Issue link: https://blog.providence.org/i/1444899
10 | Health Matters: Providence St. Joseph Hospital D iana Tran-Kim, DO, an OB-GYN on the medical staff at Providence St. Joseph, is adamant that perimenopause and menopause are just another stage of a woman's life. "Like the beginning of menses and childbirth, it is perfectly natural," she says. "I like to help women with transitions, and even though menopause is natural, it often comes with uncomfortable symptoms." The average age for menopause in the U.S. is 51.4. "The definition of menopause is cessation of the menses for a year," says Dr. Tran-Kim. "But before this, perimenopause can start at 45 or younger." Women often endure fatigue, hot flashes, heat intolerance, mood swings, increased infection, brain fog, sleep disturbances and vaginal dryness, among other things. WHAT TO DO? If you are experiencing any of these or other symptoms, Dr. Tran-Kim says, you should have a conversation with your OB-GYN. "We don't treat numbers, we treat clinical signs," she says. She is referring to the follicle-stimulating hormone (FSH) test, in which a high number denotes a reduced number of eggs. "You can have a high FSH number, though, and still be getting your period," she notes. The first order of business is to have an exam with your primary care doctor. "We want to check the thyroid—low thyroid can mimic many menopause symptoms—as well as vitamin D and iron," she says. "We also want patients to check blood pressure and risk for diabetes, and to get all of the preventive tests they need, such as mammogram, Pap smear and colonoscopy." Dr. Tran-Kim says that for women who come in during perimenopause with abnormal bleeding, the next step is to look for changes in the anatomy. "We do an ultrasound to check for fibroids, polyps and endometriosis," she says. "Then we also look at a woman's history of deep vein thrombosis (DVT), cardiovascular disease, stroke and smoking. All are risk factors that would affect the decision to prescribe hormone replacement therapy (HRT)." TREATMENT OPTIONS Treatment has a great deal to do with the length and severity of symptoms, according to Dr. Tran-Kim. "We have so many options nowadays. There are pills, transdermal preparations, rings and creams. The conversation with your doctor has to delve into what treatments you need to be comfortable and to function at a high level." Regarding treatment, Dr. Tran-Kim says, "We start with oral contraceptives, then we might use certain kinds of antidepressants that often help. For sleep disturbances alone, there are lots of things." HRT is the last line of defense. "When women are on HRT, we follow them carefully—usually a few times a year," she says. "Although the fear of replacing estrogen and progesterone isn't what it once was." Ultimately, Dr. Tran-Kim feels that women have options: "Many women just don't realize there is help and feel like they just have to endure. I say that they can have a good day-to- day quality of life without major symptoms." Menopause: Another Transition There is help for the uncomfortable aspects of this life change. Dr. Diana Tran-Kim