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August 14, 2007 > Spotlight on Women's Health

Spotlight on Women's Health

Learn from a Doctor About Midlife Menstrual Changes

There tends to be a lot of support out there for women during their childbearing years, but what about the years after that? What happens in the years preceding menopause? What about options like hormone replacement therapy (HRT)? And what exactly are the symptoms of menopause?
On Tuesday, Aug. 21, Dr. Barbara Kostick, a Washington Hospital family practice physician, will answer these questions and more during a "Midlife Menstrual Changes" discussion at the Washington Women's Center.
Perimenopause, also known as menopause transition, is the stage of a woman's reproductive life that begins several years before menopause when the ovaries gradually begin to produce less estrogen. Usually beginning in a woman's 40s, perimenopause can start as early as in the 30s as well and lasts up until menopause, the point when the ovaries stop releasing eggs.
Symptoms leading up to and into menopause can include menstrual irregularity due to fluctuating hormone levels, sporadic hot flashes, missed periods and urinary tract infections from a decreasing amount of natural lubrication.
In determining the best course of action - from no action at all to different types of hormone replacement therapy - Dr. Kostick says the most important thing to consider is the individual patient's needs.
"Every women is unique and every women has a unique experience," she says. "If she has specific questions coming into the discussion, she needs to get some data, such as frequency of periods and occurrence of hot flashes. The more history she can track, the more she'll get from the talk. I recommend bringing all the information and medications you can to get the most out of it. What do you want out of this talk? Write down specific questions and keep track of what you want to get out from it."
Dr. Kostick points out that with the baby boomer generation, women are experiencing menopausal symptoms in record numbers. Fifty years ago, she says, women weren't living as long as they are now; as a result, they didn't spend as large a percentage of their lives in menopause as today's woman.
"As women today, we expect a lot more in terms of cures and treatments, whereas women before said menopause is just a natural thing," she says.
With increased media attention raising questions such as 'Are hormones good or bad?' Dr. Kostick says she wants to start with the anatomy of the menstrual cycle, covering the natural process and describing common menopausal symptoms and how patients can effectively relay that information to their physician. She will also define hormones such as estrogen and progesterone and the role they play in the reproductive cycle.
She will go over terminology and definitions to help women better communicate with their physicians and then move into answering questions relating to individual issues - such as possible treatments for fibroid tumors and hot flashes or choosing what type of birth control to use in perimenopause.
Misinformation surrounding HRT has been prevalent over the last several years, according to Dr. Kostick. While many have begun to believe that HRT is linked to cancer, Dr. Kostick says new scientific evidence is emerging that indicates estrogen is not correlated to cancer risk, adding that with new medical guidelines and studies being published every day, it's important to talk to the doctor about your individual options.
Additionally, just because a woman may be experiencing certain symptoms related to menopause does not necessarily mean she has reached menopause, Dr. Kostick is quick to point out. Some women may spend as much as five to seven years in the perimenopausal stage before actually undergoing menopause.
"Everyone is an individual," she says. "You should address the information you hear based on you as an individual. You should develop a history on yourself to better inform your doctor about your specific needs."
In addition to physiological changes women may be experiencing during these years, Dr. Kostick points out that women have a number of other social and psychological issues to deal with as well.
"Your whole focus is changing in your middle years," says Kostick. "Your children are older; they're having relationships of their own. Then you're also dealing with your parents as they are getting older and you're watching them age. We are a little sandwich generation. It's important to remember that knowledge is a powerful tool for women during this stage of their lives."
Get the facts
Join Dr. Barbara Kostick and other women in the community for the "Midlife Menstrual Changes" discussion on Tuesday, Aug. 21, from 6:30 to 8 p.m. at the Washington Women's Center Conference Room, located at 2500 Mowry Avenue in Fremont, across the street from the main hospital.
If you have questions about programs and services at the Washington Women's Center or would like to suggest educational topics you would like to see in the future, call the center's coordinator, Kathy Hesser, at (510) 608-1356.
For more information about the comprehensive diagnostic, treatment and educational programs available at the Washington Women's Center, visit, click on "Services & Programs," and choose "Women's Health" from the drop-down menu.

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