Menopause is an inevitable phase of life that every woman will experience, with the global population of menopausal and postmenopausal women expected to reach 1.2 billion by 2030. Despite its commonality, many women are reluctant to discuss menopause, and a significant number of healthcare providers lack expertise in this area. However, Dr. Donna Kasello, a board-certified OB-GYN at Premier Medical Group, is an exception. As a Menopause Society Certified Practitioner (MSCP), she specializes in addressing hormonal imbalances, menopausal issues, and women’s sexual health.
Difficult Discussions Made Easier
Historically, women have been hesitant to discuss menopause, largely due to the 2002 Women’s Health Initiative, which associated hormone replacement therapy (HRT) with increased risks of breast cancer, stroke, and heart attack. This led to a reluctance among both patients and physicians to explore treatment options. However, Dr. Kasello explains that over the past two decades, the medical community has gained a deeper understanding of the data from the Women’s Health Initiative. She emphasizes that HRT can be highly beneficial for managing many menopausal symptoms.
A February 2023 article in The New York Times titled “Women Have Been Misled About Menopause” supports this view, raising questions about why many women have not been offered established treatments for severe symptoms such as hot flashes, insomnia, and painful intercourse.
“Today, more women are seeking help for the challenges they face during perimenopause and menopause,” Dr. Kasello noted. “It’s been a movement, and it’s still moving.”
Defining Perimenopause, Menopause, and Post-Menopause
Understanding the different phases of menopause is crucial for managing the transition effectively:
Perimenopause: This phase can last up to 10 years before menopause, marked by the gradual aging of the ovaries and the onset of hormonal changes. Symptoms can include mood swings, changes in menstrual cycles, decreased libido, energy fluctuations, and weight gain.
“Sometimes women just can’t really put their finger on it, because their menstrual cycles might be normal, but [their bodies] are changing,” Dr. Kasello said.
Menopause: Clinically defined as the cessation of menstrual cycles for one year, menopause typically occurs between the ages of 45 to 55. Some women may experience early or late onset of menopause, which can be influenced by various factors, including genetics. Symptoms during this phase can include hot flashes, night sweats, sleep disturbances, joint pain, muscle stiffness, vaginal dryness, and painful intercourse. However, Dr. Kasello points out that symptoms can vary widely from person to person.
“Every woman’s journey through menopause is different,” she said.
Surgical Menopause: Menopause can also be induced by medical interventions that affect ovarian function, such as the removal of both ovaries or treatments such as radiation therapy or chemotherapy, which can cause the ovaries to stop working as they normally would.
Surgical menopause can also occur due to the removal of the uterus through a hysterectomy or through the removal of the uterine lining. While menstruation ceases as a result, women who still have their ovaries might still experience symptoms from hormonal fluctuations associated with a menopausal transition.
Post-Menopause: This phase begins after one full year without menstruation and continues indefinitely. Some menopausal symptoms can continue after menstruating has ceased but they typically become milder and disappear completely in the postmenopausal phase.
Healthy Habits to Support Bodily Changes
Menopause brings about significant changes, including an increased risk of cardiovascular disease, hypertension, diabetes, and accelerated loss of bone density, which can lead to an increased risk of fractures. To manage these risks and symptoms, lifestyle modifications are essential. Dr. Kasello recommends maintaining a healthy weight, adopting a diet rich in fiber and complex carbohydrates, and minimizing the intake of simple carbohydrates and processed foods. Regular exercise, particularly resistance training, is crucial for maintaining muscle mass, bone strength, and overall mental health.
“Resistance training and weight training are probably more important than cardio as far as maintaining muscle mass,” Dr. Kasello advised. “It helps to maintain weight, strengthens the bones, and it’s good for mental health, too.”
Stress reduction is another key component of managing menopausal symptoms. Dr. Kasello suggests incorporating mindfulness practices, meditation, and breathing techniques like box breathing and 4-7-8 breathing into your daily routine. Practices like yoga can be extremely beneficial since it incorporates both physical and mental wellbeing components.
Adequate sleep is also vital for overall health and recovery during this life stage. Due to the nature of symptoms such as hot flashes and night sweats, sleep can be affected significantly during menopausal transition. Sleep deprivation can cause issues with overall health, including but not limited to decline in immune function and increased risk for depression. Dr. Kasello says that’s why it’s important to explore effective treatment options for symptoms, especially those that affect sleep.
You Have Options: Medical Treatments for Menopause
For those experiencing moderate to severe menopausal symptoms, there are two FDA-approved indications for hormone replacement therapy (HRT): managing hot flashes and night sweats, and preventing osteoporosis. However, HRT is not suitable for everyone. Dr. Kasello categorizes women into three groups:
Green Light: Women with no contraindications and in good health, who are generally safe to undergo HRT.
Yellow Light: Women who require cautious consideration due to potential risks.
Red Light: Women for whom HRT is contraindicated, such as those with a history of blood clots, stroke, or coronary artery disease.
A family history of breast cancer is not a contraindication, but a personal history is. Dr. Kasello notes that 85% to 90% of women fall into the “green light” category.
For those who cannot undergo HRT, alternatives are available. The FDA recently approved VEOZAH®, an oral medication for treating moderate to severe hot flashes caused by menopause. Other options include gabapentin for hot flashes and oxybutynin for overactive bladder. Natural supplements like black cohosh and dong quai are also popular, though not FDA-approved. Dr. Kasello has recommended fish oil for some postmenopausal patients due to its benefits for cardiovascular health, mood, and inflammation, but in general, she emphasizes that a healthy, balanced diet is often the best way to get most vitamins, minerals and nutrients that the body needs to function well.
Embracing a New Chapter
Dr. Kasello emphasizes that menopause doesn’t have to be something that women dread. She highlights the positive aspects of this life stage, including the freedom from menstrual cycles and pregnancy concerns, and the opportunity to enjoy financial independence, travel, and life’s other pleasures.
Dr. Kasello also encourages women to take proactive steps for their health during menopause.
“Learn to show up for yourself,” she said. “We’re trained to wait until we get sick and then treat the illness, as opposed to the things that cause us to get there. If we know what those are, then let’s not do those.”
Finding a provider who is willing to listen and help you navigate this new chapter can be immensely beneficial too. Dr. Kasello recommends visiting the North American Menopause Society website (menopause.org) for more information and resources for both women and healthcare professionals. The organization oversees clinician certification in menopause.
“[The certification] clearly shows who’s interested enough in menopause, who’s following the literature, who has the proper information, and who can provide the appropriate resources,” Dr. Kasello said.
A list of certified menopause clinicians accepting new patients is available to the public for anyone wanting to find a provider nearby. As of the date of publishing, Dr. Kasello is the only physician listed within a 25 mile radius of the Premier Medical Group gynecology office in Poughkeepsie who holds the distinction of being a Menopause Society Certified Practitioner (MSCP).
For additional resources and more information about Premier Medical Group’s OB-GYN services, visit our website or contact Donna Kasello, M.D., FACOG, MSCP at (845) 437-5000.