep, foggy brain and forgetfulness, as well as many other very bothersome symptoms such as decreased energy, overall body aches, and skin wrinkling.

Why are women so frustrated?  Because they are overwhelmed with information, confused about therapeutic options, and do not know who they can trust to help them through the menopause transition.  Often, they have tried a few options without relief or they have found relief but then heard something on the news that scared them, and they do not know what to do.  What they read is confusing and contradictory, and they do not know where to turn.  They are looking for an open-minded partner to help them to navigate their ways through these changes.

Menopause receives minimal attention in medical school and residencies.  Doctors have little knowledge about menopause when they go into practice.  And, they have little interest in menopause because they are so busy dealing with other areas of obstetrics and gynecology, for example pregnant women, birth control, abnormal Pap smears, etc.  OB/GYN is a busy specialty.  It takes time and knowledge to help women with menopause.  I recognized this early in my practice and found that I had the knowledge, interest, and expertise.  I have a Ph.D in chemistry, which coupled with my training in OB/GYN, allows me to understand hormones.

I also have abundant knowledge and training in natural and herbal therapies.  After more than 25 years of practice, I am one of the world's experts in menopause.  And, I believe in the mind-body approach.  Working with patients, I found that I have been very successful at helping women manage their menopause successfully, naturally and safely.

A perfect menopause means just that - that women can find ways to make the time of menopause and thereafter - the best years of their life.

There is a "secret" for every woman's perfect menopause.  It is an individual prescription.  But the woman must be willing to search for the prescription and be open ot receiving it just like the book "The Secret".

The most common misconception is that hormones are unsafe, risky and poison.  There is also misunderstanding of what really is "natural" and most women as well as healthcare providers do not understand the longer term issues of menopause, their importance, and that the aging process is part of this.  Not understanding the role of hormones in the longer process is a significant issue.

You think hot flashes, night sweats, and irregular periods would be the most common complaints, and they are common concerns and women need help with these.  But the most frustrating concerns are weight gain, decreased sexual interest (low libido), and problems with sleep.

I believe that there are three main categories of menopause therapies:

1.  Natural and herbal therapies, which include good nutrition and exercise, supplements, herbal therapies, and vitamins and other natural therapies such as meditation, hypnosis, yoga, Pilates, etc.

2.  Medical therapies - pharmaceutical drugs that can help with menopause symptoms.

3.  Hormonal therapies.

The benefits and risks of each would depend on the individual situation.  A woman's medical situation, personal philosophy, and severity of the situation must all be taken into account.

Keep in mind that the management of menopause should not be just a concern over hot flashes or low libido, or even weight.  It also has to do with the longer term menopause symptoms which include but are not limited to the prevention of cardiovascular disease, the prevention of bone loss and osteoporosis, prevention of cognitive disorders and Alzheimer's, as well as the prevention of dryness - body dryness inside and out along with skin aging nad other organ aging.  I recommend that women do not let themselves become a raisin - instead stay a grape!

Complete menopause management must keep these issues in mind.

I believe history helps us a great deal in understanding menopause.  Menopause is only about a hundred years old.  Before 1900, women usually did not live long enough to achieve menopause.  But since then, most women live to experience menopause.  So, we are still learning a lot about menoapause.

Before 1900, those women who did live into the menopause years found many natural ways to cope - mostly by finding sources of hormones.  For example, the elderly women in ancient times drank the urine of the young (hormones); the women of the 1800s ingested ground-up animal gonads (hormones), and women of hte early 1900s found urine extracted hormones.  These natural tendencies surely help us understand natural solutions to menopause problems.

There is alot of confusion regarding bioidentical hormones - especially on the Internet.  This is an extremely important concept for women to understand; the word bioidentical is used by entrepreneurs to imply that they are safe for women.

Read this carefully:  BIOIDENTICAL MEANS THE SAME MOLECULAR STRUCTURE AS THE HORMONE PRODUCED BY THE BODY.  So, bioidentical estrogens include estradiol, estrone, or estriol.

Bioidentical estrogens can only be obtained by:

1.  The extraction of urine of women.

2.  Laboratory conversion of plant intermediates.

Bioidentical estrogen preparations can be prepared for human use by:

1.  Pharmaceutical companies.

As well as:

2.  Compounding pharmacies.

Bioidentical does not mean compounded - this is very important!!!

Once the woman understands that bioidentical does not mean compounded and does not imply safe then I prefer the use of bioidentical because it seems to me that that is the more natural approach.

A lot has happened since WHI/2002.  It is important for women to realize that while this important study was a milestone in the history of menopause and hormone therapies, it did a great deal to give women a false scare into the risks of hormone therapy, turning them away from what could be an important prescription for long-term health and aging (for example, hormones).

First, much of the original findings of the WHI were taken back in 2002.  They recognized that the study was done incorrectly and on the wrong women, using the wrong hormones and, they found that inappropriate conclusions were therefore drawn from the study.

Here are some examples:

1.  The breast cancer risk was well overstated.

2.  The results are different with estrogen therapy alone, as well as estrogen with natural progesterone.

3.  For women 45 to 60, there actually is a window of opportunity to prevent, with estrogen therapy, cardiovascular disease, bone loss and osteoporosis, cognitive decline in Alzheimer's, skin aging/dryness.

We need to be talking more about these big benegits. 

The "risks" promoted by WHI 2002 and the media sound bites did a great disservice to women.

Weight gain beginning in the early to mid 40's, due to metabolic change, is a known phenomenon but we are not sure why.  There are lots of possible explanations.  It is likely that a combination of aging and declining hormones is responsible.  We do know that the hormonal balance in the perimenopause and menopause years, with the significantly decreasing estrogen, and the minimally decreasing testosterone, leads to change in the estrogen-to-testosterone ratio, and an increased incidence of the metabolic syndrome.  This is probably one of the causes.

No matter what the cause, decreasing metabolism and the natural tendency to be less active with age is ultimately responsible for the weight gain.

Dryness inside and out becomes noticeable after menopause.  Estrogen is very important in the hydration of skin as well as the maintenance of collagen, the basic matrix of the skin.

Dryness, and loss of collagen, leads to thin, wrinkled skin and increased overall body dryness, inside and out.

This dryness and thinning makes you into a raisin - from a grape!  By continuing to be a grape and not a raisin, you will go a long way towards prevention of aging.

We recommend aggressive hydration using fluids, humidifiers in the house, body moisturizers, vitamins and supplements, and even a consideration of estrogen for this problem.

Estrogen plays a big role in aging (did you ever notice as a couple ages, the woman physically ages faster?) and, have you ever noticed the physical appearance of the drying, aging genitals?  Susan Wyskowski, a nurse practitioner, national menopause expert, and a long term colleague, advises patients and friends to look at their aging genitals to recoginize this phenomenon.  "Have you looked at your genitals?  As you age, you will note its not pretty!"

1.  Estrogen is necessary for vaginal moisture, thickness, and vitality.

2.  Estrogen is necessary for excretion of vaginal fluids for intimacy.

3.  Estrogen is necessary for increased blood flow needed for excitement, pleasure, and orgasm.

Hormones play a big role in sexuality, and their decline obviously will affect one's sexual function.

So does of course the relationship!  Menopause is a great time to look at one's health in general, which includes the health of the relationship.

Male menopause is a very real phenomenon.  This is a time where many men begin to note a decrease in sexual desire, an increase in erectile dysfunction, and as with women, and overall increase in weight, especially in the midsection.  Sometimes the male will have lost interest in many things, and prefer to spend more and more time on the couch watching sports, rather than being actively involved.

A male menopause can vary from mild (which is actually known as male menopause) to severe - which involves a decrease in hormones and is called andropause.

The Internet can be very helpful to find some information on many things.  The Internet is a very useful source, and will be more so as the years progress.  Menopause is no different, and can  be extremely useful in helping women "find answers".

But, it is also rich with entrepreneurs, selling things.  It is very hard to tell the difference.  I advise patients to be very careful and selective with those things on the Internet associated with selling something.  A day does not go by without a patient bringing and/or calling me regarding a product that "cures" menopause symptoms, that she found on the Internet, and you can be sure it is usually not cheap.

We tell patients that it is important to search the Internet, getting some basic information, and using these concepts to develop questions to bring and to discuss with us at the office.  If it sounds too good to be true, it probably is, as the old saying goes.  But it does not mean there are not lots of option that are safe.

Also, it is very important for the woman to understand that the Internet cannot help with all her individual situations.  A trusted and knowledgeable healthcare provider can help her a great deal when she has done her basic research on the Internet.

Do not forget, I believe in the perfect menopause!  But it is an individual prescription - and needs to be given by a qualified practitioner.

Make sure your therapies and advice are kept up-to-date.  As Albert Einstein said "the answers are constantly changing".  It is difficult to keep up with current advice and knowledge on any topic, and menopause is no different.

We are designing our web site in order to help with this concept.  Stay tuned to our web site to keep up-to-date with the latest concepts, options, or even controversies regarding menopause and menopause therapies.