Ask the Expert - Dr. Kristi Tough DeSapri
Menopause, Bones & Body - Q&A with Dr. Kristi Tough DeSapri
In April, I attended a Women’s Health Event hosted by Reform PT in Wilmette. After pilates with Reform and barre with Salt, Dr. Kristi Tough DeSapri, MD, MSCP, CCD
Founding Physician; Bone and Body Women’s Health, pLLC spoke about menopause, signs of perimenopause, entering into menopause and side effects.
According to the Mayo Clinic, women are expected to spend 1/3 of our lives in menopause. Then add in perimenopause. That’s a large chunk of our life. Some women may experience this life change a lot sooner than others due to being medically induced - removing and shutting down the ovaries - because of chemotherapy, hormonal therapy or another time of treatment for a medical condition. At this step ovaries stop function, estrogen levels drop and intense side effects can take place, especially if younger.
Let’s chat with Dr. Kristi to learn about menopause, side effects - one being bone loss - how women can manage this stage of life in a way that is more comfortable, and how women with breast cancer can enter menopause earlier than others! Thank you Dr. Kristi for taking the time to be a part of this Q&A!
Let’s start with the basics
1.What is menopause ?
Menopause derived from Greek roots meaning the end of the monthly menstrual cycle.
Most cisgneder women will enter menopause transition from the ages of 45-55yrs which leads up to the final menstrual period. Menopause is a retrospective diagnosis of 12 months without a menstrual cycle. However this does not define the myriad of symptoms that occur with changing hormone levels. In addition, menopause can be natural or surgical or induced by medication, radiation or chemotherapy.
2. What are the changes, side effects that our bodies will go through during this time?
There is no one hallmark symptom of menopause. 70-80% of women experience hot flashes or night sweats which cause sleep disruption and impact daily activities. Other common symptoms may include ; cognitive changes such as brain fog, mood changes such as anxiety or depression, vaginal and vulvar dryness which cause painful intercourse, urinary frequency and even bladder infections or decreased libido.. Other changes occur in collagen and elastin in the hair, skin and nails and silent symptoms like loss of bone and muscle mass and changes in cardiovascular system such as blood pressure, glucose control and cholesterol.
3. How does one know that they are in peri-menopause and then in menopause?
There are stages of early and late perimenopause, oftentimes menstrual cycles are clues. In early perimenopause menstrual cycles can become more frequent ( shortening in length and bleeding pattern) In late perimenopause, menses space out in frequency every 60-90 days until they finally stop.
Symptoms in perimenopause are the same , and some are more bothersome given the often erratic and unpredictable hormone levels as estrogen and progesterone are on the decline.
4. How long does each one last? How does one prepare for the effects in menopause and postmenopause?
In the postreproductive years, the perimenopause starts on average in women age 40-44 years and in the US the average age of menopause is age 51.5 years.
Best way to prepare is to be informed and educated about your health and reproductive history.
Continue to see your gynecologist or primary care doctor for routine health screenings ( PAP, mammogram, blood pressure, cholesterol tests.) Maintain a healthy weight focusing optimizing lean muscle mass, balanced nutrition and avoiding smoking and keep alcohol consumption to a minimum.
5. How can women manage the effects of menopause the best and most healthy way?
As above, knowing your health history, educating yourself and advocating for your health goals and treating your symptoms. I see a trend in women taking control of their perimenopause and menopause journey and love it!
There are many hormonal, non- hormonal, lifestyle and supplements that can aid in preventing and treating menopause symptoms. Rather than rely on Dr. Google, find a menopause specialist to help guide you, answer questions and listen. https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
I have been a menopause certified provider since 2010 and think it’s so important in this evolving field to find someone who is experienced to share evidence-based medicine and review safe , effective, individualized options to navigate perimenopause and menopause.
Narrowing in on the side effects
6. One of the side effects is change in metabolism, what are the hormonal changes that occur and how is metabolism affected?
With both aging and menopause our bodies’ basal metabolic rate declines. Therefore our fueling requirements change and we need to optimize nutrition and caloric intake from high quality protein and carbohydrate and limit sugars. In addition as estrogen levels decline, there is an increase in visceral adipose ( fat) tissue which is less metabolically active than lean skeletal muscle. There is also a relative insulin resistance meaning glucose or sugars are not avidly broken down and used for fuel and deposit in midsection and contribute to risk of developing diabetes and metabolic and cardiovascular disease.
7. I read “in the years leading up to menopause, your body’s production of estrogen declines, leading to a variety of physical and emotional changes, The drop in estrogen also begins a period of accelerated bone loss, known as osteoporosis.” What can we do to help minimize our bone risk earlier in life before we hit menopause?
This is my favorite topic! We can do so much including knowing risk factors for bone loss ( again- family history, medications, medical history and lifestyle factors such as intake of calcium, vitamin D, exercise.
A screening DXA ( bone mineral density scan) can help identify if you have bone loss and what your peak bone mass is as you enter menopause. Thinner Caucasian and Asian women tend to lose more BMD through menopause transition. DXA is a painless, low radiation scan of your spine and hip ( and occasionally forearm) to evaluate your bone mineral density and strength.
8. Approximately half of women older than 50 will experience a fracture--most often of the hip, spine, or wrist--related to osteoporosis. How can we strengthen our bones during menopause?
Women are living longer, on average into their 80s. Women who develop a fracture over age 65 yrs have shortened lifespan. It’s so important to train for life. If you want to have a good quality and quantity of life our bones and muscles will keep us active, upright and moving.
If women have osteopenia, osteoporosis or have developed fractures I recommend multi-disciplinary approach of important nutrients such as calcium, vitamin D, adequate protein and caloric goals, exercise to include balance, posture and resistance training and FDA approved medications which can include those which reduce or prevention bone loss or which build and form new bone mass. This requires an individualized often lengthy exam , evaluation and treatment discussion and follow up!
9. What are some foods to eat (and not to eat) to improve menopause symptoms?
Some women note certain foods such as spicy or sweet foods or alcohol trigger or worsen hot flashes and insomnia. The phrase “wine awake” applies here.
There is some evidence that following a Mediterranean style diet can reduce menopause symptoms.
Menopause and Cancer
10.“ Certain breast cancer treatments can cause induced menopause. Treatment-induced menopause is usually more sudden and the symptoms are more severe than when menopause happens naturally. Can you review the ways menopause can happen with breast cancer treatments? (i.e.chemo, edocrine therapy, surgery)
Surgical menopause involves removal of ovaries and causes more symptoms after the abrupt loss of hormones. Other medications such as chemotherapy or medications that lower estrogen levels ( such as aromatase inhibitors or tamoxifen) can also cause menopause symptoms. Ideally the oncology team has reviewed hormonal or non- hormonal options to prevent symptoms during your cancer treatment plan.
In addition, early menopause ( before age 45 yrs) requires special attention as there is increased risk of medical conditions such as bone mineral density loss, cardiovascular disease, mood,cognitive and genito-urinary changes due to the loss of protection from estrogen, progesterone and testosterone.
11. What do you recommend for patients to do to manage their bodies, especially bones during cancer treatment - chemotherapy, surgery or radiation?
All women who undergo menopause induced by a cancer or related treatment should have a screening or updated DXA to evaluate bone density. If the bone density is low or fracture risk is elevated or expected to increase ( such as declining estrogen levels, many years of cancer treatments and aging) there should be a bone loss prevention treatment strategy with lifestyle, BMD monitoring and consideration for medication.
Now how about a little deeper…
12. I love the statement on your site, “ women deserve to function at optimal health and are gatekeepers to their families’ health.” I recently heard from a herbology teacher, it’s not about eating nutritious food and not, it’s about deserving to feel good.” It’s all about us deserving to be educated on what makes us feel good through the changes our bodies go through. What would you say is the most common question(s) or concern(s) when you see a patient for the first time? Is it about body, bone, metabolism, weight, sleep, sexual dysfunction? Other than working with you, what other resources have you found to provide them with? Givshoppe.com?
Michelle Obama said, “ There is no limit to what we, as women can accomplish” I have always felt that way when I look at my mother, grandmother, female friends, colleagues and patients I’ve treated in my career.
In starting my own practice, my mission is to listen, educate and find solutions that empower women to lead healthy lives through often challenging perimenopause and menopause years and beyond.