Dr. Jessica Shepherd Breaks Down What to Know About Perimenopause – SheKnows

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Between the seemingly endless list of symptoms to navigating treatment options and lifestyle changes, perimenopause and menopause can be overwhelming. In our inaugural ‘In Flow With’ conversation, OB-GYN, menopause expert, and Flow advisor Jessica Shepherd unpacks exactly what happens during the transition to menopause. In conversation with Cristina Velocci, Chief Content Officer of SHE Media, Dr. Shepherd covers the latest research, science, and best practices to combat menopausal symptoms. Watch their full conversation on Linked In, or read the edited transcript here. 

What is perimenopause and how is it different from menopause? 

Dr. Shepherd: That is actually a very common question that I get from my patients or friends or family members or anybody. And I think it is sometimes a little bit confusing when we kind of think of the different terms, because people don’t know if they’re in, out around, menopause and perimenopause. Really when you think of the word perimenopause, it means to surround. It really is that timeframe before you actually hit menopause. And I remember when we were discussing this recently, but menopause technically, if you were to think about it is one day, and the reason why we use this term and how we justify it is really from a clinical perspective. 

So when, say I’m speaking to another healthcare provider or even to a patient, I am letting them know that in menopause, they’ve reached that timeframe where they do not have enough estrogen or estradiol to elicit the release of an egg, therefore getting pregnant. So, it’s kind of like you’ve now turned the leaf into that reproductive phase where you can no longer get pregnant. 

And the reason why that’s different is because in the perimenopause timeframe, which usually starts in the 40’s, it can start in early 40s and sometimes mid-40s, different for every woman is that perimenopause is when you kind of have like this rollercoaster ride of decline in estrogen and other hormones as well. So, just progesterone and testosterone, that for during the reproductive time of your life were very constant were very, like they knew what their dance and song were. 

And during the perimenopausal phase, they know they’re getting ready for menopause and they just kind of like ‘Yeah, today I’m not coming to work’, or ‘I’m not going to show up today’. And so it’s the steady decline and over the course of maybe seven to 10 years you have these irregular cycles, irregular bleeding. Some people have heavier bleeding, some people have light bleeding, but it’s really this kind of variation and how people cycles become during that time frame. But once you’ve not had a period for 12 months consecutively, meaning no bleeding, no spotting, no bleeding on that timeframe at the end of that 12 months, we give you that magic term “menopause.” 

And so the reason why I said early when we started that it really is just a day is because after that day, you are menopausal, you’re now post-menopause, and so from the duration of your life there on, your postmenopausal. So it’s kind of like three phases. I would say perimenopause, starting the decline in hormones, getting to that day of menopause and your 12 month cycle, and then you’re postmenopausal. I really want to make sure people understand the context of what perimenopause, menopause, and post menopause are. And menopause is truly a day. It really is like a birthday. You know, you’re just heralding this new time in your life, which is going to be fabulous.

What age does perimenopause start, how long does it last, and what age does it typically end?

Dr. Shepherd: So, the average age of menopause in the United States is 52. There are people who can reach menopause before 52, and that’s fine as well. What we run into issues with is if someone stops their cycle completely before the age of 40, that is kind of what we call abnormal menopause because it’s premature.

And so that’s when we would have to kind of delve into why someone’s estradiol or the follicles in their ovaries are not giving off estrogen for them to have a period. That’s a whole workup and that’s something that needs to be paid attention to. If you think of just the standard distribution of a normal curve, most people won’t be at that 52 timeframe, but some of my patients are menopausal at 47. And I have some patients who still have their cycle pretty regularly or even if it’s irregular at the age of 55. It really can happen at different time frames, but the average is 50.


What are some of the causes of premature menopause?

Dr. Shepherd: That is a great question and something that people should be aware of, because I think that I’ve had a couple — again, not a lot — of patients who didn’t know how to question it. Or unfortunately, maybe they didn’t necessarily see a gynecologist or someone who’s well versed in the fact that that shouldn’t be happening, and went into premature menopause and then it was too late by the time they kind of looped into someone who can give them the proper workup or giving them some more education on why that may happen. 

And so that, again, is something that needs to be attended to very cautiously and immediately. Some of the reasons that that may happen, is family history. So it’s important again, to have these discussions with your mother or women in your family — your aunt, your grandmother — when they go through menopause. What I have heard from some of my patients who are kind of in the 40 to 50 age and there might be the case that their mothers didn’t really tell them about what they’re experiencing with menopause. So you have this kind of gap in family history where they don’t know when they went through it. And so that’s again, a reason why we should be very open with this information. 

And then you also have people who have maybe had, whether it’s pelvic cancer or any type of cancer or breast cancer, and they had chemotherapy, or some type of pelvic radiation treatment, which impacted the ovaries and therefore, the ovaries were unable to get that estradiol to give them the cycle. So that’s another reason why — if women have a diagnosis of cancer. I’ve had patients like this as well, where again, their oncologist is not necessarily well versed on reproductive timeframes and are really devoting a lot of attention to their cancer diagnosis, and they didn’t maybe give them steps in which they could take to maybe secure some follicles and eggs. So think about what this means for their fertility and then go through treatment; otherwise they’re unable to bear children because they went through premature menopause. And then obviously, people have their ovaries removed before the age of 40, then that could happen as well. So people who have autoimmune diseases like very severe thyroid disease, may show up with having premature menopause. That’s typically rare. But again, another reason why.

Is there any way to predict what age you might start experiencing perimenopause or menopause?

Dr. Shepherd: This is a great question — I wish I had the crystal ball for this. Everyone come see me for the crystal ball and I will tell you when you’ll enter menopause. But a family history is probably the best indicator of someone who might go through menopause, but there really is no definitive, ‘you will go through today on this day.’ You will start to see a lot of different changes in the cycle, which is most times the hallmark of when people can start to feel perimenopause, which is when you start to skip more periods. Some people skip four months and some people skip six months, then they’ll bleed. So again, no crystal ball for that, but I wish it would be helpful.

What are some of the signs of perimenopause — is it always skipped periods?

Dr. Shepherd: This is where the symptomatology of what people may have during the perimenopausal phase can really be very robust and complex, and different from other women. Now, the bleeding is usually what you’ll hear from a gynecology standpoint because in the absence of bleeding — menopause — but really the decrease in estrogen, is going to elicit a lot of systemic type of symptoms, namely hot flashes, night sweats, which are you know, when you have a hot flashes like wakes you up from sleep, we can have some irritability, mood disturbances. 

I would say even as a perimenopausal woman, mine was like a kind of mind fog, just like clarity. That was one that I found, particularly for me it was very evident. And then there are a lot of women who start to have a decrease in lubrication, vaginal dryness issues. Some people start to have pain with sex, decreased libido is another one that you might start to see that occurred during the perimenopausal phase. And again, this is again how that fluctuation and decline in hormones can actually impact someone, and how their symptoms appear. And then we also need to talk about in lieu of having that long list there’s about 34 symptoms that come with perimenopause that may differ in intensity and severity and frequency. 

They may have women who go like Scotch free of having any perimenopausal symptoms. There are a lot of people who have really severe types of hot flashes and night sweats in their 40s, that may not be as frequent and it may intensify as they get older. But those are some of the symptoms that you’ll start to see. But I would caution as women are starting to go through these to talk to their healthcare provider, and let them know that they are experiencing this and to not to compare themselves to other people who may have gone through before them, and are going through that same time because everyone shows up in a different way.

How can women in perimenopause and menopause alleviate symptoms?

Dr. Shepherd: I think the first place to start is awareness. And this is what these conversations are really helping with is the awareness and the changes that occur when they start to happen. 

People say, ‘Okay, this is something that I’ve heard that has happened’. And the reason why I bring this up is so many people just kind of hit this wall, and they didn’t have any information, education, conversation prior to it, and it can be very daunting, scary, and also, it just can be a lonely time because then some women don’t want to talk about it. 

And so then they feel very lonely in their journey while going through these symptoms. So you know, we’ve talked about again, this stopping of ovulation decreases in varying production, estradiol, and then also testosterone and progesterone. So now it really comes to what symptoms you’re having. And then hearing all of the options which are available, and we’ll address what symptoms that they’re having. So, when we talk about resolution, symptom decrease or decline, we want to talk about hormones and non-hormones. The reason why I put it in hormones and non-hormones is because the non-hormone category really is a lot of different, complex, and different things that you can do.

For example, diet has a big impact on how we can change some of the patterns and the foods that we eat that can really help with some of the symptoms that we’re having. And then also movement. Exercise can also really play an important part. And the good thing is that we have some good data and literature behind these forms of non-hormonal lifestyle changes. Things that can help as well as, are things like acupuncture and yoga that really have been shown to help with sleep disturbances which are definitely one of the symptoms and then also, joint issues. A lot of women have joint soreness or tenderness as they’re going through this timeframe and into menopause, and then also changes in how our body distributes, and holds on.

Many women will notice during the perimenopausal phase [that they start to have] menopausal belly. And that again is just how the body has started to change and how it delivers and stores energy, also known as glucose, what converts to fat and that’s why diet and exercise are also very important. And then there are medications and I’m moving more into the medication frame of non-hormonal and hormones is that you do have non-hormonal forms of helping with hot flashes and night sweats. 

So SSRIs (selective serotonin reuptake inhibitors) which are used for depression actually, can work for a lot of women when we think of hot flashes and night sweats, because it works on the neurotransmitters that we’ve seen that impacts sleep and hot flashes. So, this is one way to use medication to help with that. And then also there is a newer medication on the market that is just specifically geared to work on a neuron in the brain that has to do with thermal regulation. And that helps with the KNDy neuron, which helps shift the seesaw in keeping that in balance of what our temperature is when it’s upset, because it’s very dependent on estrogen. That’s how that medication can help, and then switching over to the other side of hormones which again can be a whole laundry list of different ways, methods, and delivery systems on how you can get hormones.

Is there anything specific you recommend with regard to diet?

Dr. Shepherd: I would say with diet, we have a significant, significant decrease in muscle mass as we start to age and get into menopause and a lot of that has to do with two things. Aging, just because we’re aging, but also because of estrogen we see that there’s a decrease in muscle mass. Muscle is the largest organ and it utilizes glucose, right? So when we take in food, the muscle is what takes it in and allows it to be stored. But if we have a decrease in what’s able to receive that glucose then your glucose, therefore starts to work in our body a little bit longer, which is not ideal. And so with that it’s not shuttled and utilized by the liver as much as it could be, and that’s where you start to have a shift. It also has to do with estrogen and alcohol. So I get to this part all the time. I’m actually someone who likes to drink, but I have significantly decreased my alcohol intake as I’ve gone into the premenopausal phase for two reasons. This is me personally and then I’ll give some context. One, I don’t metabolize alcohol as well as I used to in my 20s.

We don’t metabolize alcohol as well, and then we don’t feel as great after, but that also contributes to what our body is able to metabolize. Our bodies have always metabolized alcohol with a priority. But then you have alcohol that’s sitting in your body longer than it should, which is a lot of alcohol, a lot of glucose and sugar. 

We’ve heard a lot of questions around Amberen with regard to perimenopause and menopause. What is it?  

Dr. Shepherd: Because we’ve opened up the discussion of what happens during menopause, people are more on track with resolving the symptoms that come along with it. So it’s an over-the-counter product, and it can help relieve some menopausal symptoms. 

It is not FDA-approved. And I’m gonna put some context to that. I am fine, even as a physician, for women to take things that are not always FDA-approved. So that would fall into the dietary supplement category. There are some effects women can find through supplements like Amberen, that can help with hot flashes or mood changes or insomnia and some quality of life factors. So, for those who maybe don’t want to take hormone replacement therapy, or maybe for some reason that it’s a risk, that there are some over the counter products that can help and Amberen is one of those that kind of falls into the category of dietary supplements. 

Are there any other dietary supplements that you recommend trying?

Dr. Shepherd: I would say some of the ones in the category that you know, I, when my patients asked me about it, I like to give them understanding of what it can do. May not cure everything, but I think everyone always has a different response. I’ve had people who come back so for example, say black cohosh can help with hot flashes and I have some people who it works wonderfully for and some people are just like it just didn’t work.

I think vitamin D is another important feature of what women should consider and take when we think about bone health and that is a vitamin and a supplement that is over the counter. What I would say is now looking at the quality of what supplements that you’re taking and making sure, and I’m just putting this out there candidly, I think that there are a lot of white labeled products that are on shelves and a lot of people really don’t know which ones are the best. So I think that it would be helpful when we’re thinking about menopausal health and the role of vitamin D and that is to take the time to consider whether it’s through education or asking someone what is this a good product? Like just saying, look at this and is this a good product and what are the recommendations for the amount that I should be taking based on age.

Just kind of giving a laundry list of say vitamin D is that it really helps with some of your bone density. It’s not going to cure it. Other ways to help with bone density such as weight bearing exercise, but there is also a change in our lipid profile as we go through menopause and that can also help with some of the lipid changes that we see. It regulates the growth of vaginal epithelial tissue, so that’s also important and then also our immune function.

I think when we think of our immune system with the aging process, you have differences in your immune system, and this can help boost that as well. So I think there’s multiple reasons vitamin D is important. Also vitamin C, there was a controversy, I think back in the day we were like vitamin C is so important to offset osteoporosis. What we do know now is not that it’s offsetting it, it can be contributory to helping when we have declining bone mineral density. So, we say that with a caveat, because a lot of people are just really odd on vitamin C and then also things like ashwagandha I think are helpful for sexual health as well.

Now, to discuss menopause and hormones: Can we discuss the “rebrand” that HRT has has had as MHT?  

Dr. Shepherd: So, HRT is hormone replacement therapy, and MHT is menopausal hormone therapy, and they both help with the symptoms of menopause. Now, going back to the Women’s Health Initiative (WHI) study, which was in the late 90s, early 2000s This is where we started a lot of our horror story, Halloween story with HRT, and it became very controversial, in the sense of more of the risk and possible bad outcomes of HRT were brought up more from the media, from the study that was done than the actual benefit. 

And now we know in retrospect, that it actually has much more benefit than what we saw with the risk than when we were doing this study. I think just now what’s embedded in everyone’s head is and this is me from my slight marketing perspective of medicine, is that it brings up such a bad taste in anyone’s mind or thought when they think HRT because they think, oh my god, hormones are bad. 

Really, if we just give people the understanding of what it’s useful for, I think the name change helps as far as [explaining that] it’s for menopause. 

And what does that mean with the increased risk of cardiovascular disease [that can come after menopause]? What does that mean with the increased risk of fracture and dementia? This is how we can start to educate women about [the benefits of] menopause hormone therapy, without it being a scary thing. It really is a beneficial tool for combating osteoporosis, and bone health, and also dementia and then also just our overall hot flashes and night sweats as well.

When should women start to consider taking MHT?

Dr. Shepherd: We know that symptoms occur with perimenopause, so before you actually get to that age,you actually can address it with hormone therapy. Have that discussion with your doctor: What can someone like me take? 

And, if you think about it, there are a lot of women in their 40s who are still on birth control pills. And so that, technically, is some form of hormone. So, we haven’t really given a bad shot or light to taking birth control into your 40s. And given that context around it, people will be like, oh my gosh, yeah you’re right, there are a lot of women who are in their 40s or so on birth control pills, which technically is a form of hormone supplementation. 

The benefit of HRT is you’re going through that period, menopausal phases to really help with things like vaginal dryness, hot flashes, and night sweats. It is beneficial to women for quality of life factors, but also, depending on how severe a woman’s hot flashes are, we do have some good data that this can correlate to future cardiovascular disease [risk]. That’s a great tool: one, we’re going to give you something that’s going to help with your symptoms, but also is there something coming down the road that we need to kind of watch out for, almost using as a preventative tool.

What should we be mindful of when considering hormone therapy as a treatment for menopause symptoms?

Dr. Shepherd: This is where one kind of clear confusion is not to embrace that this is a topic that you should want to discuss. Now, the end outcome may be, I’m not going to use it for whatever reason, you know, whether it’s a risk, or you just don’t feel comfortable.

I think that that’s important to at least start the conversation. Many people are very scared to even enter the conversation. And I want people to embrace ‘Hey, at the end of the day, I want to know that I declined some form of HT because I knew everything there was about it rather than me just being like I can’t take it, I can’t take it. It’s really bad.’ Right? And then you’ve maybe possibly missed out on something that can be really beneficial for you. 

So, I think that that’s important. Now, when you think of risks, the risks are looking at family history, is there a significant risk of breast cancer that you have in your family? I’m also looking at: Do I have significant heart disease already? Right. Do I have hypertension? Do I have an increased risk of having a clot? And I think that those are important features that your doctor should be screening you for, and then also bringing into the discussion — because what we have seen in recent literature — is that so many people were scared of hormone replacement therapy because they thought it significantly increases your risk of breast cancer. 

And we do have some new data that shows that it does not, and so I feel like if everyone knew that it’s not a potentially significant increase in breast cancer, then maybe I can look at this a little bit differently through a different lens. And so the important part of this is the conversation before we decline anything. So you know, we have people who have decreased libido saying,  but if you have significant libido, there are medications that you can take for what we call hypoactive sexual disorder. But some people just have decreased libido. They just have less of a desire, and testosterone therapy can help with that. 

And also things like cognitive behavioral therapy as well. So again, bringing into context what people feel comfortable with. Some people say, ‘You know what, I’ve heard the conversation. I’m not quite comfortable with it yet.’ And then literally, maybe six months down the road or a year later, they say, ‘You know what, with what’s going on in my life and the symptoms, let’s re-approach that conversation again.’ But if there never was a conversation, most people kind of just stay in the scared lane of saying, ‘I’m never doing that.’

Are there any myths or misconceptions around hormone therapy that you want to set the record straight on?

Dr. Shepherd: I think one of the first ones is it’s going to cause breast cancer. That is the one thing that [women are] concerned with. But what I like to bring into the conversation is: What is the number one killer of women?

And they’ll say breast cancer, but it’s cardiovascular disease, heart disease. And so if heart disease is the number one killer of women outside of, let’s say, uterine cancer and breast cancer put together, then one of the benefits of menopause hormone treatment is that it has shown to have some impact on preventative portions of cardiovascular health. If I were presented with what is your greatest risk of cardiovascular disease? And do I want to partake in something that would help me be preventative in that way? 

And to breast cancer. We’ve come so far with breast cancer, that we have magnificent ways of the conversation and context that we have behind it. Everyone at some point has heard of how to do a breast exam or talking about breast cancer or the mammogram starts at the age of 40. We have really a lot of detection in place for breast cancer. And we have seen more early detection of cancer than we’ve ever seen before because of breast cancer, because we talk about it. Heart disease is still killing women, left, right and center. And so when you look at it from a broad lens, I think that helps people make a better decision. 

And then another myth I would say is testosterone is a bad thing. Women have much lower levels than men do, but it is a very potent hormone in the women’s body. And so I think it’s important to understand that there’s a feature of menopause behind women’s health and that it’s not just androgenic only male hormone.

Another myth is that lifestyle is not a big factor in menopause. For me, having studied so many different aspects of lifestyle medicine behind menopause, there really categorically are a lot of metabolic changes that are going on with women during this timeframe. Insulin glucose resistance shifts our muscle mass, how our heart functions, and then what are the things that are going to help these kinds of systems?

Because we’re living longer, because we are working longer, we just have more aspects of life that we would want to enjoy. We cannot be devoid of the responsibility that we have individually for ourselves to improve that lifestyle by the things that we do in our everyday life. And as a physician I would say behavior modification is one of the hardest things to do. I’m even raising my hand on this. 

But the more that you make these small consistent changes in your life early on, it really is in the next 20 to 30 years where you’re going to look back and think, oh my gosh, I’m so glad I started to do these changes, because it wouldn’t have been easy to do overnight. But over the last seven to 15 years, I now have gotten to a point where I’ve changed that one behavior and it’s helped me incredibly.

For me, it was alcohol. I’ve gotten to a point where it doesn’t mean I don’t drink, but I really think about: one, how will I feel and two, what is this doing inside my body that’s not helping me at this point. And then I can make a better decision on whether I am going to drink.

Any other changes you’re working on?

Dr. Shepherd: I’m more of a runner. So I used to do runs and I’m not saying you can’t run anymore in the menopausal timeframe, but now I’ve converted my workouts to be much more weight bearing. Now I will still have cardio in there, I just don’t do it as much. Yoga is another part of my workout that I’ve implemented because of flexibility and balance. Another part of aging that comes in is that we lose our balance. I mean the number one reason why a lot of people fall in older age is because their balance is off. It just kind of changes that landscape of how we think of our entire body rather than just one system at a time. 

What do you recommend to alleviate vaginal dryness and increase libido? 

Dr. Shepherd:  Let’s start very basic — lubricants. I’m just going to give a disclaimer on lubricants, because I think people feel that if they have to use a lubricant, something’s wrong with them. And I’m here to change that narrative. It is completely healthy.  I prefer the ones that are not necessarily water based, but silicone-based because they last longer and with the water based ones you find that it can have more of a drying effect and it doesn’t keep the vaginal canal very lubricated for very long. And then you have some vaginal inserts which just kind of give you more of a moisturized type of environment in the vagina. But really, that’s just creating a nice environment.

Now if you want to actually work on the tissue, that’s when you go to our vaginal hormone creams or estrogen creams. And then also some people take DHEA which is like a precursor of testosterone. They can use those as vaginal suppositories that can help as well. And then I’m a big fan of vaginal rejuvenation with lasers or radiofrequency, we have that and it works wonders for women. The reason a lot of women like vaginal rejuvenation with the laser is because it’s less maintenance, right? So you get treatment, and it’s three treatments the first time, four to six weeks apart, and then they one need [the treatment] maybe once a year. So that’s very low maintenance and you’re actually treating the tissue —kind of like when we do facial lasers and radiofrequency, we’re getting to the bottom and the foundation of the skin. And in this context, vaginal tissues help with the elastin and collagen, but also the blood supply. Estrogen has a big kind of factor on how our vagina is lubricated.

Do you recommend focusing more on cardio or muscle-building exercises during menopause?

Dr. Shepherd: I love that question, I hear it very often. I think cardiovascular exercise is very important for endurance.  Women in general usually shy away from weight-bearing exercise. And so for the same reason we were discussing from a metabolic perspective of how your body utilizes energy such as glucose through carbohydrates. So, your muscle and your liver obviously, but when we look at muscle mass with aging and after estrogen depletion, you really have a change in muscle structure.

If you have a change in muscle structure, it can’t support the bones, right?  It’s because of the muscle, the actual weight. But what you will notice is you’re whittling away how that mid-area of the body where the fat starts to creep into, so women typically store fat to do this. So that’s why when we’re young you are cute, your waist is small, and then we have really nice rotund, nice button thighs, and then as we start to get older, that migrates up. That’s no longer and that’s why we have that is that we have a shift in adiposity. I guess you could say that and how it’s stored, but also how it’s metabolized. So if we can increase our muscle in our weight bearing, you’ll notice that you may be seeing weight gain, but your body is whittling off fat.

Let’s talk about protein in our diet. How much do we need?

Dr. Shepherd: That’s a very important question, because one of the important parts when we were talking about diet is shifting away — not completely from carbohydrates and sugar — but you want to eat more protein because as your muscle starts to whittle away, our protein usually decreases. And so there’s nothing there to help build the muscle up, which is what a heavy protein diet will do. And so when we look at the adequate dietary protein amount, it is one to prioritize, because you want to make sure that you’re giving fuel for your muscle to build.

It’s kind of like this seesaw where we’re trying to keep the protein — it’s called a protein leverage effect. And you’re trying to keep the protein elevated so that when you build your muscle with weight bearing exercise, it has that food that it needs to keep the muscle built. And so when we think of what we want to see in that transition for the 40 through the 50-year old timeframe, it’s that you’re increasing your muscle mass by increasing your protein intake. And that is not easy to do because it’s a complete restructure of how you think about foods, and what you choose to pick up and put on your plate. We are a very carbohydrate, sugar-heavy society. So that has already been the routine in our brain, it’s I’m going to go for the carbohydrate and the sugar stuff first. And so that’s what we’ve known for years.

So if you think about a kilogram, I like to quote it in kilograms but one kilogram equals 2.2 pounds. So what you’re looking at for perimenopausal and postmenopausal you should really try to aim at 2.4 grams per kilogram of body weight. So that’s why again, this is where people need the help in understanding what they need and that’s why I always recommend going to a registered dietitian or a nutritionist to see what you need based on your weight. What do I need to intake in protein to get me to the level of requirements that I need in order to sustain my muscle?

What about acupuncture? Can that help in relieving symptoms of menopause?

Dr. Shepherd: Absolutely. So when we think about acupuncture in general, acupuncture is, for one, they’ve been doing acupuncture, much longer than we have here in western medicine, right. So Eastern philosophy of how it actually works for the body because there’s lots of different things that it can work for.

They have looked at the ability for acupuncture to help with vasomotor symptoms. There’s very good research behind it. They’re able to use that neuro-physiologic component of how they practice in order to increase endorphins or thermal regulation and help with the vasomotor symptoms. Just make sure you go to a licensed acupuncturist.

What’s next for the treatment of symptoms of perimenopause and menopause? Are there any advances or research that you’re excited about?

Dr. Shepherd:  There’s a very new medication that was released this year, for hot flashes and night sweats working the actual neuron in the brain that counters our thermoregulation. That has never been done before. That we know the beauty of estrogen and what it can do for hot flashes, because actually in that area and the brain called the KNDy neuron, it is estrogen dependent. But what happens is when estrogen declines there is now this influx of the other thing that kept us stable, right?

So now the decline in estrogen, the other one kind of upticks and you’re not able to thermoregulate hot flashes, night sweats, but bringing in this medication down regulates that one that was shifted up when the estrogen declined, and it gets back to balance even though you’re having estrogen decline.

So this is a fascinating medication for people who have had breast cancer and breast cancer survivors or diagnosed currently with it, is that this is a way for them to combat some of those intense like night sweats and hot flashes with a medication that if they’re very unsure of even approaching a hormone replacement therapy, that this is a way that it can be done. So with that, these are one of the first things that we’ve seen kind of push into the menopausal health space, which is exciting to see because that can only lead to more innovation.



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