Pink Prescriptions - December 2018



December 2018 Issue

Your December Pink Prescriptions column is all about The “M” word. And we don’t mean merry. We mean peri – and menopause. We asked our local health experts to answer some before, during, and after questions. Here’s what they had to say:

Am I experiencing menopause or perimenopause? How do I know the difference?
Menopause is defined by no menstrual cycle for at least 12 months. It occurs when your ovaries stop making estrogen. Perimenopause is the time frame prior to menopause when you start experiencing menopausal symptoms, such as hot flashes, night sweats, mood swings, and menstrual irregularities.
Most women start experiencing perimenopausal symptoms in their 40s, while the average age of menopause in the U.S. is 51. If you are still having menstrual cycles, but experiencing the above symptoms, then you are likely in perimenopause. If you have skipped your period for several months and are wondering if it is due to menopause, your gynecologist can check a lab called follicle stimulating hormone (FSH), which is elevated after menopause.

Marlena Mattingly Masavage, M.D. is an OB-GYN with Beaufort Memorial Obstetrics and Gynecology in Bluffton and Beaufort. Dr. Masavage earned her medical degree with high distinction at the University of Kentucky College of Medicine and completed her residency at Indiana University School of Medicine. During her graduate studies, she participated in the Global Health Track, serving rotations in both China and Kenya. She can be reached at 843-522-7820.

I have noticed that I have started to leak urine from time to time. Is this a normal part of menopause?
Although it’s not normal for anyone to lose urine at unwanted times, urinary incontinence affects six times more women than men, and is a common problem for women over 40. We all start to lose muscle around the age of 30, among them the muscles that support the pelvic floor, which includes the bladder, rectum, and vagina. Loss of this muscle tissue may result in decreasing control of the bladder, as well as other problems associated with pelvic organ prolapse. While not necessarily a direct cause of leaking, menopause and its resulting loss of estrogen will further decrease the strength and elasticity of the vagina, which can add to the loss of support.

Initial treatment for these problems can start at home with pelvic floor strengthening exercises, or Kegel exercises. These are easy to do and have essentially no side effects.

It is also helpful to identify any triggers in your diet which may aggravate urine loss (such as caffeine). Emptying your bladder on a schedule, as accidents are more common when your bladder is full, can assist in maintaining better bladder control.

These home treatments are helpful to most people, but may not give complete relief from your bothersome symptoms. There are a number of additional treatment options you may want to discuss with your physician. These include medications, physical therapy, support devices, or surgery.
A planned, systematic approach can usually be effective in helping to improve or cure your incontinence symptoms in order to maintain an active and healthy lifestyle!

Gregory Glover, MD, FACOG, FPMRS, is a board-certified urogynecologist with Werner & Glover Women’s Health in Beaufort. A member of the Beaufort Memorial medical staff, Dr. Glover specializes in female pelvic medicine and reconstructive surgery, treating such issues as incontinence, pelvic organ prolapse and overactive bladder. He can be reached at 843-524-2466.912.554.8220.

Is there a genetic connection to the way we go through menopause?
In other words: is my menopause going to be like my mom’s?
There is a genetic link to the age of menopause onset in approximately 50 percent of women. A woman may enter menopause at a young age if her mother had early onset menopause. Early onset menopause is when the ovaries stop functioning prior to the age of 40. However, this is not your mother’s menopause. Each woman experiences menopause differently. Symptoms may vary for each individual. Family history of particular symptoms, therefore, is not predictive of how you will experience menopause.

Dr. Soldrea Thompson, M.D., FACOG, is a board-certified OB-GYN with Beaufort Memorial Obstetrics & Gynecology in Bluffton and Beaufort. A graduate of the University of Chicago Parker School of Medicine, Dr. Thompson moved to the Lowcountry last year after several years in practice at the Cleveland Clinic’s Ashtabula County Medical Center. She can be reached at 843-522-7820.

What can I do to lessen my menopausal symptoms?
Bothersome menopausal symptoms such as hot flashes, night sweats, insomnia, and irritability are often exacerbated by things that we least expect. For most of our life, we have ways of dealing with side effects of food and alcohol, but when our estrogen is on a downward rollercoaster, these everyday things can make our symptoms even worse. Add stress to this equation and things can be just miserable.

Having a glass of wine with dinner, or a mixed drink, can show up as a series of night sweats four to six hours later and can also contribute to insomnia. While alcohol can help us relax and “chill out,” sometimes it warms the body and can increase hot flashes immediately or hours later. Eating spicy foods can also set off your body into menopausal power surges as you dilate your skin blood vessels to deal with the heat. Coffee, chocolate and tea containing caffeine are common culprits that make can amplify mild symptoms into bothersome full body hot sweats.

Aggravation is perhaps the most common reason patients suffer the most with menopausal symptoms. Estrogen is closely tied to the neurotransmitters in the brain such as serotonin that help keep us calm and cool. Rising blood pressure also can decrease your body’s ability to deal with heat so symptoms feel much worse. New research studying mindfulness practices, which can take as little as three minutes, have shown tremendous improvement of bothersome menopausal symptoms.

The list of treatments for menopausal symptoms continues to grow. From herbal remedies (soy, black cohosh, red clover) to antidepressants (venlafaxine, paroxetine) to hormonal therapies (estrogen, testosterone, progesterone) the right choice for you is very personalized. While it seems that summer lasts longer and longer in the South, your “personal summer” doesn’t have to with the right food and healthy lifestyle choices.

Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist at Beaufort Memorial Lowcountry Medical Group. A graduate of the University of Medicine and Dentistry of New Jersey, Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine. She can be reached at 843-770-0404.

Does birth control affect the timing or symptoms of perimenopause or menopause?
One of the more common reasons to start older women on low dose birth control is to treat the symptoms of perimenopause: irregular, sometimes heavy bleeding, mood swings, irritability, and early night sweats and hot flashes.

During perimenopause, the ovaries are releasing any remaining eggs irregularly, which results in these symptoms. Once a woman reaches menopause, there are no further eggs to release, estrogen levels go down and we see the symptoms associated with menopause, as well as some of the physical changes. Since a woman is born with the total number of eggs she will ever have, using birth control does not change when she will enter into menopause; it’s sometimes just harder to tell as birth control pills will also control the symptoms of menopause.

A woman on birth control may notice that her period gets lighter or goes away completely, signaling she has entered menopause. We also have blood tests we can do that let us know when a woman has entered into menopause. Once in menopause, we can then switch from the low dose birth control pill to even lower replacement doses of hormones to control menopausal symptoms, protect bones, and prevent vaginal dryness and pain with intercourse.

There are also some new studies coming out showing that estrogen replacement may help prevent Alzheimer’s disease by protecting the female brain. You should speak with your physician regarding what replacement regimen would be best for you and how long you should continue on it.

Dr. Laura Knobel is a board certified Family Physician seeing patients of all ages in Plantation Park in Bluffton. She has a direct primary care practice where you can get your primary care for $50 a month or less. Office phone: 843-836-2200.  Website:

Can I get pregnant during perimenopause?
A woman can absolutely get pregnant during perimenopause, which is the two to eight years prior to menopause (when periods have been absent for 12 months).  Perimenopause is a tricky time to track because it can start any time from 35 years old to 50 plus years in age. The average time frame is in the mid to late 40s, but every woman starts her hormone changes on her own biological clock. So, while some women are done with periods by 45, others are still ticking late into their 50s. It’s a confusing time because many of the changes mimic pregnancy: irregular periods, head aches, mood changes, hot flashes, nausea, and insomnia to name a few. A pregnancy test should be done if a period is late, and if it is negative, then the focus can be on symptoms.

Fertility rates decrease every year after 30: A woman at age 30 has about a 20 percent chance of conceiving each month, while that same woman at 40 would have about a 5 percent chance of pregnancy each month. By 45 years old, there is only a <1 percent chance of pregnancy each month. So, even though it may seem easy for 50-year-old celebrities to get pregnant, many of them are using the help of pregnancy specialists. So, even though the symptoms a woman is experiencing are more than likely perimenopause, in her 40s contraception should be used if pregnancy is not desired.

Dr. Tracy Blusewicz, M.D., F.A.C.O.G., compassionate, genuine bedside manner has earned her the trust of many women for their health care needs. She can be contacted at Advanced Women’s Care.

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