Menopause & Perimenopause

Jill Gustafson, CNM provides a variety of menopause services for women in Boise, Idaho and surrounding areas. Each woman's experience with menopause is different, so Jill offers personalized menopause services for each patient she sees. Whether you are looking for guidance about what to expect or are experiencing daily discomfort and imbalance that pulls your focus and joy away - we have solutions.

Menopause Q & A

What is Menopause?

menopause | perimenopause

Menopause is the time in a woman's life when she is finished with ovulating and having periods. Once we reach menopause, our bodies stop producing the hormones necessary to reproduce. The hormones we "miss" the most are estrogen and testosterone. The transition to menopause is not smooth – our hormone levels fluctuate wildly for months or even years, similar to what happens during the hormonal on-boarding of adolescence. These dramatic ups and downs in hormone levels cause uncomfortable symptoms for many women. We can start feeling the effects of hormone changes many years before menopause is reached, on average 3-10 years before menopause is reached! This time period before we reach menopause, when we start feeling the effects of hormonal changes, is called perimenopause. There are many aspects of our lives that can be affected by hormonal changes of menopause- for example, sleep, mood, sex, metabolism, skin, bones, and hair. There are also safe and effective treatments for all of these, which we specialize in at Quantum Women's Health.

Once a woman reaches menopause, which doctors define as 12 consecutive months without a menstrual period, hormone fluctuations and their associated symptoms begin to smooth out.

What happens post-menopause?

menopause | perimenopause

After about four to five years post-menopause, women can begin to notice permanent changes to their vulva and genital tract. The cells of the vagina, urethra, and vulva are highly sensitive to estrogen and testorone, and the withdrawal of those hormones naturally results in atrophy of these tissues for most women. This condition is called genito-urinary syndrome of menopause, and it can cause painful sex, vaginal dryness or vaginal atrophy, increased urinary tract infections, and increased vaginal infections.

Quantum Women's Health offers evidence-based treatments and lifestyle counseling for perimenopause, menopause, and genitourinary syndrome of menopause to help women thrive in midlife and beyond.

What is perimenopause?

The gradual transition between the reproductive years and menopause (the cessation of menstrual periods) is called perimenopause (literally meaning "around menopause"). It is generally a transition that is many years long and can be associated with shorter menstrual intervals, irregular menses, night sweats, and other symptoms. In some women, these symptoms are troublesome enough to need medical intervention. We specialize in support and education for women going through perimenopause - check out our Classes section for more information.

What Do Menopause Services Include?

Menopause services include annual wellness gynecological exams, evaluation and treatment of menopause symptoms, gynecologic care of women after childbearing years, and evaluation and treatment of sexual problems during and after menopause. Menopause services may also include screening for breast health, osteoporosis, colon cancer, and other disorders that sometimes occur after menopause, such as pelvic organ prolapse, urinary incontinence, and overactive bladder. If a woman is in perimenopause, we may also discuss birth control needs and management of the menopause transition.

In some cases, hormone replacement therapy is included in menopause services. Hormone replacement therapy keeps hormone levels smooth, reducing uncomfortable symptoms of menopause. A woman stops taking hormone replacement therapy after she reaches menopause, and sometimes sooner.

Who Can Benefit from Menopause Services?

menopause | perimenopause

Menopause services are appropriate for women between the ages of 40 to 60 years old who are experiencing symptoms of menopause, such as hot flashes, night sweats, changes in the menstrual cycle, moodiness, vaginal changes, fatigue, weight gain, and more. Even women who do not suffer from uncomfortable symptoms benefit from screenings and wellness checks including in menopause services. These screenings and checks can reduce every woman's risk for the thinning and weak bones of osteoporosis, colon cancer, gynecological problems and other health conditions.

What is hormone therapy?

Hormone therapy (HRT) is the prescription drug used most often to treat hot flashes and genitourinary syndrome of menopause (GSM), which includes vaginal dryness, after menopause. For hot flashes, hormones are given in pills, patches, sprays, gels, or a vaginal ring that delivers hormones throughout the body—known as "systemic" therapy. For genitourinary symptoms, hormones are given in creams, pills, or rings that are inserted into the vagina. (An approved pill is also available to treat genitourinary symptoms that is not considered a hormone but does affect estrogen receptors, mostly in and around the vagina.)

Systemic hormones include estrogens—either the same or similar to the estrogens the body produces naturally—and progestogens, which include progesterone—the progestogen the body produces naturally—or a similar compound. Another approach to systemic hormone therapy is a pill that combines conjugated estrogens (those in the brand Premarin) and a compound known as a "SERM" (selective estrogen receptor modulator) that protects the uterus but is not a progestogen. Women who have had a hysterectomy (had their uterus or womb removed) can use estrogen alone to control their hot flashes. Women who still have a uterus or womb need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer. Systemic hormones are very effective for hot flashes and have other benefits, such as protecting your bones. They also carry risks, such as blood clots and breast cancer. The breast cancer risk usually doesn't rise until after about 5 years with estrogen-progestogen therapy or after 7 years with estrogen alone.

Vaginal estrogen therapy for GSM after menopause is administered in the vagina and is effective for both moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower.

Book a menopause consultation to discuss your individual risks and preferences with us to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you.

How do I cope with hot flashes?

menopause | perimenopause

Hot flashes occur in up to 75% of women, and although most women experience them for 6 months to 2 years, some women may experience bothersome hot flashes for 10 years or longer. Hot flashes can be especially bothersome if they disrupt your sleep, night after night, for years on end.

Lifestyle changes, including keeping core body temperature low, maintaining a healthy body weight, refraining from smoking, exercising regularly, and practicing relaxation techniques, may provide some relief.

Nonprescription remedies such as soy, isoflavone supplements, black cohosh, vitamin E, and omega-3 fatty acids are generally low risk, but randomized-controlled trials show that their efficacy is like a placebo. This means that you may expect some relief from taking these over-the-counter remedies for about 3 months, but not much longer than that.

Menopausal hormone therapy is the most effective treatment for vasomotor symptoms, statistically speaking. Options include systemic estrogen or estrogen-progestogen (in women with a uterus), progestogen alone, or combined oral contraceptives in women requiring contraception.

There are some other prescription medications that may be modestly effective in reducing hot flashes. Book your menopause consultation to learn how you can find the best tools for your unique situation.