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Menopause

August 23, 2023 by John Ray

Menopause
North Fulton Studio
Menopause
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Menopause

Menopause (Episode 91, To Your Health with Dr. Jim Morrow)

Host Dr. Jim Morrow addressed the topic of menopause on this episode of To Your Health. He clarified what qualifies as menopause, how it’s diagnosed, the range of symptoms, potential treatments such as hormone replacement therapy, the impact on sleep, bone health, heart health, and more.

To Your Health is brought to you by Village Medical (formerly Morrow Family Medicine), which brings the care back to healthcare.

About Village Medical (formerly Morrow Family Medicine)

Village Medical, formerly Morrow Family Medicine, is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Village Medical one that will remind you of the way healthcare should be.  At Village Medical, we like to say we are “bringing the care back to healthcare!”  The practice has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Village Medical offers a comprehensive suite of primary care services including preventative care, treatment for illness and injury, and management of chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD) and kidney disease. Atlanta-area patients can learn more about the practice here.

Dr. Jim Morrow, Village Medical, and Host of To Your Health with Dr. Jim Morrow

Covid-19 misconceptionsDr. Jim Morrow is the founder of Morrow Family Medicine. He has been a trailblazer and evangelist in healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook | LinkedIn | Twitter

The complete show archive of To Your Health with Dr. Jim Morrow addresses a wide range of health and wellness topics.

Dr. Morrow’s Show Notes

What is menopause?

  • Menopause is when a person’s menstrual periods permanently end. 
  • Perimenopause is the term for the 3 to 5 years around the time of menopause and before your final period. During this time, people experience fewer periods that are further apart.

When does menopause occur?

  • The timing of actual menopause is different for each person. 
    • The average age for a person to have their last period is about 51. 
      • But it’s normal for menopause to occur any time from age 40 to 59. 
      • A person often goes through menopause at about the same age as their mother.
  • You may stop having periods early (before age 40). 
    • If so, your doctor can do a blood test to see if you’re actually going through menopause. 
      • If you’re not, the doctor will look for another cause for your missed periods.
  • Menopause is a gradual process that can take several years. 
    • You’re not really through menopause until you haven’t had a period for 12 months. 
      • (During this time, keep using birth control if you don’t want to become pregnant.)
  • People who have both ovaries removed during surgery will go through “surgical menopause” at the time of their surgery. 
    • If the uterus is taken out but the ovaries are not, a person will stop having periods, but they will not go through surgical menopause.

What causes menopause?

  • Menopause is what happens when your ovaries stop producing the hormones that control menstruation. 
    • These hormones are estrogen and progesterone. 
    • Without these hormones, your body will no longer release an egg each month.

How is menopause diagnosed?

  • If you believe you are going through menopause and have concerns, talk to your doctor. 
    • Menopause does not require an official diagnosis unless you want to confirm it. 
      • Your doctor may order a blood test to check your hormone levels. 
      • They will check for estrogen as well as a follicle-stimulating hormone (FSH).

Can menopause be prevented or avoided?

  • Menopause cannot be prevented or avoided.

Symptoms of menopause

  • Symptoms of menopause vary. 
    • Some people just stop having periods. 
      • Most people experience some symptoms, such as the following:
        • A change in your menstrual cycle.
          • This is one of the first signs of nearing menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.
        • Hot flashes.
          • Hot flashes are the most common symptom of menopause. When you have a hot flash, you’ll feel warm from your chest to your head. These often happen in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.
        • Vaginal dryness.
          • During and after menopause, the skin of your vagina and vulva (the area around your vagina) becomes thinner. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex. You may need to help supplement vaginal moisture to make sex less painful. You can use an over-the-counter water-based sexual lubricant (such as K-Y Jelly). Or you can use moisturizers for the vaginal area (such as Vagisil). You can also talk to your doctor about the benefits and risks of using prescription estrogen cream for vaginal changes.
        • Urinary tract problems
          • You’re more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom more often or feel an urgent need to urinate. Also let your doctor know if you feel a burning sensation when urinating or are not able to urinate.
        • Headaches, night sweats, trouble sleeping, and tiredness. 
          • As you’re going through menopause, you may have trouble falling asleep or staying asleep. Night sweats may wake you up. You may not get enough rapid eye movement (REM) sleep (the stage of sleep during which you dream). A lack of REM sleep may make you feel tired, moody, and stressed out.
        • Weight gain
          • Many people gain weight during menopause. A healthy diet and exercising most, if not all, days of the week will help keep you fit.
  • Talk to your doctor if you have:
    • A change in your monthly cycle.
    • Heavy bleeding.
    • Bleeding that lasts longer than usual.
    • Bleeding more often than every 3 weeks.
    • Bleeding after sexual intercourse.
    • Any blood spotting between periods.

Does menopause have emotional symptoms?

  • Many people experience emotional symptoms during menopause.
    • These symptoms may include sadness, anxiety, and mood swings. 
    • For some people, symptoms can be severe. 
      • If you find that you’re having emotional problems, talk to your family doctor.

Menopause treatment

  • There isn’t a set treatment for menopause. 
    • There are ways to manage some of its symptoms. 
    • Talk to your doctor if you are struggling with hot flashes, if sex is painful, or if your emotions seem unbalanced.

What is hormone replacement therapy?

  • Hormone replacement therapy (HRT) is a treatment for menopause symptoms. 
    • It involves taking synthetic hormones (which are made in a laboratory rather than by the body). 
    • HRT can involve taking estrogen alone or estrogen combined with another hormone, progestin. 
    • Some people have found that HRT can relieve menopause symptoms. 
    • These symptoms include hot flashes, vaginal dryness, and some urinary problems. 
    • However, HRT is not for everyone. 
      • Recent studies suggest that for most people, the risks of using HRT may outweigh the benefits. 
      • Talk to your doctor about the risks and benefits of HRT.

Are other treatments available?

  • Yes, other medicines may help ease some menopausal symptoms. 
    • These include estrogen cream, low-dose antidepressants, soy products, and certain herbal supplements. 
      • Discuss these options with your doctor.

What are phytoestrogens?

  • Phytoestrogens are plant-based substances found in some cereals, vegetables, beans and other legumes, and herbs. 
    • They may work in the body like a weak form of estrogen. 
      • Researchers are studying whether phytoestrogens can be used to relieve some symptoms of menopause. 
      • They are also studying the side effects caused by these substances. 
      • Many soy products are good sources of phytoestrogens. 
      • These include tofu, soymilk, and soy nuts. 
        • Some studies indicate that soy supplements may reduce hot flashes after menopause.
  • However, the results haven’t been consistent. 
    • There is not enough scientific evidence to recommend the use of herbs that contain phytoestrogens to treat symptoms of menopause. 
      • This is also true of pills and creams made with these herbs. 
      • In addition, not enough is known about the risks of using these products. 
      • Herbs and supplements are not regulated like medicines. 
        • Some herbs and supplements can be harmful when combined with certain medicines. 
        • If you’re considering using any natural or herbal products to ease your symptoms, talk to your doctor first.

Living with menopause

    • Living with menopause is easier for some people than others. 
      • It depends on the severity of your symptoms. 
      • Use these tips to help ease symptoms and to learn more about how to deal with menopause.
  • Should I avoid certain foods or drinks during menopause?
        • If you have hot flashes, you may want to avoid spicy or hot foods and drinks. 
        • These can trigger hot flashes. 
          • Alcohol can trigger hot flashes, too. 
          • It also interferes with bone growth and calcium absorption. 
          • People who are going through menopause should avoid or limit alcohol.
  • Can my diet affect how well I sleep?
      • The following tips can help reduce sleep problems:
        • Eat regular meals at regular times.
        • Avoid late-night meals and heavy late-night snacks.
        • Limit caffeine, which is found in coffee, tea, chocolate, and cola drinks. 
          • Caffeine stays in the bloodstream for up to 6 hours and can interfere with sleep.
        • Avoid alcohol. 
          • It may make you feel sleepy, but it actually affects the cycle of REM and non-REM sleep. 
          • This may cause you to wake up throughout the night.

Help for hot flashes

  • Turn your thermostat down. Sleep in a cool room.
  • Dress in layers, so you can remove clothing when you get too warm.
  • Wear cotton and other natural fabrics that “breathe” so you don’t get overheated. Use cotton sheets on your bed.
  • Drink cool water or other beverages when a hot flash starts.
  • Get plenty of exercise.
  • Find out what triggers your hot flashes and avoid them. Spicy foods, alcohol, tight clothing, and hot, humid weather are some common triggers.

How does menopause affect bone health?

  • The older a person is, the greater their risk of osteoporosis. 
    • A person’s risk becomes even greater when they go through menopause. 
    • When your estrogen level decreases during menopause, you lose more bone than your body can replace. 
    • This makes your bones weaker and more likely to break. 
    • To keep your bones strong, it’s important to get enough calcium and vitamin D in your diet. 
    • These help your body absorb calcium. 
    • Your doctor can suggest ways to get more calcium through food, drink, and, possibly, a calcium supplement. 
    • They may also suggest that you take a vitamin D supplement to help your body process calcium. 
    • Ask your doctor what amount of daily calcium and vitamin D is right for you.

How does menopause affect heart health?

  • People are more likely to develop heart disease after menopause. 
    • Lower estrogen levels may be part of the cause. 
    • It also could be that other health issues that are more common as people get older. 
      • These include gaining weight, becoming less active, and developing high blood pressure or diabetes. 
      • You can reduce your risk of these health problems by eating a variety of healthy, nutrient-rich foods. 
      • It also helps to stay active and maintain an appropriate weight.

Previous experience with hormone replacement and how science continues to change the way we practice.

Tagged With: Dr James Morrow, hormones, Hot flashes, HRT, menopause, night sweats, osteoporosis, post & pre menopausal, postmenopausal women, Village Medical, weight loss after menopause, women's health

To Your Health With Dr. Jim Morrow: Episode 17, Testosterone

September 25, 2019 by John Ray

North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 17, Testosterone
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

To Your Health With Dr. Jim Morrow: Episode 17, Testosterone

How do men and women know if they have low testosterone levels? What are the symptoms of low testosterone levels due to aging, as well as other causes? Dr. Jim Morrow answers these questions and more on this edition of “To Your Health.” “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Testosterone

Physiology of Testosterone and Causes of Hypogonadism in Males

  • Testosterone is produced by the testes.
  • Decreased production of testosterone by testes in men is categorized as hypogonadism.
  • Primary hypogonadism is the failure of the testes to produce sufficient testosterone.

 Testosterone Therapy

  • Testosterone therapy is increasingly common in the United States, and many of these prescriptions are written by primary care physicians.
  • There is conflicting evidence on the benefit of male testosterone therapy for age-related declines in testosterone.
    • Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia.
    • The U.S. Food and Drug Administration clarified in 2015 that prescribing testosterone for low testosterone levels due to aging constitutes off-label use.
    • Depressed mood, fatigue, decreased strength, and a decreased sense of vitality are less specific to male hypogonadism.
    • Testosterone therapy should be initiated only after two morning total serum testosterone measurements show decreased levels, and all patients should be counseled on the potential risks and benefits before starting therapy.
    • Male hypogonadism should be diagnosed only if there are signs or symptoms of hypogonadism and total serum testosterone levels are low on at least two occasions.
    • Potential benefits of therapy include
      • increased libido,
      • improved sexual function,
      • improved mood and well-being, and
      • increased muscle mass and bone density;
      • however, there is little or mixed evidence confirming clinically significant benefits.
    • The U.S. Food and Drug Administration warns that testosterone therapy may increase the risk of cardiovascular complications.
      • Other possible risks include
        • rising prostate-specific antigen levels,
        • worsening lower urinary tract symptoms,
        • polycythemia, and
        • increased risk of venous thromboembolism.
        • Patients receiving testosterone therapy should be monitored to ensure testosterone levels rise appropriately, clinical improvement occurs, and no complications develop.
        • Testosterone therapy may also be used to treat hypoactive sexual desire disorder in postmenopausal women and to produce physical male sex characteristics in female-to-male transgender patients.

Monitoring of Men on Testosterone Therapy

  • Men receiving testosterone therapy should be monitored regularly for adverse effects and to ensure normalization of serum testosterone level.
  • Before initiation of testosterone therapy, testing should include:
    • a complete blood count to measure hematocrit, and
    • a PSA test to detect preexisting prostate cancer.
  • Patients should be reevaluated for therapeutic response and adverse effects three to six months after initiation of treatment, including:
    • a repeat testosterone measurement,
    • complete blood count,
    • and PSA test.
  • Reevaluation needs to be performed regularly.
  • An increase in hematocrit to greater than 54% should lead to
    • cessation of treatment,
    • lowering of the dose, or
    • change to a lower-risk formulation.
  • An increase in PSA of greater than 1.4 ng per mL (1.4 mcg per L) over 12 months or an abnormal digital rectal examination result should prompt referral to a urologist.

Testosterone Therapy in Women

  • In women, testosterone is produced by the ovaries and adrenal glands, and by conversion of proandrogens in peripheral tissues.
  • Levels decrease gradually starting in the 20s or 30s.
  • There is no abrupt decrease during menopause, with the exception of surgical menopause.
  • Testosterone is also converted to estrogen by aromatases in many tissues; therefore, testosterone is an important source of estrogen in postmenopausal women.
  • Testosterone deficiency in women may be associated with problems with sexual function, mood, cognition, and body composition.
  • A comprehensive meta-analysis of post-menopausal women found improvement in sexual function with testosterone therapy.
  • There was no evidence of improvement in
    • anxiety,
    • mood,
    • body weight or mass, or
    • bone density.
    • Subsequently, a consensus statement released by several major organizations, including the Endocrine Society and American College of Obstetricians and Gynecologists, supported the use of testosterone therapy for hypoactive sexual desire disorder in postmenopausal women but not for any other indication.
    • Of note, there are no FDA-approved products for testosterone therapy in women, and no formulations are readily available in the United States that provide the recommended treatment dosage for women (300 mcg per day), necessitating the use of compounding pharmacies.

Tagged With: Cumming doctor, Cumming family care, Cumming family doctor, Cumming family medicine, Cumming family physician, Cumming family practice, Cumming md, Cumming physician, Dr. Jim Morrow, erectile dysfunction, female testosterone, female-to-male transgender, hypoactive sexual desire disorder, hypogonadism, increase in PSA, libido, loss of body hair, male testosterone, male testosterone therapy, menopause, Milton doctor, Milton family care, Milton family doctor, Milton family medicine, Milton family physician, Milton family practice, Milton md, Milton physician, Morrow Family Medicine, normal testosterone levels, postmenopausal women, prostate cancer, PSA test, serum levels, serum testosterone levels, sexual dysfunction, sexual function, Testes, testosterone, testosterone deficiency, To Your Health, urinary tract symptoms

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