Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I had children right out of college.  I am 45 and my youngest child is off to college in the fall.  I am an English teacher at our local public middle school. I am beginning menopause now, with irregular cycles and really heavy periods and rare hot flashes.  I am 30 pounds overweight, like many of the teachers in my school, and starting to have problems with blood pressure, but I take no medications and am otherwise fine. I eat protein bars in between classes in order to have enough energy to get through teaching 25 rowdy sixth-grade students, hour after hour.

I manage the house and meals with a little help from my daughter and husband; then I have to work creating lesson plans and grading tests and essays. I eat at night to keep going.  I rarely drink alcohol, and my sleep is still good.  I have a wonderful marriage and a great husband who appreciates my contribution to the family finances. I know that I have much to be grateful for.  I have two months off this summer and plan to focus on getting in shape—for once—and I don’t want menopause to derail my plans.  So many of my older colleagues at school became really fat, nasty-tempered, and depressed with menopause.  I don’t want that to happen to me.   Where do I start?

Caren

 

Dr. Pat Responds:

Dear Caren,

Menopause is never old news, because there is a new freshman class entering this life stage every year.  Women are now bombarded about the symptoms and the options for management.  However, much of this is information overload, as well as information that may have as its purpose the sale of medicines and products, marketed to your demographic in a way that often leads to more anxiety.

Here is a lesson plan for your summer of reinvention, based on your goals, age, current lifestyle, health issues, and your interest in managing the symptoms of the often decade-long menopausal transition in a positive way.

Dr. Pat’s Lesson Plan

  1. See your gynecologist for evaluation of the “very heavy bleeding.” Once you are reassured by appropriate evaluation that there is no reason for surgical evaluation or operative treatment of the heavy bleeding (see our previous Ask Dr. Pat post, “Is Endometrial Cancer Common?”),  discuss the use of a progesterone-coated IUD) for management of this problem.  This form of IUD delivers a low level of progesterone directly to the endometrial lining, which often becomes thickened during the peri-menopause when the ovaries produce too much estrogen and not enough progesterone.  The progesterone IUDs are an excellent contraceptive option for women over 40 and often provide control of the common problem of heavy bleeding during part of the menopausal transition. (See “A Peri-Menopausal Flood). Untreated heavy menstrual bleeding can lead to iron deficiency, which causes anemia, fatigue, and even hair loss.  Untreated heavy menstrual bleeding can even lead to hysterectomies that would often not be needed if this problem had been managed in an early and proactive way. Read More »

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