Menopausal Medicine

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Menopause, or more correctly, “the menopause” is an oft misunderstood period in a woman’s life. Derived from the Greek terms “men”, meaning month and “pausis”, meaning cessation, it literally means cessation of the monthly. The menopause is the point in time when a permanent cessation of menses (the menstrual cycle or “period”) occurs following the loss of ovarian function.The menopause is a normal part of the physiology of aging, and it is often marked by vasomotor symptoms, changes in vaginal health, changes in sexual function and libido, and decreased bone density. While these symptoms can be bothersome and pose certain health risks, there are many options available with which Dr. Grisham can ease the transition and counteract these unwanted effects. Most commonly, people complain of hot flashes/flushes and night sweats. These are so-called “vasomotor” symptoms that occur with a change in circulating estrogen levels.

There are a variety of forms of hormone replacement therapy or “HRT” which can alleviate these symptoms, improve quality of life and provide other health benefits like increased bone density, increased cognitive function and memory, as well as decreasing the risk of colon cancer and Alzheimer’s disease.There are also some risks associated with HRT, and Dr. Grisham can discuss which forms of HRT are most appropriate for you, thus providing maximal benefits while minimizing risks. Some of the options in hormone replacement therapy include oral HRT such as Premarin, Prempro, FemHRT, Estrace and Menest. There are also HRT patches (Climara and Vivelle dot), gels (Divigel) and sprays (Evamist).

Vaginal health, sexual function and libido can all be affected by the change in hormone production and decreased estrogen availability during and after the menopause. Over time the lack of sufficient estrogen can lead to atrophy or weakening of the vaginal tissue. This can lead to uncomfortable or painful intercourse, lubrication difficulties and eventually atrophic vaginitis which is accompanied by an uncomfortable burning sensation causing the patient to think she has a vaginal infection. Dr. Grisham can prescribe vaginal creams (Premarin Cream, Estrace Cream), rings (Estring), or ovules (Vagifem) that can all help alleviate these symptoms and provide a healthier vaginal environment.

Estrogen plays a critical role in bone density. Following menopause, the decreased estrogen levels can result in decreased bone density, osteopenia and, in its most severe form, osteoporosis. This decreased bone density greatly increases risk of spine, hip and other fractures as well as tooth loss. Evaluating bone mineral density and providing treatment to those with osteoporosis is critical when caring for postmenopausal patients. There are a variety of medications and treatments available to address osteoporosis including bisphosphonates (Fosamax, Actonel and Boniva), selective estrogen receptor modulators or “SERMs” (Evista and Fablyn), or parathyroid hormone (Forteo). After a complete evaluation, Dr. Grisham can discuss which options are best for you. Dr. Grisham also provides the convenience of on-site bone mineral density or “DEXA” testing.

Dr. Grisham is dedicated to providing individualized therapy for each patient when addressing peri- and postmenopausal issues. With proper education, evaluation and treatment, patients can have a seamless transition from their reproductive years, through perimenopause, menopause and the postmenopausal state. To schedule an appointment to discuss your symptoms and treatment options with Dr. Grisham, click here.