Well Wisconsin Radio

Disclaimer:

The information in this podcast does not provide medical advice, a diagnosis, or treatment. It should not be used as a substitution for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.

Interviewer:

Hello, and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all over the state of Wisconsin. I’m your host, Jennifer Schmidt. Today’s episode is part two in our series, Strong and Steady Through Perimenopause and Menopause. In part one, we focused on perimenopause, the transition leading up to menopause, and the early changes many women notice.

Today, we’re shifting the conversation to menopause and post-menopause, what this stage means for the body, the symptoms women may experience, and the health considerations that become increasingly important. Once again, I’m joined by Dr. Melissa Emmerich from Sanford Health Marshall Clinic Eau Claire Center, who is helping guide us through this conversation with evidence-based insight and a practical perspective.

Together, we’ll also explore the opportunities for strength, stability, and thriving in this next phase of life, and how women can feel in-in-informed, empowered, and supported moving forward. Dr. Emmerich, welcome back. Can you please tell us about yourself and your professional background for our new listeners today that might not have had the chance to, uh, hear, uh, part one?

Guest:

Yes. Thanks, Jen. Thanks for having me back to talk about my other favorite topic, menopause. Yeah, I have been practicing OBGYN for thirty-four years. Initially, I was in the US Navy, um, traveled overseas and practiced over there. And then after I completed my Navy obligation, I came back to the United States, and eventually we settle-settled in Eau Claire.

So, I’ve been practicing with the Marshfield Clinic here in Eau Claire for the last twenty-six years. And my practice has evolved from caring for obstetric patients to, um, now I probably see majority of perimenopause and menopausal women in our department. So, this is a particular focus of interest for me, and it, it really is talking about the women that I see every day.

Interviewer:

Great. Well, I’m so glad you could join us for part two again. So, let’s just get started with, you know, uh, the first question. What exactly is menopause?

Guest:

So, menopause is once we have gone a full year without a menstrual cycle, or it could be a surgical menopause. So, a younger woman who’s had her uterus and her ovaries removed can go through a surgical menopause, and that can be, unfortunately, at a very young age, which changes risk.

That actually increases her risk So what menopause means is that our ovaries either are no longer there, as in the surgical menopause, or are no longer producing estrogen. And the definitions would be a premature menopause would be someone who goes through menopause less than 40 years old. Early menopause is if someone goes through menopause between 40 and 45. The average age of menopause for women in the United States is somewhere between 51 and 52, but it can range anywhere from 45 to 65.

Interviewer:

Thank you. So, I know in part one we talked about symptoms, you know, that are happening, uh, that can be very broad, um, and individualized for each woman. But, uh, during menopause, symptoms, you know, you were saying earlier in that first part may ease for some women but continue for others. What are the hallmark symptoms women may still experience in menopause?

Guest:

Yeah, we can talk about those symptoms, but one thing I want to clarify from the very beginning is that along with menopause occurring as we get older, we also are getting older. So, I think sometimes there’s a lot of confusion about, okay, is this menopause symptom or is this because I’m getting older?

So, a lot of the symptoms that women experience as they get into their later 50s, 60s, and on into their 70s and 80s are really caused by aging process. And, you know, menopause can make it seem like a jumpstart when you first go through that, but I think it’s really important just to, to clarify with women, some of this is not just because of menopause and it’s not just because of loss of estrogen, and it’s not all fixable by giving you back estrogen.

So, I think really just clarifying. You know, a lot of these changes that we see in our bodies is because we’re getting older, and unfortunately that estrogen is not going to prevent us from getting older. Okay? So, the things that obviously occur when we go through menopause is we stop having menstruation and we’re no longer fertile, which can be a freedom. Right? So, for many women, it’s a very good time in their life. They feel this freedom. Um, some women will still have some vasomotor symptoms, some of the hot flashes and night sweats that continue on into menopause. Although generally, those are symptoms that gradually get better once we stop getting the fluctuating hormone levels.

So most women, as they get deeper into menopause, have less of the vasomotor symptoms. Things that increase, and again, I would argue they’re not just because of menopause, they’re because of aging, are the joint aches and the muscle aches. Weight gain can again be a problem unless we do something very conscientiously to prevent that.

There is progressive muscle loss both for men and women as we age. Also, a lot of women will start to notice more dry skin and dry vagina, and something that we call genitourinary syndrome of menopause. So, genital would be referring to the vulvar and vaginal area, the urinary area, which is right next to the vagina.

And the symptom that we can, we’ll see more of in menopausal women, especially the longer they’ve been menopausal, some will develop dryness, burning, itching, sometimes even sexual pain because of the skin changes in the vulvar area. There also can be an increase in urinary symptoms, and women may notice increase in urinary frequency, urgency, more problems with incontinence, and more problems with needing to get up at night to go to the bathroom.

Interviewer:

So, what are some of the best strategies for managing those symptoms? Because it can it sounds like a lot of those symptoms can clearly be uncomfortable and concerning- Yeah … for many women.

Guest:

Yeah. So, for the, specifically for the genitourinary syndrome of menopause, definitely, um, being really cautious about hygiene. There’s a tendency for women to have excess hygiene, especially in the vulvar area. And it’s what we recommend, especially after menopause, is no longer using any soaps or anything that’s scented, um, in the vaginal or vulvar area. Just gentle cleansing with water once a day, not showering or bathing excessively, because that can just exacerbate the symptoms.

The other thing, if there really is dryness, some women will benefit from using, um, a protective moisture barrier layer, something like some A&D ointment or Aquaphor or coconut oil, just on a daily basis as a vulvar skin moisturizer. If the symptoms are very severe, particularly if women are getting pain with intercourse, some women may benefit from some vaginal estrogen use.

Interviewer:

So, there’s a variety of different things and options, especially just over-the-counter things that we could purchase. But also, some hormone therapy when appropriate, um, can still help as well, and that’s something that they would need, you know, to be referred to, um, an OB-GYN for.

Guest:

Or in some primary care providers also will prescribe estrogen cream. Um, the estrogen cream also has been shown to be associated with less risk of urinary tract infections. So, some women are more prone to urinary tract infections after going through menopause, and vaginal estrogen can actually decrease that risk.

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Return to Interview:

And now we’ll head back to the Well Wisconsin radio interview.

Interviewer:

So, several different options out there for women to combat those, uh, uncomfortable symptoms. Are there any other options out there that are important to note or any changes with, you know, we talked a little bit in part one about hormone therapy. Uh, is hormone therapy still used, or is that the gold standard for when a woman is in menopause officially?

Guest:

Yeah. Once a woman has gone through menopause and is getting older, the risks of hormone therapy can potentially increase, and that’s just because with age, our risk of breast cancer, cardiovascular disease, stroke, high blood pressure, diabetes, unfortunately, all of those things increase with age.

And then if we add estrogen on top of that, for some women, that will increase the risk excessively. So again, it becomes a, a very personalized decision in talking with a woman and determining what her risks are as far as going on, like, systemic hormone therapy. Now, I think it’s really important to explain the difference between systemic, which would be a hormone that you take by mouth or a patch or a gel Versus vaginal estrogen.

So vaginal estrogen is actually safe in that it is not absorbed systemically, so it doesn’t increase the risk of any of those things, cardiovascular disease, breast di- breast disease or anything. So vaginal estrogen actually would be safe for just about any woman, unless she had, like, an allergic reaction or something to it.

Interviewer:

Good to know. So beyond the symptoms, I know in part one, um, when we were talking about perimenopause, we talked about some big health considerations, um, that women go through or at or are at an increased risk for when they’re starting to transition into me you know, perimenopause and then into menopause.

Um, we, we talked about, you know, bone health, heart health, um, metabolism and weight, um, and then on also some brain, uh, changes that women might experience. Do those, um, changes, um, or risk, uh, you know, continue to increase as we not alone just age, but also are going through menopause?

Guest:

Yes. So the things that are going to just progressively increase risk would be the cardiovascular disease risk, and as we talked about, um, previously, the, the things that we can do, we can’t change our aging, we can’t change the fact that we go through menopause and lose our estrogen, but we can exercise regularly.

So cardiovascular disease, 30 minutes… I’m sorry, cardiovascular exercise would be recommended for at least 30 minutes, at least five days a week. Also to, you know, our bone density will gradually decrease after we go through menopause and with age, and we can battle that by making sure we’re getting adequate calcium and vitamin D in our diet, and that we’re doing some strength training where we’re strengthening our bones and strengthening our muscles at least two or three days a week.

The other things that do increase would be the genitourinary syndrome of menopause that we just talked about, and we talked about potential options for managing that. And then there are the memory and cognitive changes. Now, these aren’t so much related to the hormones. So, there’s been a lot of studies that have looked at estrogen and progesterone and combination hormones and the relationship to dementia, and they’re really, it’s a, it’s a neutral effect.

So, it doesn’t– So going on hormones does not decrease risk of dementia. Going through menopause does not, you know, increase the risk of dementia. It’s really independent of that. So, hormone therapy is not recommended for memory and cognitive changes. It’s more, um, social support, keeping that brain active, being out there and doing things, physical activity.

All of those things can help to protect our brain as well So this is a stage to really prioritize themselves, take, you know, participate in things to, for their overall wellbeing, from nutrition to bone health, heart health, um, because all of these things that women start experiencing in perimenopause continue into menopause, where they need to focus on all that for prevention.

Interviewer:

What types of screenings, um, do women, um, need to be, you know, continuing on? I think of, like, mammograms. Do they need to continue, um, coming in for their, like, yearly physical, um, exam, um, to address these, you know, changes as well to make sure that their healthcare provider is up to date on what, you know, they’re going through, through this stage?

Guest:

Absolutely, cause there’s so many things that we don’t see unless we check for them. So, it is really important, especially as we age, to get an annual physical, have our blood pressure checked. We should regularly be checked for our cholesterol levels. We should know what our blood sugar levels are to look for diabetes, because if we do develop those things, the earlier we manage them, the better our outcome is going to be.

Um, the other thing I think is really important is to just not be afraid to talk about symptoms. So, you know, occasionally I’ll come across a woman who has had, you know, a lot of the urinary symptoms or the sexual symptoms, um, for many years, and it’s just she’s not felt comfortable talking about it. So be…you know, feel empowered to just bring up any symptoms you have noticed because a lot of times we can do something about it. Um, the other thing is to, you know, request the appropriate screening test. You know, bone density after age 65 should be checked regularly. You know, and, and again, that’s something you don’t know until you check for it.

A mammogram screening would be recommended either every year or every other year, depending on whose recommendations you listen to. Mine would be yearly, um, up until about age 75. At age 75, it becomes more of a discussion of, okay, what is the likelihood of you living another 10 years? You know, women are living very healthy into older age, so many, for many women, it’s appropriate to continue mammogram screening into their 70s, into their 80s, unless they have significant other, um, health issues that necessarily the, the cancer screening wouldn’t be indicated.

As far as, like, Pap smear screening and pelvic exams, that’s become much more personalized. If someone has had normal Pap smears for 25 years up until the age of 65, they can stop screening for a Pap. Pelvic exams have never been shown to decrease the risk of uterine cancer or ovarian cancer, so it’s really based on symptoms.

So, it’s important to talk with a provider about, okay, what pelvic symptoms do I have to watch out for? How do I know when I need a pelvic exam or need to see a gynecologist? So again, I think as in all of medicine, we’re becoming, um, better informed and more personalized in the type of care we deliver. Um, and the other thing is we’ve had a lot of advances in knowledge.

So, I think that by having a good relationship with your provider, you have an opportunity to improve the quality, quality of your life, not just the longevity of life, and that’s really what we want. We don’t, we don’t all just want to live to be 100. We want to live to be healthy into old age, right?

Interviewer:

Exactly. That should be the goal, um, to not just make it to 100, but to actually be enjoying our life at 100- Mm-hmm. Yeah … and making it. Yeah. So, it sounds like there’s a variety of, of improvements and a variety of different things women can do just proactively themselves by focusing on, um, ways to stay healthy just in general.

So, whether it’s exercise, nutrition, staying on top of those screenings, um, and just focusing on overall lifestyle, uh, which we talked a lot about, um, all of these topics in part one. Uh, so including not smoking, moderate alcohol or no alcohol, and then remembering to prioritize sleep. Um, and then just open communication, you know, with their, their primary care provider or their OB-GYN.

Guest:

Agreed.

Interviewer:

Dr. Emmerich, anything, any other insights or any other advice, uh, for this stage, um, you know, of life that women are going through, um, that you’d recommend?

Guest:

I would say enjoy it. You know, it’s really a time of freedom. It should be a time of freedom. You know, many times women kind of get caught in the middle where they have children and grandchildren and maybe aging parents, they’re taking care of. I think it’s really important to, to step back and say, “You know, this is a time I need to take care of myself first and enjoy life.” Yes, it’s important to take care of all of them, but I, I see a lot of women kind of getting trapped as that care provider. Once they retire from their job, they’re now the care provider for everybody who needs care.

So, um, take– Acknowledge that it, it is not selfish to take care of my own needs first, because then I will be a better care provider and a better companion, a, a better support system for everybody else around me.

Interviewer:

That’s some great advice for everybody out there so that we don’t get stuck in the caregiver role. So, thank you so much for, for sharing your insights at this, on this stage. Are there any other resources, um, that you would, uh, send women to, to learn more about, uh, you know, this stage, menopause?

Guest:

Yeah. Again, I, my, my primary recommendation would be to go to the American Menopause Society, or now it’s just called the Menopause Society. They have a very good, um, webpage with a lot of links to reliable scientific-based information, which is really where we should be going rather than, than to chat rooms and, um, just listening to everybody else’s opinion online.

Interviewer:

Well, Dr. Emmerich, thank you for joining me again today. I want to tell our viewers that there are, uh, endless resources out there for, uh, perimenopause and menopause, and that nobody should suffer in silence, and to reach out for, for help and just be open, uh, to communicating with your healthcare team on what you’re going through.

Guest:

Very well stated. Thank you, Jen.

Interviewer:

Thanks for listening to Well Wisconsin Radio. I hope you enjoyed the show. We love hearing from our community, so please take a moment to visit the Well Wisconsin Radio card under the Benefits tab in your Well Wisconsin portal to share your feedback or suggest a guest for future episodes. You can find our transcripts and previous episodes all at www.webmdhealthservices.com/wellwisconsinradio. If you’re listening to this podcast on your platform of choice, be sure to subscribe so you never miss an episode.

In this episode, we continue the conversation in part two of our Strong and Steady series. Last month, we discussed navigating perimenopause, and now we shift the focus to menopause and post-menopause with Dr. Melissa Emmerich, OB-GYN at Marshfield Clinic Eau Claire Center. Together, they explore what happens during this stage of life, including common symptoms, hormone therapy considerations, bone and heart health, cognitive changes, and the importance of preventive screenings. Dr. Emmerich also shares practical strategies women can use to support their overall wellbeing and thrive through menopause with confidence, knowledge, and self-care.

The information in this podcast does not provide medical advice, a diagnosis, or treatment. It should not be used as a substitution for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.

Resources discussed during interview:

• Talk to a health coach individually or sign up for group coaching today by calling 800-821-6591.
• The Menopause Society at menopause.org