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'Women are suffering in silence': UVa midlife health expert talks menopause

Menopause has a stigma of “don’t ask, don’t tell” that causes more midlife health complications than necessary, according to JoAnn Pinkerton.

“The biggest thing that I see is that women are suffering in silence,” Pinkerton, a gynecologist and the director of midlife health at University of Virginia Medical Center, said at a health briefing on Friday. “They may have asked for help and their provider didn’t listen to them or blew them off. Here at UVa, we really listen to all of your issues. Is it a bleeding issue? Is it a depression issue? Is it a marital or partner issue?”

Pinkerton, who is also the executive director emeritus of the North American Menopause Society, said that, when discussing women’s midlife health, it is important to recognize the difference between menopause – the time of life when a woman’s ovaries stop producing hormones – and perimenopause – the time of change leading up to menopause when the ovaries gradually produce fewer hormones and eggs.

On average, women experience perimenopause and menopause between 45 and 55 years old, though the lengths of each stage vary from woman to woman.

“Lack of periods can last over 60 days and then, finally, up to 12 months,” Pinkerton said. “No periods for 12 months if you’re not pregnant defines menopause. The three most common symptoms are hot flashes, night sweats and vaginal dryness.”

Women in menopause may experience seven or more hot flashes, also known as vasomotor symptoms, every day, Pinkerton said. Among the 80% of women who experience hot flashes, 25% request treatment to tame them.

Hot flash treatment has come a long way from being confined to a fan and a cold washcloth to the forehead, Pinkerton said.

Today, menopausal hormone therapy is the most effective treatment for hot flashes. Pinkerton said the treatment reduces the frequency and severity of hot flashes while aiding in sleep regularity, mood swings, fatigue, bone aches, vaginal health and heart health. Hormonal therapy also prevents major health issues associated with women who have early menopause due to having their ovaries removed before turning 40.

“I think the future is really bright,” Pinkerton said. “Because, for women who are candidates for hormone therapy, we have many options, including FDA-approved identical hormones. Hormone therapy is available in a variety of routes – oral, transdermal, vaginal – so we can really individualize [treatment] based on a woman’s risks and benefits of therapy.”

Midlife health experts at UVa Medical Center are investigating a drug similar to neurokinin receptor antagonists that modulates the brain circuits that are changed when a woman’s estrogen levels decrease during menopause. The drug, currently under FDA review, would help dampen the center of the brain to reduce the frequency and severity of hot flashes.

The drug is still in the early stages of clinical trials but has already shown its ability to relieve hot flashes, night sweats, sleep and mood swings, Pinkerton said.

While menopausal hormone therapy has seen significant success at UVa Medical Center, the midlife health division also offers alternative treatments such as an FDA-approved, low-dose paroxetine salt and antidepressants, which are available for women who prefer nonhormone therapies.

While there are primary symptoms that are frequently used to identify menopause in middle-aged women, Pinkerton said women may experience much more during that time. Additional menopause and perimenopause symptoms also include of loss of sex drive, sleep issues, an increase in belly fat, a change in breast size and shape, heart palpitations and brain fog – one of the biggest concerns among women Pinkerton sees at the Midlife Health and Gynecologic Specialties at the UVa Northridge Medical Park.

“For women who have navigated the hot flashes, the sleep, the mood, the bleeding issues; now they’re better and all of a sudden it starts to hurt when they have sex or they start avoiding it,” Pinkerton said. “Talk to us or your provider because we have a lot of local vaginal therapies that can treat the loss of estrogen in the vagina.”

Pinkerton said UVa carries creams, tablets and ring suppositories; practices pelvic floor therapy; and employs a gynecology specialist to address additional menopause and perimenopause symptoms.

“It’s important to recognize that we have a credentialed menopause specialist here at the Midlife Health Center,” Pinkerton said. “We are trained in perimenopause, menopause and beyond, but we also work really closely with other departments, such as mammography, for finding the right type of imaging. We have a bone specialist so women who have severe osteoporosis can do bone-specific therapies. We have women’s health psychiatry that can help with navigating some of the mood issues because menopause is one of the times when depression can get worse.”

Don’t suffer in silence when help is available, Pinkerton said.

The early stages of menopause can closely resemble symptoms of premenstrual syndrome, causing some women to miss the signs right away. Perimenopause brings slight changes such as the occasional missed menstrual cycle, but those changes intensify over time.

Pinkerton said she recommends all of her female patients use for additional information and guides for navigating hormonal and physical changes. The website also helps women who are not located in Central Virginia find specialists in their area by ZIP code.


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