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SARA LOMAX-REESE:       Right now I want to welcome in studio, we have Dr. Donee Patterson,our regular resident expert in family medicine from Einstein Department of Medicine and joining her today is Dr. Elizabeth Zadzielski and she is with the Department of OB/GYN at Einstein as well.  Welcome.


DONEE PATTERSON, MD:         Thank you.

LOMAX-REESE:       Thank you guys, both.  This is a very, very important topic clearly and very timely of course because we are in the month of March, which is Women's History Month so we are talking all things women.  Let's just start right at the top, menopause, what is it?  Can you define it for us Dr. Donee?

PATTERSON:         Sure, a lot of people think that menopause has something to do with men or being male but no, it literally means the end of the month.  It means cessation, the pause part is stop and the men part means month.  So it is end of monthly menses.  I want people to know it's not a symptom, it's not a disease, it is a natural part of the life cycle and we want encourage men not to turn their channels because they have to know some women in their 40s, 50s or 60s that are starting or going through menopause and Dr. Zadzielski and I were talking that it really does effect the whole family.  Sometimes women will have depression surrounding it or heart disease surrounding it or she was even mentioning how if a woman throws the covers off the cat is affected at night, so it affects the whole family and we encourage people to tune in, ask questions and find out more about how to take care of it and some of the significant health conditions surrounding it.

LOMAX-REESE:        I want to bring Dr. Zadzielski into the conversation.  I hear what Dr. Donee says that it is a natural part of the woman's life cycle, but very often it is treated like an illness; it's treated because we are talking abut treating menopause.  I want you,Dr. Zadzielski,  to talk about as an OB/GYN, why is there this kind of medicalization or this medical approach to something that is in fact a very natural part of the women's life cycle.

ZADZIELSKI:         Well thank you Sara and Dr. Donee for having me here today. I think you touched on a very important aspect; that is menopause really is not a disease and part of it is the fact that women are now living longer and healthier lives.  Typically, life expectancy, most women didn't live past their mid-60s or even into their early 70s,but now that we are enjoying a longer life span, we are recognizing the fact that this is not a disease state, but actually a natural progression of our bodies.  It really has been through organizations such as the North American Menopause Society that we have gained a greater understanding of the physiological, natural changes that women go through. 

LOMAX-REESE:        So let's talk about those natural changes because I have a bunch of exclamation points next to….it's irregular periods, but hot flashes, this is peri-menopause, hot flashes, vaginal dryness,night sweats, insomnia, mood changes, weight gain, breast size thinning and thinner skin.  My question…well I put "this sucks" with big exclamation points, sorry if I offended anyone, but what is the upside?  Let me just ask that; what is the upside of menopause when you hear a list of kind of not so great effects?

ZADZIELSKI:         For some people, they are very excited not to have a menses anymore or monthly menses they've had almost since 10, 11, 12 years old.  That's an upside for some people.  For others notable to get pregnant, you can get pregnant in the premenopausal period, so you have to be careful about that but once you are menopausal you are no longer able to get pregnant.  For some people that is a really positive thing, but it is just a natural part of life and everyone doesn't get all of these symptoms. There are ways to kind of make sure that it doesn't hit with full force and that's why we want to talk today.  We don't just want to focus on the negative sides; we want to focus on preventing some of the horrible sides of menopause.

PATTERSON:         I think an important aspect as well is that it is in fact a transition, meaning to another phase of a woman's life that is really just being recognized.  Everyone will recall when you were a child the transition to adolescent was a little rocky and then we all become adults and we then lead productive lives. Same too with menopause, menopause transition can be a little rocky at first but we've gained so much understanding that we can now help women adapt to a new phase of their lives.  Part of the problem that a lot of women encounter as well is the way our culture always focuses on youth and always having to have the clearest skin or the tightest body or the tightest abs, and something that I work with my patients on is recognizing that yes,there are changes that are going to happen as part of what is a normal process and then just understanding and being able to grow into your body as you come into an exciting phase where we don't have to worry bout birth control, you don't have to worry about periods.  There are a lot of great thing that women can still do.

LOMAX-REESE:       One of the people that I turn to, there is a physician named Dr. Christiane Northrop who wrote a book called The Wisdom of Menopause, Which is a wonderful book and she writes…"After working with 1,000s of women who have gone through this process as well as experiencing myself, I can say that with great assurance that menopause is an exciting developmental stage, one when participated in consciously holds enormous promise for transforming and healing our bodies, minds and spirits at the deepest levels."So I wanted to see if you guys could talk a little bit, before we get into the nitty gritty of the physical, because we are going to get into that, but the emotional transitions because the other thing that is happening at this phase of life is your kids are older, they're growing up, that is probably an upside too. There are a lot of emotional upheavals as well in terms of your relationships; your empty nesters, those kinds of things and I wanted to see if you could talk a little bit about navigating that as a part of this process before we get into the physical. Dr. Donee?

PATTERSON:         I want to step back and make sure that I mention that all of these changes are hormonal.  There is a loss of estrogen and that causes a lot of these changes; a lot of changes inside the blood vessel that can increase risk of other chronic conditions, the thinning and breast changes, all those things are all hormonal and so it will change emotions at time.  Women often say sometimes they feel a little foggier; they don't feel as clear; sometimes people have increase anxiety or depression and that is all part of natural life and how transitions happen.  So there are definitely things that you can do; you can talk to your doctor;there are medications; there are hormonal and herbal supplements;there are things that you can do to kind of help with that phase.

LOMAX-REESE:        I wanted to see Dr. Zadzielski, if you could talk about the hormonal therapy because many years ago at this point there was a big revelation that hormone replacement therapy which was being prescribed to many, many women actually increased the risk of heart disease and so there has been kind of a reversal in some instances.  I wanted to see if you could talk a little bit about hormonal replacement therapy and what some of the things that can be done to make this transition smoother.

ZADZIELSKI:         And it is something that Dr. Patterson and I have been talking about over the last two days.  I am sure everyone at this point is well aware of the results of the Women's Health Initiative.  This was a study that came out in July of 2012 and you are absolutely right, it did completely change our perspective on how hormone therapy is prescribed.  Prior to that, because I have been fortunate in that I have been practicing now since 1989 and I can say that when I first came out in practice, we gave hormone therapy to every single patient who came through the door and this is a really great example of how looking at the evidence critically has changed how we prescribe medication and our approach to menopause.  There was recently, again, NAMS, or the North American Menopause Society just came out with a statement that said the expert now agree, because we all know it has been this huge pendulum where patients were told to absolutely come off of hormone therapy because a lot of the things we did think that it helped, meaning heart disease, prevention of Alzheimer's disease, colorectal cancer, there was a whole slew of benefits we thought we were getting.  That in fact was not supported from the Women's Health Initiative.  What we have now seen and what we now agree to is that hormone therapy can be used for short periods of time in order to help women through the menopause transition because it is really, as women begin to experience those declining estrogen levels, that the vasomotor symptoms are the worst. 

LOMAX-REESE:       OK, vasomotor?

ZADZIELSKI:         Meaning hot flashes, I'm sorry or the night sweats, which are something that I, as a menopause practitioner, many of my patients will come in saying I can understand the periods being irregulars,I can understand some of the mood swings, but as a working woman,the one thing that most women have difficulty with is really not being able to get a good night's sleep because these hot flashes will, sometimes you may not even be aware that you are having them because they are so subtle that they interrupt with what is called your REM sleep, or your deepest sleep.  Your sleep quality is not as good, so women will wake up not feeling as though they have rested and that sets them up for an entire cascade during the day where they are really not able to cope with the challenges of being a working mom and all of the other responsibilities that they have to handle. 

LOMAX-REESE:        We are talking today about menopause; it's Women's History Month and we are talking today with our Einstein's docs, Dr. Donee Patterson and Dr. Elizabeth Zadzielski.  We want to invite you, if you have a question about menopause, to give us call, 215-634-8065,toll free 866-361-0900. One of the things I was told years ago that the healthier you are going into menopause, the healthier your process, your transition, in menopause will be.  So I wanted to see if you guys could kind of outline some strategies, both for women who are premenopause and need to take this into account and women who are in menopause.  What can we all, as women, do to make this process healthier?

PATTERSON:         I am going to emphasize again that all of these are stages of life,so just like pregnancy, the healthier you are before pregnancy, you tend to have a healthier pregnancy outcome and it's the same as menopause.  I want people to be prepared for this; this is why we wanted to talk about it today.  Again, we are back to fruits and vegetables, eating healthy, decrease the red meat,decrease your weight, exercise regularly, but I want to definitely emphasize to decrease smoking because again, smoking can damage blood vessels and it can lead to heart disease and heart disease is dramatically increased in menopause.  I would be remiss….

LOMAX-REESE:       Why is that?  I know that you mentioned the hormonal shifts and all of that, but it seems like everything is dramatically increased during or after menopause in terms of cancers and all of this stuff, so what's that about?

PATTERSON:         I'm glad that you said that because it really is the loss of estrogen.  Estrogen has a protective effect before menopause and it actually protects the heart so you have higher HDLs which is the good cholesterol, we talked about that last week and you have usually better LDLs which is the bad cholesterol that tends not to clog the arteries and so in menopause when you lose that positive estrogen effect the good cholesterol that acts as a vacuum to clean out the arteries, it tends to go down and the bad cholesterol tends to go up. The blood vessels, the tone of the blood vessels, changes and so arteries can get clogged and within several years after a woman becomes menopausal their risk of heart disease almost exacts to a man's risk of heart disease where before it was much lower.  You also have increased risk of diabetes for those same reasons, increase risk of stroke for those same reasons,increased risk of osteoporosis.  That is why we want to talk today; not to make this very depressing, but to say….

LOMAX-REESE:       I'm officially depressed.

PATTERSON:         You don't have to be; you can make sure you are on top of your cholesterol, make sure you are eating well which I know that you do; eating well, drinking proper things so you can starve off a lot for these things.  It doesn't mean jut because you go through menopause this means you are going to heave a heart attack, it means that in our perimenopause years, if we pay attention to these things we decrease our risk for these things later.

LOMAX-REESE:       Absolutely, so we are trying to be proactive here.

PATTERSON:         Yes.

LOMAX-REESE:        We are not trying to be Debbie downers, we are trying to be proactive and I think it really is incredibly valuable information as women because I think within my lifetime there has been a much better understanding of the differences between men and women and how we need to treat the different aspects of our evolutions differently.  I want to turn to you Dr. Zadzielski, because one of the things that is recommended for menopausal women you should get a bone density scan or exam and I am wondering what that's about?  What's up with the bones?

ZADZIELSKI:         As Dr. Patterson has said, there is a loss of estrogen and estrogen is known to be a co-factor for your bones in helping your bones retain calcium so that once you go through menopause without estrogen your bones do lose calcium.  It is recommended that we do a bone density test and at this point a bone density should be done at the age of 65 in order to assess how a patient's bones are doing.  As Dr. Patterson has also said, we can also take an example from scouting.  Scouting says always be prepared,so that is what I am going to encourage all women to do and I am sure the listeners at some point have heard there is a great website that actually  helps with diet, called Choose MyPlate.gov and if any of our listeners would like to go on to that site it is something Michele Obama helps develop and it gives anyone a really great tool to be able to put in your height and your weight and it will actually help you tailor a diet plan that encourages healthier eating and then helps you track your progress.  It will also give you feedback in terms of the type of exercise that you can be doing.  That is a free tool that is out there that I would encourage everyone to take a look at so that you can make those changes that will actually help increase your longevity.

LOMAX-REESE:        So that's Choose My Plate.gov and we should all take a look at that.  We are going to take a quick break and when we comeback we will go to the phones, Emmanuel just hold tight and I do want to get in some natural treatments, some ways we can address menopause.  Don't go away we will be right back.

We are back, you are listening to HealthQuest Live, on 900am WURD.  We are talking about menopause today with Dr. Donee Patterson and Dr. Elizabeth Zadzielski, both from Einstein. When we left off, I said I would go right to the phones, and we've Emmanuel from Delaware County on the line, welcome to the show.

EMMANUEL:    Thank you very much.  This is a great topic for married men.

LOMAX-REESE:       Yes.

EMMANUEL:    I just need some information on how married men deal with this situation, like I'm being as calm as possible; I'm helping wherever I can, ask her things that she may need, but sometimes it just comes with some resentment and snapping for sure, a very short temper.  I have been able to handle it so far, but it does get to a point where you know no matter what you do it's wrong.

LOMAX-REESE:       Great question Emmanuel and I applaud you calling in and seeking some advise and guidance.  I will turn it to the doctors.

PATTERSON:         Bravo Emmanuel or calling in and asking this very important question.  That is why we didn't want men to tune out. We want people to be sympathetic because it really is something that is going on that a woman often can't control, so thank you for being sympathetic.  You also can help her do things like to keep the room cool, to keep cold glasses of water close, to do things to improve sleep, like to make sure it's dark and to decrease some of the noise.  You and her can practice relaxation together, you can help her in exercising, you can come up with an exercise plan together and that can be a bonding type thing you can do together.  Definitely if she smokes, help herand support her through stopping smoking.  Take vitamins regularly.  A lot of little things and if you really do recognize that maybe she is depressed or having significant insomnia, sleep problems, encourage her to see her doctor because there are things we can do to help her.

LOMAX-REESE:       Excellent question.  Go ahead Dr. Zadzielski?

ZADZIELSKI:         I would have to also echo Dr. Patterson and applaud you for your patience and that is probably the best thing that you can do because it can be a very unpredictable and stressful time. Just continuing to serve in a supportive role is probably…she could not ask for more. 

PATTERSON:         On the flip side, men do go through a version, it's not exactly the same, but a version of male menopause where their hormones drop as well, but it is not as dramatic drop or an abrupt drop I should say and so they often have decreased libido and decreased energy and decreased fatigue.  Women also have to be patient with their males, especially if their males have high blood pressure or diabetes, because their testosterone can go down and so they will lose a lot of thee functions or a lot of these emotions and so women also have to realize that their significant other is getting older and they also have to be patient as well.

LOMAX-REESE:       Patience, patience, patience.

EMMANUAEL:              I just want to ask you one question, choice my plate.gov is the website, correct?

ZADZIELSKI:         Correct.

EMMANUEL:              I wrote that down and I will write the exercise routine, the cool room, plenty of water, and the patience of Jobe.

PATTERSON:         Awesome; you are doing a good job.

EMMANUEL:    Thank you very much; I do appreciate it.

LOMAX-REESE:       Thank you for calling in Emmanuel.  We are going to Danay from Maryland; welcome to the program Danay.

DANAY:           Yes, hi.  I am excited that you all are having this particularconversation today and wanted to just say hi to Dr. DoneePatterson, I love her shows and the things that she is doing, sheis doing an awesome job in the health community.  My question today I have been experiencing some symptoms that appear to be menopausal and yet every time I talk to someone about that they say I am too young to be going through menopause at this particular time.

PATTERSON:         How old are you Denay?

DANAY:           I will be 46 this year.  I want to find out how does a doctor test to see if you are actually going through perimenopause, if you are in that stage or if you are going through menopause.  Is it just that you give the symptoms or is there an actual test and then the second question, genetically, if you have a mother who went through it early, does that determine that you will have the early symptoms as well.

LOMAX-REESE:       Two great questions.

PATTERSON:         Really great questions.  One is the average age for menopause is 51, so that means there is going to be some women in their 40s and some women in their late 50s or 60s who make up that average of 51.  So 46 is not too early.  Women before their 40s, we call that premature menopause and it happens for pretty much medical reasons so you need to talk to your doctor.  There is no one test to test for menopause; it's pretty much based on history.  We often ask a lot of questions and do a very good physical exam, although there are some blood tests; they are not always as reliable in the perimenopausal stage.  Her second question was about….

LOMAX-REESE:       Genetics.

PATTERSON: Genetics, thank you.  There is a genetic component and it often is related to, if your mother went through early or late menopause, so that is helpful to know, but it doesn't always have to go on that because sometimes women, their mothers have surgery and people can go through surgical menopause.

LOMAX-REESE:       Dr. Zadzielski do you want to add anything?

ZADZIELSKI:         I just wanted to ask what type of symptoms you were having because sometimes your doctor may also be concerned about other conditions that may be causing similar types of symptoms.

LOMAX-REESE:        Idon't know if you said this in the beginning, but I think you Dr.Donee said that what constitutes menopause, you are officially in menopause when you have not had a period for at least a year?

PATTERSON:         Yes.  So you are officially in menopause when you haven't hada period for a year and if, after that year, you have bleeding,it's unfortunately cancer until otherwise proven so take that very seriously.  But Danay, you are absolutely right, you do need to have some other blood tests done, particularly a thyroid because thyroid disease can mimic menopause.  You should get ahemoglobin because anemia can mimic menopause and then some otherlabs in between.  Definitely, you are not too early for it but you should have some basic lab work as well.

LOMAX-REESE:       Excellent, excellent.  Well thank you Danay for your call and we are out of time. 

PATTERSON:         Wow.

LOMAX-REESE:        I know, that just flew by and I agree Dr. Donee said on the break,this is a topic we could definitely spend a whole hour focused in on because there are lots and lots more questions that I know I have and I am sure our listeners have as well.  But we at least laid the foundation for this conversation and I know that there is a special gift involved for the Einstein.

PATTERSON:         As usual, we have a Shop Rite gift card to the first person who goes to the Einstein Health Facebook page and answers the question and then we will be in touch with you to give you the gift card.  You can also follow us on Twitter or you can follow me, @DrDonee on Twitter as well.

LOMAX-REESE:       What is the address for the Facebook page; how do they find it?

PATTERSON:         It's Einstein Health.

LOMAX-REESE:       Einstein Health and they just find the Shop Rite gift card.

PATTERSON:         Exactly.

LOMAX-REESE:       Great, great, great.  Any final, final thoughts and I will start with you Dr. Zadzielski.

ZADZIELSKI:         I would say as Dr. Patterson had said earlier, diet, exercise, healthy eating, and a good attitude towards what is a transitional phase is going to wind up with at least another 20 years of healthy living.

LOMAX-REESE:       And Dr. Donee?

PATTERSON:         I just want to remind people that this is a natural part of life; we should embrace it and not think it is something negative coming, but also make sure we take the necessary steps to make sure we are healthy as we transition into this phase.

LOMAX-REESE:       Thank you very much; very encouraging; very importantinformation.  Dr. Donee Patterson, Dr. Elizabeth Zadzielski,both from Einstein and we thank you both for being here.

PATTERSON:                    Thanks for having us.

ZADZIELSKI:         Thank you.

Communications Team

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