Ask Dr. Pat · Menopause

Surgical Menopause

2. Ask your health care provider to do blood work for common causes of fatigue and weight gain to rule out a medical cause for these complaints. The basic tests are a blood count for anemia, Vitamin D, iron, and B12 levels along with a thyroid panel and screening for diabetes and metabolic syndrome. Correct any abnormality with supplements or further evaluation and treatment.

3. Peg, find a therapist. You have a positive screen for depression, which includes little interest or pleasure in doing things, feeling down or depressed, trouble falling or staying asleep, or sleeping too much, feeling tired or having little energy, poor appetite or overeating, feeling bad about yourself or that you are a failure or have let yourself or your family down. You have been through too much and have too much to lose to “just tough it out” as you decided when conventional estrogen therapy didn’t work for you. You have an understanding partner, a job where you are clearly valued since you have been consistently promoted and in spite of this past difficult year, you do not report that anyone at work has complained. You deserve to have your life back.

4. While you may benefit from work with a therapist, if you find that you still have these symptoms of depression after three months of interpersonal or cognitive behavioral therapy, along with three months of a hormone dose and preparation that works for you, you may benefit from an evaluation by a psychiatrist who might suggest a low-dose antidepressant that not only helps with mood disturbance but may help with hot flashes as well as you continue to recover.

5. Look online for recommendations for support groups in your area for women in menopause. Many of these groups are led by a trained social worker and women who have been through menopause and volunteer to offer support. No one knows the secrets to surviving a difficult menopause better than women who have successfully made the journey themselves.

6. Have a frank but hopeful talk with your partner about what you can do to improve comfort with sexual activity when you begin to feel more like yourself. You may need a form of local vaginal estrogen if the systemic dose of estrogen that you can tolerate does not control the dryness and discomfort that accompanies menopause for many women. Do use lubrication as well.

7. As you continue your recovery, you will find the energy (and, yes, somehow, the time) to exercise, perhaps with your partner or with a friend. Exercise improves mood and exercise designed to build muscle will help with weight loss long after the exercise stops. You mentioned that you have gained thirty pounds in the last year since your surgical menopause. Part of the weight gain may be from emotional eating and no exercise. Menopausal status does have an impact on weight gain for some women as well. Weight management is also affected by our circadian rhythm. Bariatric medicine specialists are encouraging patients to focus on what they eat, how much they eat, but also when they eat. Avoiding all food and drink (water, unsweetened tea and coffee are permitted) after 8 p.m. and fasting overnight until 10 a.m. are helpful in weight loss. Avoid sugar, alcohol and simple carbohydrate foods for a more effective weight management plan. I am sorry to report that weight management in the second half of life really continues to be a daily and mindful way of living even when you have reached the weight and size that feels right for you. Ask family and friends to be part of a healthy eating way of life because you will need the support. We all need help in some part of our lives and often don’t get it because we just don’t ask. I find that friends, family, and neighbors often want to do something meaningful for others but often don’t know how to offer to help.

8. Work on sleep disturbance. Meditation is helpful to calm the mind before sleep and starting the day and for brief periods during the day. An online search for a recommendation for meditation training may be a good way to find a local resource.

Finally, Peg, I believe in you. You have managed to work and be promoted in a competitive environment during years of disabling pain, to manage a meaningful long-term relationship and nurture good friendships in spite of significantly stressful health issues and a very bad menopausal year. You are a survivor. Now it is time not just to survive but to begin to live again. I send my good wishes for a wonderful second half of life.

Dr. Pat

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  • Emily Scholnick January 6, 2020 at 10:37 am

    I also tried traditional forms of estrogen when I was in my 40’s. Nothing worked.
    My endocrinologist suggested a compounding pharmacy, Women’s International Pharmacy in Wisconsin…I’m in Connecticut. I’m 67 now and have just had a total hysterectomy for fibroids. Initially I stopped the hormones but found that my body And mind were much
    happier with the same dosage.

    I’m told by my gynecologist that I can take this forever!

    Reply
    • Dr. Pat January 6, 2020 at 11:01 am

      Dear Emily,
      Your gynecologist is right.
      As we age and continue systemic hormone therapy,
      the risk for breast cancer, blood clots, heart attack and stroke increase.
      Thanks for writing,
      Dr. Pat

      Reply