Monday, August 22, 2011

Is Hormone Therapy an Option in 2011?

Women need to know the risks and benefits of post-menopausal therapy

By Chris Danz, APNP
Nurse Practitioner


Despite the “information age” in which we live, confusion about post-menopausal hormone therapy persists. This is due to several factors.

In more than 60 years of research in menopausal medicine, studies have found both good and bad regarding hormone replacement therapy. The primary reasons for confusion regarding hormone therapy to treat the symptoms of menopause include:

• Menopause study results, which are fairly frequently changing, have not always been clearly communicated in an up-to-date manner
• Misrepresentation of study data by the media has at times resulted in further misinformation
• Outspoken celebrities, while making women aware of choices available to them, have provided information out of context at times, therefore contributing to misunderstanding of the risks and benefits of hormone therapy

In 2011, knowledge based on scientifically obtained information leads many menopausal experts to agree that hormone therapy for menopausal women can have a place in the management of symptoms of menopause.

Though not the only option, hormones are undoubtedly the most effective way to treat symptoms including:
• Hot flashes
• Night sweats
• Mood swings
• Cognitive changes (memory/focus)

Additionally, hormones are generally effective for treatment of vaginal dryness that results in pain with intercourse. Estrogen can also benefit fatigue, muscle and joint pain, and bone density. Although it continues to be debated, many physicians feel that if given early in menopause, estrogen can help minimize heart disease.

What about cancer risk with hormones?

In women who have a uterus, progesterone must be used in combination with estrogen to protect the lining of the uterus from becoming a cancer-prone environment.

Because estrogen and progestin used together appears to be the link between hormones and breast cancer, this is obviously of concern. However, newer ways of administering hormones using the lowest possible dose and cycling the progestin to limit exposure may decrease that probability.

Recent research has also found that numbers of years of use increases the risk most notably. Therefore, short-term use of hormones (less than 5 years) is generally recommended. Other risk factors such as age, weight and family history also indicate risk and need to be considered.

For every woman, both possible risks as well as potential benefits of hormone therapy need to be evaluated. Each woman has a unique health history and each patient’s symptoms, personal and family history, and long-term health goals need to be considered when making a decision to use or avoid hormone therapy.

If you do choose hormone therapy, here are some helpful hints to ensure you get the most benefit out of your menopause treatment plan:

• Work with your health care provider to individualize your menopause plan.
• Be comfortable with your health care provider and the information they are providing you.
• Request the lowest possible dose which allows you to be comfortable, and for the shortest duration of time, to get the greatest benefit while minimizing the risks.
• Request discussion about the safest possible way to deliver the hormones to your body.
• Follow up regularly with your hormone prescriber to be made aware of any changes in research or recommendations for hormone replacement. 
• Be aware that information in the media may be incorrectly represented. Find out the facts from your health care provider.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, August 15, 2011

Menopausal Symptoms & Stages

What you can expect during the stages of menopause

By Chris Danz, APNP
Nurse Practitioner
View Chris' Video Bio!


Although every woman experiences menopause uniquely and with variable intensity, most women will experience some symptoms. This is because most of the body’s organs have estrogen receptors, which are affected in one way or another by the circulating hormones. As the hormone levels decline, the resulting estrogen deficiency results in symptoms.

Menopausal symptoms can be divided into three (3) time frames:
• Early menopausal changes
• Intermediate menopause
• Perimenopause (“late” menopause)

The “early” menopausal changes often overlap with the perimenopause time. In other words, some of the early symptoms are a continuation of those noted as hormonal changes of the late 30’s and 40’s.

The most common early menopause symptoms, one or more of which 85% of all women will experience, are:
• Changes in energy level (fatigue)
• Joint or muscle pain
• Sleep disturbance
• Hot flashes
• Night sweats

Other early symptoms can be vaginal changes, breast tenderness, decrease in sexual desire, weight gain and increased abdominal bloating. Many women will also notice cognitive changes, which include change in mental alertness, memory and ability to stay focused.

Altogether, these symptoms often result in a general decrease in well-being, which can further fuel or cause depression.

Some early symptoms do resolve after a time as the body adapts to lower hormone levels.  However, many persist and progress to the intermediate and late menopausal time, when the longer time of hormone deficiency results in further issues.

Intermediate menopausal symptoms can include:
• Vaginal dryness
• Pelvic tissue changes that often result in painful intercourse
• Further decline in sexual responsiveness
• Bladder changes

Late menopause symptoms can include:
• Bone density loss that can result in osteoporosis
• Changes in the heart that make women at greater risk for heart disease
• In general, more issues of aging are noted

As you work with your health care provider to identify a plan of care for your menopause, it can be most helpful to provide him or her with a list of symptoms you are experiencing, along with a “rating” of those which you are most affected by. It is also helpful to share possible long-term issues which are most worrisome to you. In this way, each of you will be able to focus on those options which will result in optimal improvement in your health and well-being.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Tuesday, August 2, 2011

Puberty in Reverse -- Know Your Menopause

What to know and expect when entering the stages of menopause

By Chris Danz, APNP
Nurse Practitioner




Menopause is a time in a woman’s life where her body goes through many physical and physiologic changes, due to hormone changes. Providers specializing in menopausal medicine help women during this stage of life by educating them and advising them on treatment options for conditions that may arise.

What is menopause?
Menopause is generally considered the end of a woman’s reproductive life. The ovaries stop producing eggs and the hormones that bring about ovulation and the ability to get pregnant. The average age of menopause in the United States is about 51 years, though some women experience this change at 40, and almost all women will be menopausal by age 60. The average woman can anticipate spending one-third of her lifetime in menopause.

Estrogen is the most commonly discussed hormone of menopause. In fact, many of the changes which occur are directly related to estrogen decline. However, progesterone changes also contribute to the end of menstruation, and testosterone changes also occur, though generally more gradually.

How does menopause begin?
The first and most obvious change for a woman entering menopause is that menstrual cycles change and eventually, stop. By definition, a woman is considered menopausal if she has not had a period in one year.

Every woman will experience the hormone changes of menopause uniquely. For some, the onset may be very abrupt, quite intense, and difficult. For others, symptoms may be more subtle (or even absent). Most women will notice some symptoms, but these will vary from one woman to the next as to which ones are most bothersome to her.

What women need to know
However, whether symptomatic or not, women should understand the transition their bodies are undergoing, make choices and lifestyle changes to accommodate those changes, and embrace this new era in their female life-cycle.

Menopause is a relatively new phenomenon, as prior to 1900 many women did not live long enough to experience menopause. Because of this, the field of menopausal medicine is relatively new. There has been notable new knowledge and information in very recent years that affects choices available to women at this time in their life.

Despite the increase in available information, or perhaps because of it, many women are confused about menopause and treatment options they may have. Educating yourself is the first and most important step in managing your menopause. This blog will cover some of the issues related to menopause in the coming months. Topics will include:
* Symptoms of hormone decline
* Are hormones an option in 2011?
* Let’s talk about “bio-identical” hormones
* Non-prescription choices to manage symptoms
* Choosing a health care provider who will help meet your menopause treatment goals
* What about heart disease and menopause?
* Osteoporosis: am I at risk?
* Managing dryness - inside and out
* Menopausal weight gain
* Changes in sexuality
* Why am I not sleeping any more?

Stay tuned for these topics about menopause to be covered in upcoming blog posts!
Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.