Kathryn (Moderator) - 12:00 PM:
Our menopause chat is now open. You can submit questions at any time during this chat.

Dr. Margaret Salamon (NorthShore) - 12:01 PM:
Good afternoon. My name is Dr. Margaret Salamon. I am a gynecologist with NorthShore University HealthSystem. I’m excited to be here today to answer your questions about menopause.

  Marilee (Evanston, IL) - 12:02 PM:
If hot flashes do not go away after several years, could it be due to another health condition other than menopause?

Dr. Margaret Salamon (NorthShore) - 12:04 PM:
Marilee - that is a good question. Although it is possible that hot flashes are caused by another condition, generally if they start at the time of menopause, and continue on, they are best explained by the hormonal changes of menopause. Hot flashes can also be caused by triggers. For example spicy foods, coffee, chocolate can cause flashes for some women. Also stress can be a cause of hot flashes.

  Anna (Rolling Meadows, IL) - 12:06 PM:
I am on a low dose estorgen patch 0.1mg per day. At times, it seems that my symptoms of menopause subside and I go months with wearing my patch. Is there any harm going without that patch for months and then returning to the patch if symptoms increase?

Dr. Margaret Salamon (NorthShore) - 12:07 PM:
Anna - There are many different ways to use hormone therapy in menopause. Generally women do not use hormones intermittently. This is an involved discussion and it is important for you to sit down with a doctor to discuss details of correct ways to use hormones. Most importantly, if you are using estrogen and you have a uterus, you must also be using a progesterone to protect your uterus from a pre-cancer or cancer.

  Cheryl (Aurora, IL) - 12:07 PM:
I am 55 and have been experiencing sporadic very heavy clotting periods/bleeding. Is this common?

Dr. Margaret Salamon (NorthShore) - 12:11 PM:
Cheryl- It is very common in the years approaching menopause to have changes in your periods. Sometimes the bleeding can be heavier and sometimes lighter. You might skip some periods and then return to a normal cycle again. Sometimes women have very, very heavy periods with lots of clots. Although this is not uncommon, it is important that you discuss this with your doctor. Heavy bleeding can lead to anemia at times. It also can be a sign that something is wrong and this needs to be investigated further. If you have gone for a full year without a period then it is not normal to have any bleeding and you must follow up with your doctor for an evaluation right away.

  Debra (Evanston, IL) - 12:11 PM:
I have completely lost my libido (my poor but patient husband!!). Can hormone therapy help return those desires? If so, which hormones should I discuss with my own doctor?

Dr. Margaret Salamon (NorthShore) - 12:15 PM:
Debra -- This is really a VERY common problem for many women, and sadly there is no easy answer. Hormone therapy is not generally very effective in improving sexual desire. However, sometimes there is pain with sex, because of dryness in menopause, and vaginal estrogen can help improve this pain. Improving this pain, won't improve libido but should at least make it a little more fun. The only thing that I can suggest for increasing libido is to increase your sexual thinking, do something new and be creative.

  Sheryl (Round Lake, IL) - 12:16 PM:
Hi Dr. Salamon, good day, I am 51 and is in early stage menopause. How can you tell the difference between cervical cancer and menopause, being as the symptoms are so similar?

Dr. Margaret Salamon (NorthShore) - 12:21 PM:
Sheryl - Actually cervical cancer and menopause don't have lots of symptoms in common. The only overlap would only be with abnormal vaginal bleeding. Once you have entered menopause (have had no period for one complete year) you should not have any bleeding at all. If you do bleed, you should see a doctor for an evaluation. But, if you have had regular annual gynecologic exams with routine pap smears, cervical cancer will not be high on the list of what is causing the bleeding. This is a good time for me to stress that it really is important to stay up to date on your pap smears, because generally pap smears find pre-cancers of the cervix and keep women from having cervical cancer.

  Brenda (Matteson, IL) - 12:22 PM:
I'm 7 yrs into surgically-induced menopause. The hot flashes are,relentless. Did estrogen for 7 years, which was not helpful. What else can I do? It's so debilitating.

Dr. Margaret Salamon (NorthShore) - 12:26 PM:
Brenda - I am sorry to hear that you are having such a difficult time with hot flashes. I am surprised that the estrogen didn't help at all, and I would want you to make sure that you were taking the correct amount. When menopause is surgically induced in a younger women, they often need higher doses than with a natural menopause. But there are other things that you can do to help hot flashes. Some women find that regular aerobic exercise can make a big difference for them and can really improve the frequency of their flashes. As I mentioned in an earlier question, you could keep a diary and see if there are any triggers to your flashes and you might be able to help some of them this way. Finally, many women have excellent success using low dose anti-depressants to help with hot flashes. I have had many patients be cured of flashes using these medications.

  Toni (Evanston, IL) - 12:27 PM:
My body aches a lot over the past 6 months. Could this a symptom of menopause, and if so, what can I do to relief?

Dr. Margaret Salamon (NorthShore) - 12:29 PM:
Toni -- Body aches and joint pain can be seen in the early menopausal years. This is a symptom that should first be evaluated more carefully to make sure there is no other reason for it. But if it occurs right at the start of menopause, and you are having lots of other classic symptoms of menopause then it could be related. Exercise would be the first thing to try. If the pain is disruptive to your life, hormone therapy or a low dose anti-depressant can often be very helpful for this.

  Tess (Chicago, IL) - 12:30 PM:
Do women who have been through menopause still need an annual pap smear? Thank you.

Dr. Margaret Salamon (NorthShore) - 12:33 PM:
Tess -- this is a great question. Absolutely you should continue to have pap smears after menopause. The average age of menopause is 51-52 and you should continue regular paps until age 65. After 65, if you have never had a problem with abnormal Pap smears then you might be able to stop having them.

  Cornelia (Chicago, IL) - 12:34 PM:
I am 48 years old, is bloating a symptom of pre-menopause?

Dr. Margaret Salamon (NorthShore) - 12:37 PM:
Cornelia - In the years approaching menopause, there are many fluctuations in your hormone levels. Some women can experience increased bloating with these hormonal changes. It is similar to the way some women feel bloated just before their periods. However, if you are having severe bloating that is every day and lasting for months you should talk to your doctor about this.

Kathryn (Moderator) - 12:38 PM:
We are seeing a lot of questions come in - please feel free to continue to send, but we may not get to your question. We will work to address these after the chat.

  Jane (Niles, IL) - 12:40 PM:
Is it true that the earlier a woman started menstruating, the earlier she will start menopause? For instance, I started my first cycle at age 9. Does that mean I should expect menopause in my 30s or 40s?

Dr. Margaret Salamon (NorthShore) - 12:42 PM:
Jane - The average age girls start menstruating (in the US) is about 12 years old. The average age of menopause is 51-52. There is a slightly increased chance that women who started their periods at a very young age could have a slightly earlier menopause. But it is very unusual to have menopause before 40, and most women will go through menopause between the ages of 45 and 55. You might fall into the younger range here.

  Katie (Oak Brook, IL) - 12:46 PM:
Why is there so much controversy in regards to bioidentical hormone replacement? There seem to be women who take it who were on Doctor prescribed HRT, and have glowing feedback. Plus, everything I'm reading says it's supposed to minimize your chances of developing cancer as HRT may increase your risk.

Dr. Margaret Salamon (NorthShore) - 12:51 PM:
Katie -- I was worried that someone would ask this question because it is quite an involved answer. Different doctors have different opinions on this, and I can only give you mine. Generally when women are talking about "bioidentical hormones" they are referring to specially formulated compounded products. Because of a lack of FDA oversight, most compounded preparations have not undergone any rigorous clinical testing for either safety or efficacy, the purity, potency, and quality of compounded preparations are a concern. Because of the lack of scientific evidence for using these formulations, I prefer to use a more well studied combination of hormones. I know that many people talk about the idea that the bioidentical hormones are safer, but this is really just because there are not a lot of studies on their safety.

  Irene (Chicago, IL) - 12:55 PM:
My most annoying menopause symptom is night sweats, which wake me up 2 -5 times per night, causing poor sleep and the problems that follow that. What can I do?

Dr. Margaret Salamon (NorthShore) - 12:57 PM:
Irene -- Although the available treatments for hot flashes do not always cure hot flashes, they do offer relief. Hot flashes usually fade away eventually without treatment, and no treatment is necessary unless hot flashes are bothersome. A few women have an occasional hot flash forever. As I mentioned earlier in the chat, there are a number of low-risk coping strategies and lifestyle changes that may be helpful for managing hot flashes, but if hot flashes remain very disruptive, prescription therapy may be considered. Prescription hormone therapy (estrogen and progesterone ) is the standard treatment. 

For women who prefer not to take hormones or cannot take hormones, there are some non-hormone drugs approved to treat depression. Using these medications in a low dose often can really help with hot flashes.

  Fran (Chicago, IL) - 12:57 PM:
I just had a major bout with fibroids. 2 surgeries and no period for the last 2 years. I'm starting to spot occasionally and have constant sweating. I'm 53; is this a sign of menopause?

Dr. Margaret Salamon (NorthShore) - 1:00 PM:
Fran -- If you have not had a period for 2 years, you are considered to be in menopause. You must see a doctor for an evaluation to make sure that there is not a worrisome cause of your bleeding. Fifty three is still a young age and it is possible that you are still having some fluctuations of your hormones that could be causing the bleeding. But is is really important that you see a doctor to rule out a pre-cancer or cancer of the uterus.

Kathryn (Moderator) - 1:00 PM:
This will be the end of our chat. Thank you for your questions - we will be sure to provide follow up materials for the items we did not have time to address. For more information on the numbers from your checkups, or to speak with a specialist like Dr. Salamon, you can contact the Department of Obstetrics and Gynecology.