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17. Navigating Menopause: Hormone Therapy or Birth Control? with Dr. James H. Liu
47 Plays9 months ago
Navigating Menopause Part 1: Hormone Therapy or Birth Control?
September is Perimenopause Awareness Month! And we are diving into all things perimenopause and menopause.
In Part 1 of this episode, we dive deep into the complexities of perimenopause and menopause with expert guidance from Dr. James H. Liu, a renowned menopause expert and past president of the Menopause Society. As we celebrate Perimenopause Awareness Month, we aim to shed light on the common symptoms and treatments women experience during this transformative phase of life.
Here is some practical advice from one of the top voices in the menopause field, Dr. James H. Liu on the difference between hormone therapy and birth control for managing symptoms like hot flashes, vaginal dryness, and irregular periods.
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Transcript
Introduction and Expert Credentials
00:00:00
Speaker
any self-proclaimed menopause experts on social media. And here I have an actual expert on menopause. the University Hospitals Cleveland Medical Center OBGYN department while I was a resident and beyond.
00:00:18
Speaker
but which is why I got the privilege of pulling his ear out of retirement to ask him these questions about perimenopause. So
Effectiveness of Hormonal Therapies
00:00:27
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Dr. Lu, thank you for taking the time and I wanted to ask you, why does menopausal hormone therapy work better for perimenopausal symptoms than birth control pills? Well, actually, perimenopausal symptoms such as hot flashes, vaginal dryness, and irregular cycles, birth control pills actually work better.
00:00:45
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the menopausal hormone therapy.
Understanding Perimenopausal and Menopausal Symptoms
00:00:47
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okay tell So let's first look at the the patient who is what we consider paramedicopausal. These individuals do not have absolute no bleeding because menopause is defined as one year without bleeding. So within a three or four month period, if the woman still experiences some bleeding, she is paramedopausal and not menopausal.
00:01:13
Speaker
right So this would be age range from about 45 to 52.
Role of Birth Control Pills in Perimenopause
00:01:18
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During this time, a woman might have hot flashes later in her cycle, even though she may be still ovulating at a little bit of a risk of pregnancy, although very low. So she's at the lower end of her fertility in her reproductive lifespan. So in that sense, birth control pills would prevent her from ovulating and being accidentally pregnant. Birth control pills contain estrogen, which is similar to what's made by the ovary, and so it relieves some of the low estrogen time frames during the pyraminopause when an egg may or may not be
Transition to Menopause
00:01:55
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released. So, menopause really occurs when all functional eggs are not able to be released from the ovary.
00:02:02
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um And that's why there are no menstrual cycles at that point. In contrast, the menopausal hormones, estrogen and progesterone, similar in terms of combinations to birth control pills, may work, but not to a great extent, in that the ovary can supersede and take over while she is on hormone therapy, and thus it doesn't control the bleeding aspects.
00:02:25
Speaker
as much as just the symptoms. So it leaves some of the symptoms, but it doesn't relieve the bleeding aspects and it doesn't protect against pregnancy that could accidentally
Anecdotes and Personal Experiences
00:02:36
Speaker
occur. And I've seen two or three women in my 35 or 40 years of practice where they have had prolonged periods of amenorrhea, thought they were in menopause, but didn't have hot flashes and came into the office and found that they were like 15, 20 weeks pregnant. Wow. That's quite far along.
00:02:51
Speaker
but
Managing Side Effects of Hormonal Treatments
00:02:52
Speaker
Right. So how about this? I have patients who tell me they've always done poorly with birth control pills from side effects standpoint where they feel nausea or they don't feel themselves and they don't like birth control pills for that reason, but then they end up okay with menopausal hormone therapy. So the nausea is due to, and it may be transient due to the fact that when they first take the birth control pill, their ovaries aren't shut down. And so the low dose birth control pills, which are used predominantly now tend to not immediately suppress ovulation. And so it takes a few days for that to happen. And during that time, there's overlap between the two hormones and women do feel nauseated, sort of similar to morning sickness.
00:03:33
Speaker
when pregnancy hormones of estrogen are very high. And so that really actually will abate. One option is to take it in the evening before bedtime, which reduces the peak trough effect of the estrogen being released while they're sleep so asleep so they are not consciously nausea effect. Right. Okay. Well, thank you so much for your time.