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Doctor teaches women what to do
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Dr. Stephanie Van Zandt poses in front of her Menopause Practitioner certificate from the North American Menopause Society.
CLEARWATER – Dr. Stephanie Van Zandt always tells her patients, “You don’t get to choose menopause. Menopause chooses you. You don’t choose your symptoms. Your symptoms choose you.”

Menopause and perimenopause can be a turbulent time in a woman’s life, and all women who live long enough must go through it, said Van Zandt, an OBGYN with Contemporary Women’s Care in Clearwater and Seminole. She is also one of the county’s few North American Menopause Society menopause practitioners. Since every woman goes through this period, there is much misinformation about it, she said. Van Zandt wants to clear up some of these misconceptions.

Menopause is a woman’s final menstrual period, which is confirmed when a woman has not had her period for 12 consecutive months, according to the North American Menopause Society. Perimenopause is the time leading up to menopause.

“Perimenopause is the time when women have a diminishment in their natural hormone production,” Van Zandt said. “Your estrogen and progesterone decline, but your progesterone declines at a little bit faster rate.”

Women begin to suffer any number of symptoms due to the change in hormone levels. Women can get more PMS, more premenstrual irritability, perimenopause headaches, breast tenderness, more cramps, heavier bleeding, hot flashes, night sweats, mood swings, forgetfulness, anxiety, palpitations, depression, achy joints, migraines, weight gain, insomnia and vaginal dryness, Van Zandt said.

Women also can tell if they are menopausal by a blood test, she said.

While a girl is still in her mother’s uterus, she has about two or three million follicles, Van Zandt said. These are the compartments in her ovaries that make progesterone, estrogen and hold the eggs. By the time the girl is born, she is down to about a million and a half follicles, she said. Later, each time a woman menstruates, she starts blowing about 1,000 a month, each time she ovulates.

When hormone levels drop, the woman’s pituitary gland realizes that there is not enough estrogen in the blood stream, it sends a follicle stimulator hormone down to the ovaries to tell them to start producing more estrogen, Van Zandt said.

“If you’re not ovulating anymore because you don’t have any more eggs, the body says, ‘Hey, there’s not enough estrogen here,’ and then it will send a messenger hormone down to the ovaries to kick some butt to say, “Hello, follicles, we’re here to stimulate you. Let’s get going,’ Van Zandt said. “But if there are no more follicles, there’s nobody home, and the estrogen gets lower and lower and the pituitary gland screams louder and louder, so your follicle stimulating hormone gets quite high, so that’s how we know you’re menopausal.”

Most women will experience some side effects from estrogen withdrawal, but for some, it can greatly affect their lives, Van Zandt said. One solution for these women is bio-identical hormone replacement therapy, she said.

“Does everybody need to be on hormones? No,” Van Zandt said. “The big driver of hormone replacement therapy is the woman themselves because they’re coming in here like a maniac. They’re a menopausal maniac mess. Symptoms are the primary driver.”

The bio-identical hormone replacement therapy that Van Zandt recommends uses natural estrogen and progesterone that is absorbed through the skin, either in a gel, as a patch or through the vagina. It can also be taken orally, although it is less effective because it has to filter through the liver, although the oral dose is less expensive, she said. This therapy counteracts the symptoms of perimenopause and menopause as well as some of the other problems that crop up during this period of time, she said.

With menopause, women are also significantly more prone to cardiovascular disease and osteoporosis, Van Zandt said.

“Most women enter menopause with beautiful blood vessels, and with the loss of estrogen, it dramatically changes over the next couple of years,” Van Zandt said.

Once women hit age 50, their risk of dying of cardiovascular disease becomes 50 percent, although bio-identical hormone replacement therapy early enough can help prevent this, Van Zandt said.

However, Van Zandt discourages compounded hormone replacement therapy because many of these are not FDA approved, are not research-based and end up with inconsistent doses because the quality control is up to the individual pharmacist. Batch to batch, the balance could be different each time, she said.

Other ways to combat the effects of menopause are to exercise, especially strengthening one’s core; eat healthy foods; watch one’s intake of carbohydrates and fats; take multi-vitamins, especially Vitamin D; and start taking calcium daily from age 35 onwards. Women age 40 and older should also especially make sure they get yearly mammograms and gynecological exams because the risk of breast and other female cancers go up at this time, she said. Women in this age group should also get their cholesterol and triglycerides checked regularly, she said.

Van Zandt encourages family members of menopausal women to educate themselves and be understanding of the symptoms. If they feel the woman has life disruptive symptoms, she recommends they encourage her to see her doctor for menopause counseling.

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