DEAR READER: Menopause occurs only after a woman stops menstruating completely for 12 months. My guess is you have perimenopause, a stage that precedes menopause. This occurs because your body is not producing hormones as it did before. It generally consists of irregular cycles. They may be more frequent, shorter in length, lighter, or you may skip a month or two only to return to a normal monthly pattern. You may experience hot flashes, night sweats, mood changes or periods of poor concentration. Your hair may thin, and you may experience insomnia. Things won’t be as bad as they sound. Speak with your physician or gynecologist if you have specific questions.

The key is to take care of your body, eat well, exercise often, don’t smoke, and take life a day at a time.

To provide related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44091-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Thank you for your kind comments. I am happy to have helped.

Bee pollen has been used for years. It is touted to cure certain health problems and to be an exceptionally nutritious food. It has undergone years of research, but so far, nothing can be confirmed. However, there is a plethora of anecdotal information about its use and benefits, especially online.

Bee pollen is simply pollen that is collected from the bodies of bees. It has vitamins, minerals, protein, fats and carbohydrates and may even contain some bee saliva.

Available in many health-food stores, it can be found as a supplement or in skin-softening products. Some even claim that it can be beneficial in treating or even curing, asthma, allergies, alcoholism, stomach upset and more, but remember that none of this has been proven scientifically.

If you suffer from allergies to pollen, this supplement may cause a serious or even life-threatening reaction, so it is important to talk to your physician before using it. It shouldn’t be used by pregnant or breastfeeding women but otherwise appears to be safe for short-term use.

To provide related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: As you are aware, hormonal changes occur during menopause. Those changes can produce symptoms of insomnia that can range from transient and temporary to chronic and annoying. A woman actually goes through three phases: perimenopause, menopause and postmenopause. During the first stage, estrogen levels can decline, resulting in abnormal cycles, hot flashes and temporary insomnia. Menopause occurs when a woman has remained free of a cycle for 12 months. A woman may awaken during the night (or whenever she sleeps) leading to chronic insomnia. Postmenopause can lead to still more pronounced sleep disturbances such as sleep apnea and restless-legs syndrome. So yes, there is definitely a strong link.

Estrogen is produced in the ovaries and adrenal glands in females. In menopausal women, it is prescribed to reduce the unpleasant symptoms that can plague a woman. Some physicians might choose to prescribe hormone-replacement therapy (HRT) if symptoms of menopause are severe. I don’t know that I would be one of them. That decision is best left for you to determine with your gynecologist, based on your full medical history. You might consider modifying your diet to include cucumbers, soy sprouts, garlic, green beans, yams, apples, corn, peas, olive oil, sunflower seeds and beets. During waking hours, consider adding yoga or another exercise program. Retire at about the same time each evening. Be sure your room is dark, quiet and free of distractions. Attempt to clear issues and coordinate activities before retiring so you don’t awaken at 2 a.m. to problem solve. On particularly difficult evenings, consider melatonin, an over-the-counter sleep aid.

To provide related information, I am sending you copies of my Health Reports “Menopause” and “Sleep Wake Disorders.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: Simply put, perimenopause is an introduction to menopause. It commonly occurs when a female is in her 40s, but can happen to some women in their mid-30s. It generally lasts between two to eight years and is a natural part of the aging process. Estrogen levels rise and fall in an erratic pattern, and women may experience problems sleeping, hot flashes, vaginal dryness, mood changes and more. Repeated menstrual irregularity, however, is one of the most widely recognized initial phases of the condition. As long as the irregularity isn’t accompanied by extremely heavy bleeding, breakthrough bleeding between cycles, bleeding that lasts longer than eight days and cycles that occur fewer than 21 days apart, you can usually consider things as progressing normally. However, complications outside these guidelines should be brought to your primary-care physician’s or gynecologist’s attention.

There are several circumstances that have a bearing on when perimenopause or menopause might begin. Smoking, for example, is known to trigger menopause up to two years earlier than in those without a history. Other signs of an earlier-than-normal occurrence are chemotherapy for childhood cancer, never having delivered a baby, hysterectomy and pelvic radiation therapy.

Therapy might include the use of oral contraceptives for the purpose of regulating cycles, and reducing vaginal dryness and hot flashes. A progestin-containing IUD (intrauterine device) might control heavy bleeding, while progestin therapy might regulate cycles.

If you are satisfied with the information you already received, I recommend you continue as you are, eat well, exercise, avoid alcohol and caffeine, which can trigger hot flashes, and enjoy each day to the fullest. If you are dissatisfied, either jot down a list of questions and return to your physician for an explanation, or request a second opinion.

In the interim, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Is it possible to be having cold chills instead of hot flashes? I hope you can help me.

DEAR READER: You have certainly set up a confusing smoke screen for me. Tobacco use is known to affect circulation, but you don’t smoke. Alcohol can adversely affect the system, but you don’t drink. Some medications cause chills, but you don’t take any. Your thyroid is functioning normally, so that isn’t a contributing factor.
Menopause can cause hot flashes but can also, in a small percentage of women, cause chills. However, you were 47 when you visited the hospital. That’s relatively early for menopause, which is common for women in their early 50s. This natural biological process occurs once a woman has been free of menstrual periods for one year. Perhaps you have perimenopause, a transitional condition prior to menopause that can occur as early as the mid-30s or 40s and last up to eight years. As with menopause, hormonal changes occur and estrogen levels rise and fall. A common symptom, however, is hot flashes, not chills. Your physician can order simple laboratory testing to determine whether you are in either stage of menopause.
Other possible causes are infections of any type, such as strep throat or dental issues, autoimmune disorders, leukemia and lymphoma. Along these lines, you might choose to speak with your physician regarding additional testing to rule out other possible causes. Once you cover all the bases, you can put your mind at ease on at least a few of the possibilities for your chills.
To provide related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I have friends who rave about what hormone-replacement therapy has done for them. I’m interested but not comfortable discussing the topic with my male doctor.

DEAR READER: As a woman enters menopause, the ovaries decrease production of both estrogen and progesterone. This reduction causes menstruation and fertility to ultimately cease. Common side effects of menopause include hot flashes, vaginal dryness, mood swings and more.

Until several years ago, these symptoms were thought to be best treated with hormone-replacement therapy (HRT). It appeared simple enough. What the body was no longer able to provide could be handled easily by medication. At the time, it was also thought that elevated estrogen levels could ward off osteoporosis and heart disease and improve quality of life. However, a large clinical trial known as the Women’s Health Initiative (WHI) determined that HRT didn’t provide what was expected and, in reality, posed some health risks. As the number of hazards involving HRT grew, physicians became less likely to prescribe hormone therapy.

Estrogen alone has been associated with a slight increase in the number of strokes and some menopausal symptoms. Estrogen/progestin combination therapy has been linked to a greater number of abnormal mammogram reports. Evidence is now showing that the link between increased postmenopausal use of HRT and breast cancer is stronger and more conclusive. Nonetheless, the benefits of short-term therapy outweigh the potential risks one could experience.

All is not negative, however. Estrogen is the most effective treatment known for relief of hot flashes, vaginal dryness, burning and itching. HRT is believed to decrease the risk of colorectal cancer. Studies remain ongoing but are incomplete regarding a reduction in heart disease when estrogen is taken early in the menopause cycle.
Confusion remains. Even my answer to you is negative and positive at the same time. What is known is that HRT does not provide the spectacular benefits once thought possible, but it is believed the risk to a woman taking hormone therapy is quite low.
There are a number of herbal alternatives touted to help with the symptoms of menopause. Red clover, for example, contains a plant estrogen known as coumestrol that presumably stimulates the ovaries. However, there is no scientific evidence that any herbal supplement is effective. All studies have been small and relatively inconclusive. While I don’t believe this supplement will cause any harm, you will likely be better served by getting professional guidance.

Because you feel uncomfortable speaking with your male physician, I recommend you make an appointment with a female gynecologist. Provide your complete medical history and, together, determine whether HRT is right for you. Keep in mind that there are a number of over-the-counter lubricants available. The fact that you want to maintain an interest in sex is positive. Work together with your doctor and your husband.

To provide related information, I am sending you a copy of my Health Report “Menopause.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER:
An increase in sweating may be related to menopause. I suggest you check with your gynecologist regarding possible testing and treatment options.

To give you related information, I am sending you a copy of my Health Report “Menopause”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
If your physician is unconcerned, I would take that as a good sign. Most women your age no longer experience the side effects of menopause.

Make an appointment with a gynecologist. If he or she expresses concern, proper testing can be coordinated.

To give you related information, I am sending you a copy of my Health Report “Menopause”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I am not in good financial health so would rather not see a physician unless absolutely necessary. I take vitamins and minerals regularly and continue to feel fine. What should I do?

DEAR READER:
You need to see a gynecologist. I urge you to make an appointment as soon as possible to avoid the risk of anemia. Prolonged bleeding from menstruation can have many causes ranging from blood clots to fibroids to cancer. It is important to find out the cause and have it promptly treated.

Regardless of the cause of your bleeding, you are losing a significant amount of blood and are risk for anemia which can cause weakness, faintness, fatigue and other problems. You should start a daily iron supplement regimen to reduce symptoms.

I should also mention that at the start of menopause, known as peri-menopause, normal monthly menses become abnormal, often skipping a month or two at a time, but it can also cause heavier or more frequent bleeding. As I stated above, it is important to see your gynecologist as soon as possible. Only he or she can determine the cause and proper route of treatment.

To give you related information, I am sending you a copy of my Health Report “Menopause”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

In 2002 I was told that my cervix was closing so I underwent a procedure to reopen it. I am looking at the same procedure again this year to get a good pap smear. At my age do you feel this is a necessary procedure? I have a pap smear every year and they are never bad. There is a history of cancer in my mother’s family. My grandmother and one of my aunts had cancer. I only have hospital coverage and will have to pay for the procedure.

I have frequent hot flashes. They only last about five minutes, but happen at all hours of the day and night. They are so bad I feel as if I am about to melt. My face and neck get extremely red, my heart races, I feel nauseated, hear my pulse in my ears and sweat so profusely that my hair and clothing get soaked. My concern is if they can adversely affect my health.

DEAR READER:
I believe you are suffering from the ill effects of menopause. Hot flashes are harmless but annoying. They often occur in women during and after menopause when the brain has trouble determining if the body is hot or cold. It, therefore, dilates and constricts the blood vessels spontaneously (or after certain triggers, such as stress) which causes the symptoms you have experienced. There are several treatment options for menopause-induced hot flashes, such as hormone replace therapy, black cohosh, and more. Speak to your gynecologist about this.

As for your cervix closing, I believe this is also due to menopause. During menopause, some women experience a thickening of the cervix (cervical stenosis) which can lead to partial or complete closure. In most instances it is harmless and needs no treatment. If pain, fever, bleeding/spotting or abnormal drainage occur, cervical dilation may be necessary to determine if there is another cause such as cancer, fibroids, or other conditions. Remember that a pelvic exam is a god test to have regularly. It can diagnose several types of reproductive cancers.

Since you have had consecutive normal pap smears and are post-menopausal, you may not need to have yearly pap tests. You do have a family history of close female relatives having cancer but you fail to say what kind. If it were cancer of the cervix, or other reproductive organ, perhaps you should have a pap every 2 or 3 years. If not, talk to your gynecologist about stopping them. You will still need to be seen for any spotting, increasing abdominal girth, bleeding, abnormal discharge or other symptoms but because you are otherwise healthy, have had no bad tests, I believe it is in your best interest to stop.

If your physician is unwilling, request a referral to another gynecologist for a second opinion.

To give you related information, I am sending you a copy of my Health Report “Menopause”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.