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Dr. Carilyn Hoffman's Guide to Menopause Medication & Relief
Women undergo multiple hormonal changes throughout their lives, leading to different physical and emotional experiences. Dr. Carilyn Hoffman, at Renown Women's Health, explains these confusing life stages and helps decode menopause. Perimenopause: Transitioning Towards Menopause Defined as the time "around menopause," perimenopausal symptoms are caused by hormonal fluctuations that occur as the ovarian function declines. Levels of estrogen and progesterone decrease, and follicle stimulating hormone increases. These hormonal fluctuations may cause a range of symptoms including: Irregular or abnormal periods: Initially cycles intervals vary in length by greater than 7 days, then in later stages the interval increases to greater than 60 days between cycles Hot flashes and night sweats: This is the most common symptom and 50-82% of women will have vasomotor symptoms Mood swings and memory problems Anxiety or insomnia Heart palpitations Decreased libido and vaginal dryness Weight gain and thinning hair Increased risk of urinary tract infections Decreased bone density Menopause Menopause is defined as year without a menstrual cycle and marks the timeframe when the ovaries stop making estrogen. This signifies the end of the reproductive years. The average age of menopause is 51; however, the menopausal transition can last about 8 years. This means that women in their late 30’s and 40’s may start to have symptoms of perimenopause. The worst vasomotor symptoms are typically experienced at the one-year mark since the last period. Unfortunately, some women experience symptoms throughout the entire menopausal transition. Postmenopausal After 12 months without a menstrual cycle, a woman is confirmed to be postmenopausal. This is sometimes difficult to define, as women may have had procedures that cause menstrual suppression such as a uterine ablation or hysterectomy or they may still be on contraception. Sometimes, lab work may be recommended to help determine menopausal status. However, due to the broad time period that the menopausal transition occurs and the variations in normal hormone levels throughout a cycle, lab work is not always helpful. Dr. Hoffman explains the importance of thorough counseling for patients seeking to "check their hormone levels." She emphasizes that menopause is diagnosed clinically, focusing more on the individual's symptoms rather than lab values. This approach ensures that patients understand the implications of the test results and the treatment strategy. Menopause Medical Management Medical management of symptoms should be tailored to the individual’s concerns. Abnormal Bleeding: There are a range of medications, IUDs and procedures available if the main concern is irregular or prolonged menstrual bleeding during perimenopause. Hot Flashes and Night Sweats: Hormone Replacement Therapy (HRT): HRT is currently the most effective method for relieving vasomotor symptoms. However, it's important to discuss potential risks with a healthcare provider, as HRT can increase your risk of blood clots and breast cancer. If improperly prescribed, it can also increase the risk of uterine cancer. The American College of Obstetricians and Gynecologists recommends the lowest dose for the shortest duration. Low-dose antidepressants: SSRIs/SSNIs may mitigate hot flashes and mood disorders for those who are not candidates or prefer to avoid HRT. Currently, only Paroxetine is FDA-approved for this use. Fezolinetant: This is a newly FDA-approved non-hormonal medication that works at the brain's level to treat vasomotor symptoms. Gabapentin: This is an anticonvulsant medication that has been shown in several studies to be helpful for vasomotor symptoms, but it is not currently FDA-approved. Genitourinary Symptoms of Menopause: Vaginal estrogen: Vaginal dryness and pain with intercourse due to thinning vaginal tissue is a common symptom of menopause. Vaginal estrogen is highly effective at decreasing these symptoms and has fewer side effects than systemic HRT. Ospemifene: This is a selective estrogen receptor modulator that is a non-hormonal FDA-approved medication for severe vaginal dryness. Natural Symptom Relief Strategies: Nutrition: Incorporate calcium, vitamin D, and high-quality protein to support bone health and muscle maintenance. There are limited studies on phytoestrogens (found in soy and tofu) and vasomotor symptoms. While the data doesn’t necessarily support that these phytoestrogens relieve symptoms, no detrimental effects were found and these tend to be high quality and healthy proteins. Exercise: Regular physical activity can ease menopausal symptoms and support weight management. Data doesn’t support that this reduces vasomotor symptoms, but it can be helpful in weight management and sleep quality. Beverage choices: Limiting alcohol and caffeine can help decrease the frequency of vasomotor symptoms and may also improve sleep quality. Alternative remedies: One study shows that Chinese herbal medicine and acupuncture are effective at relieving vasomotor symptoms. There is not enough evidence to recommend Black Cohosh, and it is associated with liver toxicity in high doses. Studies don’t show that St. John’s Wart or Gingko Balboa are any better than placebo. Always mention your alternative medical therapies to your provider as some do interact with other prescribed medications. By understanding and recognizing that the symptoms of menopause are real and treatable, women are empowered to manage this transition better and can maintain their well-being and quality of life. Please schedule an appointment with Renown Women’s Health if you’d like to discuss your menopause symptoms with a provider.
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Reno Home to Two of the Nation's Best Physician Communicators
Dr. Marie McCormack of Renown Medical Group and Dr. Daniel Spogen of University Health selected as Best in the Nation with 2023 “Excellence in Healthcare” Award from Professional Research Consultants “One of the best I have ever seen.” “Prepared, thorough and tuned in to whole picture.” “Compassionate and listens.” “Wonderful.” “Excellent physician.” Always willing to congratulate successes, answer questions fully and in a way that I can understand and give good advice.” “Exceptional!” “You are knowledgeable, thorough, intelligent and compassionate.” “I love you. I thank you.” These are some of the comments made by patients regarding two Reno physicians lauded by Professional Research Consultants, a national firm that interviews patients following their physician and healthcare visits. The Excellence in Healthcare annual award honors physicians who demonstrate exceptional communications skills in their clinical practice, as awarded by their patients. Recipients of this award are ranked as Top Performers in the “Overall Doctor Rating” and rank in the 100th percentile nationally. Over 3 million patients responded to the Centers for Medicare & Medicaid Services’ (CG-CAPHS) or Clinician and Group Consumer Assessment of Healthcare Providers and Systems patient experience survey in 2022. “We at Renown Health are so proud of Dr. Marie McCormack of Renown Medical Group and Dr. Daniel Spogen of University Health. As Excellence in Healthcare awardees, every one of their patients surveyed in 2022 gave them an A+. These physicians set the gold standard for excellent communications with patients, scoring in the top 1% nationally,” said Brian Erling, MD, MBA, President & CEO for Renown Health. “We are honored that over 500 physicians and advanced practice providers of Renown Medical Group and University Health care for more than 200,000 patients annually at medical practices across Reno, Sparks, Carson City and in our rural communities of Fallon, Fernley, and Silver Springs. In 2022, 17,600 Renown Medical Group patients were surveyed by PRC; 83% of them ranked Renown Medical Group providers as a 9 or 10, the highest rating possible, for physician communication with patients, a key indicator of overall patient satisfaction.” Marie McCormack, MD is a board-certified family physician with an emphasis on preventive health care. She has cared for thousands of patients, from the smallest of babies to golden agers in northern Nevada for 15 years. Dr. McCormack graduated from the University of Nevada, Reno School of Medicine and completed her residency at the University of Kansas. She currently serves as Medical Director of the Primary Care Group for Renown Medical Group, overseeing primary care for 18 medical offices and more than 70 primary care providers for the largest not-for-profit healthcare network in Northern Nevada. She previously served as the Medical Director for the Rural Clinics seeing patients in Fernley, Fallon, Silver Springs, and Carson City. Dr. McCormack has garnered the highest 5-star rating from over 1,359 actual patients and their comments can be read on the Renown “Find a Provider” website. See video of Dr. McCormack discussing her passion for patient care. Daniel Spogen, MD is also a board-certified family physician. He has a special interest and emphasis in sports medicine and has served thousands of patients and athletes over his 21 year career with University Health, assisting them with care, treatment, rehabilitation and training so they can return to their sport. Dr. Spogen also served as former Chair, Department of Family Medicine at University of Nevada School of Medicine for over 16 years. He completed his Doctor of Medicine degree from the University of Southern California and his residency at Glendale Adventist Medical Center in CA. More information about Dr. Spogen can be found at https://www.renown.org/find-a-doctor/daniel-spogen. “It is an honor to recognize Marie McCormack, MD, and Daniel Spogen, MD, of Renown Health with the Excellence in Healthcare Awards for their deserving work,” said Joe M. Inguanzo, Ph.D., President and CEO of PRC. “It takes true dedication and determination to achieve this level of excellence in healthcare and Renown has shown their commitment to making their hospital and medical practices a better place to work, a better place to practice medicine, and a better place for patients to be treated.” To learn more about healthcare services or to schedule an appointment with a Renown Medical Group or University Health provider, visit mychart.renown.org or call our agents available by phone- Wed-Fri: 7 a.m. to 7 p.m., Sat-Sun: 7 a.m. to 6 p.m., at 775-982-5000. Renown Health is hiring! To join the Renown Health team visit www.renown.org/careers. To learn more about the 2022 Excellence in Healthcare Awards, including eligibility and criteria, visit PRCCustomResearch.com. About PRC PRC, a leader in the healthcare intelligence space with the most comprehensive healthcare discovery platform, is taking surveys to a new level. PRC’s surveys and intuitive reporting focus on changing the way organizations manage and improve five key areas of the healthcare experience—patient, physician, employee, community, and brand. Over 2,800 healthcare organizations across the United States have used PRC to listen, understand, and take action to create cultures of excellence. To ensure clients have access to leading practices, coaches, and learning resources, PRC is partnered with Healthcare Experience Foundation (HXF) to accelerate paths to excellence. The PRC healthcare discovery platform is a system designed to drive action, optimize engagement, and increase loyalty while building a positive culture across the healthcare ecosystem. www.PRCCustomResearch.com About Renown Health Renown Health is Nevada’s largest, not-for-profit integrated healthcare network serving Nevada, Lake Tahoe, and northeast California. With a diverse workforce of more than 7,000 employees, Renown has fostered a longstanding culture of excellence, determination, and innovation. The organization comprises a trauma center, two acute care hospitals, a children’s hospital, a rehabilitation hospital, a medical group and urgent care network, and the locally owned not-for-profit insurance company, Hometown Health. To join the Renown Health team visit www.renown.org/careers.
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