Menopause is a natural part of aging, ushering women into their next life stage. It occurs when women’s ovaries stop producing hormones, and they have not had a period or spotting for an entire year.
While some women have no signs, others can experience challenging symptoms, among them hot flashes, night sweats, painful joints, depression, difficulty concentrating, and mood fluctuations that can last for several years.
On Nov. 19 at 6 pm at the Vineyard Haven library, Daniel E. Pesch, MD, and Marcy E. Holmes, NP, will look at how our understanding and treatment of menopause have changed over the years, along with the latest recommendations.
Pesch is the associate chief medical officer and vice president of medical affairs at Martha’s Vineyard Hospital. He is an obstetrician-gynecologist with more than 33 years of experience. In our conversation, Pesch reflected that before the Women’s Health Initiative landmark 2002 study, there was widespread use of hormone replacement therapy to manage symptoms. However, when the study indicated that using estrogen plus progesterone hormone therapy after menopause could raise the risk of heart disease, stroke, blood clots, breast cancer, and dementia, its use decreased by almost half.
“It was a landmark piece of research that gave us a lot of information about hormone replacement therapy for women’s health,” says Pesch. “It swung the pendulum back so far that we stopped prescribing.”
“In the years since its publication, we’ve learned much more,” he continues. “What I credit it with is that it made us think a lot more about estrogen and progesterone and hormonal medications as medicines. It is not that they should never be prescribed, but it should be done cautiously and appropriately. The nuances are the timing of starting hormone replacement therapy, and how long you should be on it. We can quantify the risks for patients, and I credit the Women’s Health Initiative for that.”
Pesch will also speak about where science is today. For instance, there are medications to extend endogenous hormones (those produced naturally within the body) to allow women to cycle longer, because it can help maintain bone mass and prevent heart disease. There are pluses and minuses when it comes to other risks. However, the frontier of menopause medicine is expanding.
Holmes has been an adult primary care nurse practitioner at Martha’s Vineyard Hospital since 2017, and has helped women seeking options for perimenopause or menopause symptoms. She will address different types of therapies, nutrition, and lifestyle strategies. “If someone is suffering, we have a host of nonhormonal remedies, but nutrition and lifestyle are still paramount. I refer to the big bad four as sugar, alcohol, caffeine, and stress — which are always going to make a variety of symptoms worse.”
Holmes points out that sometimes hormone replacement therapy might be an option, say, for hot flashes and night sweats. “The benefits are hot flash and night sweat reduction, less joint pain, better mood, and sleep. If you have more restorative sleep, then you have more energy, and then you have more lift in your mood. Side effects can be that hormones stimulate irregular breathing, breast tenderness, or nausea. However, these usually can be managed by slow introduction at a low dose.”
Holmes continues, “The hormones we are prescribing now, by and large, are bioidentical, which means they are a human match instead of being from an animal, so we have more hormone replacement choices available. Also, we now prefer lower doses delivered through the skin, which might reduce some of the risks.”
Pesch adds, “There are a lot of women who are on medications that treat the symptoms of menopause but are tangential, like Prozac. But while it may make hot flashes better in 60 to 70 percent of women, it only treats a little bit of the patient’s symptoms. Hormone therapy can treat them more globally if it’s safe for them. This way, they are not taking many separate medications, each with its own side effects. There are an awful lot of safe choices that women can take now.”
Holmes wants people to come away with an understanding of the options they have to help them with menopause-related symptoms. “Hormone replacement therapy is one of many. And you can’t escape the nutrition and lifestyle aspects to help your health and how you feel.”
Pesch says, “Since women are spending a greater portion of their lives in menopause, our responsibility in medicine and science is to ensure those years are well-lived, and that you have the opportunity to make informed decisions.”
Daniel E. Pesch, MD, and Marcy E. Holmes, NP, will present “Trends in Menopause — Then and Now” on Tuesday, Nov. 19, at 6 pm at the Vineyard Haven library. For more information, please contact the library at vhpl_programs@clamsnet.org, or 508-696-4211.
