More Than Hot Flashes: Recognizing Perimenopause and Menopause Symptoms

Transcript:
Jamie Forward: Dr. Piasta, what are the early signs of this?

Dr. Jackie Piasta: There is no one menopause syndrome, so it can be so variable. I know for me, mine started distinctly at age 36, which is kind of thought to be on the younger end. I think I had the fortune of practicing in this field, so I sort of knew what to look out for. But it was night sweats and severe moodiness and a dip in my libido that was different from my typical baseline and wasn’t explained by other things. Dr. Ali mentioned that for women that don’t have their periods, that we can’t obviously use that period benchmark, so we get hormonal markers. But a lot of times, part of the workup is actually looking at other tests to make sure that these symptoms can’t be attributed to other things, and then we go on our path looking at treating the symptoms.

But again, the most common or the most well-accepted symptom of menopause and perimenopause is hot flashes and night sweats. We lump those under a term called vasomotor symptoms. But I hear things anywhere from brain fog, joint pain, tinnitus or the ringing in your ears, electric shocks down your body, vaginal dryness, dip in libido. There’s a myriad or a constellation of symptoms. It’s really important for people to recognize that it’s not just one thing. Our patients, as Dr. Ali said, they’re not the textbook where you don’t read the textbook, you can present in a variety of different ways.

Jamie Forward: Yeah. And it’s really different for everybody. 

So, you’re both in the clinic. So, Dr. Ali, what do you hear most often from women?

Dr. Nina Ali: You know, as Dr. Piasta mentioned, often the symptom that we know most about, talk most about are the vasomotor symptoms. But it’s really interesting, especially in this early part of perimenopause, oftentimes before those things start showing up, what we’re appreciating more and more is that hormone changes, and even sometimes mild changes that aren’t enough to affect our period pattern significantly can affect the way our brain functions. So, the sleep patterns, the mood-type things, those are often kind of early symptoms that are showing up, and there’s a lot of confusion around what the cause is of those, so that.

And, of course, the brain fog or not feeling like myself, these things that are hard to even express that something’s different, but it’s hard to put your finger on what exactly that is.

So, I’m hearing a lot about that. And then just general things affecting metabolism like fatigue, gaining weight even though I’m doing all the things, and I’m working really hard and working harder. So, those sorts of things. And then again, referencing back to the SWAN study, an appreciation that different ethnic groups sometimes are more likely to experience different symptoms. So, I found it so interesting to learn that women of Asian background may have more joint aches and those sorts of symptoms more so than other groups who have the hot flashes more dominantly.

So, there’s so much that we’re learning about it, but myriad of symptoms. We know hormone receptors are present in all tissues of the body, so we might all have the same hormone change happening but manifest that in different ways.

So, sometimes it’s just teasing out what could potentially be hormonal and then the added challenge on our end is, everything isn’t because of your hormones, there are also medical things that come up, issues that are natural parts of aging. So, we’re trying to just have an understanding and listen and take care of the whole patient.

Jamie Forward: Sure. And I think listening to your body obviously is so important. And, yeah, the cognitive part is so alarming at first when it’s like a word recall issue. It’s like …

Dr. Nina Ali: Absolutely.

Jamie Forward: Yeah. It’s constant. Good days and bad days though. So, there are also some lesser known symptoms that we often hear about. I know I’ve heard recently that frozen shoulder might be associated, and even one of our attendees sent in a question asking about sciatic nerve pain. So, Dr. Piasta, do you want to comment on some of the lesser-known symptoms?

Dr. Jackie Piasta: Sure. And I mentioned one earlier, which is tinnitus, which is the ringing in the ears. There’s also dry mouth. People can actually have itchiness in their ear or just itchiness all over. It’s really important to understand that there are estrogen receptors in every single cell of our body, and estrogen – I’m going to highlight estrogen here, not to say that our other reproductive hormones aren’t just as important, but estrogen really influences a lot of our bodily functioning. And so, when estrogen goes down in menopause as we go through menopause, that’s going to have some ripple effects on the body, and it’s going to create these symptoms.

Perimenopause into the first few years of the menopause transition is really this time of recalibration. So, I like to also reassure patients that for the most part, these symptoms do improve over time. So, while you might be experiencing hot flashes and night sweats or joint pain or something like that.

Or even brain fog tends to be actually one of the ones that tends to improve with time. Not joint pain so much because joint pain is this little marriage between the effects of estrogen loss and time and aging. So, as Dr. Ali said, many things are linked to menopause and are associated with the decline in estrogen. But it’s really important that we don’t put the brunt of the labor on it all being estrogen’s job to fix when we add estrogen back into the picture if that’s something that’s part of your care plan because there are certainly things that we know, particularly that estrogen is very good at doing just like we know our non-hormonals are good at doing. And there are things that it’s not very good at doing.

Like, let’s just take frozen shoulder for an example. Frozen shoulder is really something that I personally in my clinical practice haven’t had a lot of luck actually treating with estrogen. Is it heavily influenced by a decline in estrogen? One hundred percent. And inflammation, the inflammatory changes that happen in menopause.

But again it’s this sort of, we have to kind of make sense of a lot of the noise out there in terms of what is menopause, what is perimenopause, and then what we’re actually able to accomplish with the therapies that we have to give our patients and those people out there realistic expectations of what that looks like. Hopefully you agree, Dr. Ali.

Dr. Nina Ali: Yeah. Absolutely. And I think a lot of it – and honestly, we don’t have enough research and data into so many of these things. So, it puts us as practitioners and sitting down with your patient, it’s a one-to-one, and we have to be very frank and forthright about what we know, what we know well with good evidence, and really what we don’t know. And sometimes you’re in situations where you might have somebody with a frozen shoulder and it’s the timing of when we know they’re going through menopause, and it has come on at this time.

And say, “Hey, it’s the appropriate time for us to start hormone therapy with you. It’s going to help with your sleep and your hot flashes, we know that really well. And we may find out over the next few months if it is also going to help with your frozen shoulder. But if it’s not helping, definitely you want to pursue other known treatments.” So, it’s kind of navigating those areas where we really wish we had more info and hopefully that will be forthcoming, but we’re working with where we are now.