Participants: Eric Shadle, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000112
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00:51 Hello and welcome to "Health for a Lifetime"
00:53 I'm your host Don Mackintosh 00:55 We're glad you've joined us today. 00:56 We're going to be talking about women's health issues today, 00:59 and joining us to talk about this vital subject 01:02 is Dr. Eric Shadle 01:03 Welcome Dr. Shadle. Thank you 01:06 We're glad that you're with us. 01:07 Now, you know, you've been in obstetrics and gynecology, 01:10 I guess is the subspecialty that you're in, 01:12 for about what, 15-16 years now. Yes, that's right 01:16 And so you've seen a lot of things that deal with 01:19 women's health issues, but today we're going to be 01:20 talking about menopause. Yes 01:23 And, is this a big problem, a lot of people 01:25 coming to see you about this? 01:26 Actually, it's probably one of the 01:28 bigger problems that I'm consulted for. 01:32 Of course, all women, if they live long enough, 01:35 go through the menopause, and so it's something that 01:39 is a big issue for most women. 01:41 What exactly is menopause, 01:43 and what are the stages involved in that. 01:45 Well there are at least 2 stages 01:47 that I'd want to talk about today... 01:49 One, is the perimenopause, that's the first stage, 01:52 and that's the time when the ovaries function is decreasing; 01:57 it's making less and less estrogen, 02:00 and there could be a variety of 02:01 symptoms associated with that. 02:03 And then there's the menopause itself which is when the 02:06 ovaries stop functioning altogether. 02:08 So really, that's what the word "meno-pause" means 02:11 a pausing or cessation maybe of the menses or the period. 02:16 Yeah, that's right... And I think you have a graphic 02:18 about this that kind of gives us the details and there it is. 02:22 It talks a little bit about the definitions. 02:24 The perimenopause actually the average age is 47, 02:30 though it can last for several years. 02:32 I think the graphic talks about that it can last for 2-6 years, 02:37 and it may not occur at all, though sometimes the ovaries 02:42 just stop functioning until you have regular periods 02:45 right up into the menopause... 02:47 And then the average age for menopause is age 51, 02:51 and 90% of women actually go through the menopause by age 55, 02:56 so it's rare to go beyond the age of 55. 03:00 So then in making the diagnosis, I mean... 03:02 the age factors into it and other different things... 03:04 What kind of things do you say - Hey, this is what's happening... 03:09 Well the most common way to make a diagnosis 03:11 of the menopause is simply by history. 03:13 The clinical history - when a woman comes in and says, 03:17 "Well, I haven't had period for 6 months or for a year" 03:20 ...then I know that she is menopausal; 03:24 her ovaries aren't functioning. 03:27 But we can confirm that with laboratory tests. 03:29 There is a laboratory test, something called "FSH" 03:33 That's "follicle stimulating hormone" 03:34 That's a hormone made in the pituitary gland that 03:38 controls ovarian function and it is secreted by the 03:42 pituitary gland to tell the ovary... what to do and when. 03:46 That's right... And when the ovary stops functioning, 03:49 the pituitary glad goes into overdrive, 03:52 and keeps reminding the ovary to function 03:56 even though it won't do it at that time because it's 03:59 physiologically time for the ovary to stop functioning. 04:02 So it goes up - in other words, 04:05 but there's no response from the ovary. That's right 04:07 And you can see that in the blood and you say, 04:09 "Okay, this is what's happening, so you're at that stage 04:12 and it's okay" That's right - it's okay 04:15 But interestingly enough, that FSH does stay high 04:19 throughout a woman's life. 04:21 So, there's something in the pituitary gland 04:25 that keeps secreting that FSH - 04:27 even though it doesn't do anything, 04:30 and so some of us in the field believe that FSH probably has 04:36 another function because I don't think that 04:41 God would have made a woman's pituitary gland in a way 04:46 that wouldn't down-regulate 04:48 once it realized the ovary was not functioning. 04:51 I mean you're just trying to figure out what that is, 04:53 and don't know exactly... Yeah that's right - not exactly 04:55 Now you have down here something about 04:56 perimenopausal transition. 04:58 It sounds like a big word but I suppose it's talking about 05:01 the transition from having the regular periods to none at all. 05:05 Is that what that means? Yes, exactly, 05:07 and that can be a difficult time for many women... 05:12 And in fact, menopausal symptoms that most women talk about 05:17 are actually in this transition time, 05:19 this perimenopausal transition that can last for years, 05:23 and can have a variety of symptoms. 05:26 Their vaginal bleeding can be very unpredictable. 05:30 It can be heavy or they may miss periods, 05:33 and it could be very light and it all has to do with the 05:38 fluctuation in estrogen levels that's occurring in the ovary. 05:43 So it really has some things that affect how someone feels 05:46 emotionally and this and that. Yes 05:49 I've never been through that myself and neither has my wife, 05:53 you know, we're not quite to that stage. 05:57 These kind of things though I certainly have heard about, 06:00 and we certainly know about. 06:02 So what are some real symptoms then of the perimenopausal time? 06:05 Well, we have symptoms of the perimenopause which... 06:09 Like up here in the graphics like hot flashes... That's right 06:12 Hot flashes, the irregular periods that I talked about - 06:14 that can be periods that a woman may miss periods, 06:22 or she may have frequent periods. 06:24 It can include mood swings, fluid retention which can 06:29 be one of the symptoms of fluid retention may be bloating; 06:32 memory problems, headaches - 06:34 Those are some of the perimenopausal symptoms 06:38 that we see and we... So when people come in 06:41 and they have that, how do you help them, 06:44 for instance, can you help someone with hot flashes? 06:47 Yes, we can help women with hot flashes. 06:50 I guess you're going to talk about that a little bit later... 06:53 And with all these things, there are things that you do 06:55 that help them. Right 06:57 And depending on the level... 06:59 There are specific symptoms and we can either 07:04 look at it as treating each individual symptom 07:07 or try to treat the underlying cause which many of those 07:12 may be an estrogen deficiency, 07:15 but that's another issue that maybe we can get to 07:20 a little bit later. 07:21 And really, you know, let's say we're talking in a 07:24 Western medical model... That's right 07:26 We're talking in America and we're talking Western medicine, 07:31 but later on sometime, we can talk about 07:34 what you would do if these things started happening 07:36 in your country or if you're in a place 07:37 where you can't go see someone like you. 07:40 What does that mean? 07:43 That's perimenopause, the hot flashes, 07:45 and all those things we talked about. 07:47 What are the symptoms then in menopause? 07:48 Well the first symptom I would describe would be 07:52 vaginal dryness. 07:53 There can also be symptoms such as skin changes, 07:57 urinary problems, decreased sexual drive or libido 08:02 is described as well as some of the symptoms of menopause. 08:06 Skin changes, what do you mean by that? 08:07 It can be skin dryness, wrinkling 08:10 can occur more and more. 08:12 Is this because there is not as much estrogen? 08:14 It is thought that estrogen certainly plays a role 08:18 in that because it increases the elasticity of the tissue 08:22 and so as estrogen is withdrawn, 08:25 there is less elasticity in this dryer skin and more wrinkling. 08:29 So these kind of things though can really cause - 08:32 what would you say - maybe disruptions or 08:36 fluctuations in someone's relationships too 08:39 I mean, these are very intimate things we're talking about. 08:41 And do you find yourself talking not just to 08:45 the lady but also the man sometimes in these situations? 08:51 For menopausal symptoms, actually I don't have husbands 08:55 coming in with their wives very often. 08:57 That occurs in other situations in my practice, 09:01 for example, infertility issues, couples that are wanting 09:05 to get pregnant... 09:06 But generally, women in the menopause, of course, are mature 09:12 and they kind of have their own ideas on what 09:18 their issues are and they generally don't bring 09:20 their husbands with them. 09:21 But you're right, it does impact the couple; 09:24 it can impact them greatly. 09:27 So how should a man be reacting at this particular time? 09:30 I mean, I know that's a really open question, 09:32 but are there some pointers that you sometimes - 09:35 you would say? I know this is not on our 09:37 list of things but how should they react; 09:39 just sensitively and... Absolutely 09:42 I think a man needs to understand that there are 09:46 changes that occur in a woman that are physiologic. 09:49 There are changes that occur because she's going 09:52 through hormonal fluctuations and that has real effects 09:58 on her body. 10:00 It's not imaginary, she's not imagining these things... 10:03 And mood swings could occur that we haven't listed 10:09 on graphics but mood swings certainly can be 10:12 one of the things that women have in the transition 10:15 or even in the menopause. 10:17 So then, what is the timing here of the menopause? 10:21 We've talked about how it comes... 10:23 There is the perimenopause which is physiologically, 10:26 but what more about timing do we need to know about? 10:29 Well, timing is determined... it seems to be predetermined 10:34 in many ways by a programmed loss of the ovarian follicles. 10:38 Those follicles are the eggs that a woman has. 10:44 She has a certain number of eggs in her ovaries, 10:47 and several of them are maturing each month due to 10:52 hormonal stimulation and so several of them are used up 10:57 every single cycle... 11:00 And at a given time, they're all used up more or less, 11:06 and that's when we see the menopause occurring, 11:10 and as I said before, the average age is 51; 11:13 55 is considered to be the upper limits of normal 11:18 of an age to go through the menopause. 11:20 If you smoke does that make a difference? 11:21 Smoking does cause the menopause to come earlier. 11:26 Also if a woman has never had children, 11:28 she could probably expect to go 11:30 through the menopause earlier... 11:32 And maybe that's because for those 9 months of pregnancy, 11:35 there are no eggs being used each month. 11:39 I just was going to ask that so that explains it. 11:41 So let's come back to this issue of hot flashes. 11:44 What exactly is happening 11:45 physiologically there, what's going on? 11:47 Well hot flashes actually occur in about 75% of menopausal women 11:53 It's a very common symptom and we think it's due 11:57 primarily to estrogen deficiency... 12:00 But there can be a variety of causes for hot flashes. 12:04 The first type of causes would be physiologic 12:08 such as the menopause, but other physiologic causes 12:13 would be hot drinks or emotional distress. 12:16 So men can have hot flashes too. 12:18 I bet our viewers didn't realize 12:22 that actually men can have hot flashes. 12:24 So when you mean "hot drinks," something you drink that 12:26 makes you feel hot? That's right 12:28 It can actually cause a response that would cause a flushing 12:33 especially in the chest and the face and the head. 12:36 So I guess if you take some niacin too - some people tell me 12:39 that that will make you have a serious hot flash. 12:42 That's exactly right, a serious hot flash. 12:45 So what about, you have down here also some drugs 12:47 that can make you feel like you have a 12:49 hot flash-type symptom. 12:50 Yes, drugs and under drugs I would include 12:54 not only medications but drugs such as alcohol, 12:57 especially in Asian women alcohol has a big effect. 13:02 There are other medications that may have an effect as well. 13:08 That cause you to just feel like you're flushed and flashed 13:12 and everything like that. 13:13 So you kind of have to work through those. 13:15 It could be menopause but it could be something 13:16 else you're taking... There could be medications 13:18 that we'd have to look at or could be actually diseases. 13:20 One of the most common would be carcinoid syndrome. 13:24 It can be serious... What is carcinoid syndrome? 13:26 It's actually a syndrome where the body starts making 13:31 too much of a certain hormone, 13:33 and it can cause dramatic effects on the heart, 13:37 blood pressure and other effects. 13:40 So hot flashes then could be from something you drink, 13:45 some medication or drugs you're taking, 13:47 and then also various diseases. 13:49 So, if you're having hot flash, basically the bottom line is... 13:52 and you don't know what's causing it, 13:53 or you have any suspicion, they really should 13:55 see somebody like you, is that right? Yes 13:58 Because that can be a real sign of something. 14:00 It can be a sign of something, but we learn something 14:04 in medical school - if you hear hoof beats, 14:06 you generally think of horses not zebras, 14:08 and so we look for the most common. 14:12 So you have a woman who is 51, 14:14 she had her last period 8 months ago and she's having hot flashes 14:20 ...then we know that that's most likely menopausal symptoms. 14:25 It's due to an estrogen deficiency, 14:26 and something that we need to look at. 14:28 What is you're having hot flashes and you're 17? 14:30 Or if you're having hot flashes, and you already 14:33 went through menopause, and now you're 70, 14:35 and you're having those again, that's a different thing. 14:38 That may be a different thing altogether. 14:39 Okay, so that's something that we need... 14:41 When the light goes off in the car, 14:43 you know - that dummy light that says, 14:45 "Hey, you better get it checked out" 14:47 This is that kind of thing. That's right. 14:49 Anything else about hot flashes? 14:50 We don't want to miss anything on that. 14:51 Well, they are caused by, we think what we'd call 14:55 a thermoregulatory dysfunction in the brain. 14:58 The brain actually controls our temperature, 15:05 and there is something there that can reset that, 15:10 and it is sensitive to estrogen, 15:12 that's why we do think that estrogen is a major part in that 15:15 Do we ever get over hot flashes, or will they leave? 15:18 I mean, maybe people just starting that and they say, 15:20 Man, I can't do this anymore... They get over them? Generally 15:24 Hot flashes are self-limited but that self-limiting factor 15:29 can be for 5-6 years, so it's pretty hard to tell 15:31 a woman who has just started hot flashes in the last 15:36 few months - to tell her, "Don't worry about it, 15:38 they'll go away in 6 years" 15:40 because she may have several a day and they can be very 15:44 disturbing to her; they may be embarrassing 15:46 because she may feel like she's red even though she's not, 15:50 and she feels like everybody can 15:52 see her and it can be very distracting to her. 15:56 We're talking with Dr. Eric Shadle 15:58 He is a specialist in women's health issues, 16:01 obstetrics and gynecology. 16:03 We've been talking about some very practical issues today. 16:06 When we come back, we're going to be talking about 16:07 more things that occur with the 16:10 body at or after the time of menopause. 16:12 We hope that you join us when we come back. 16:22 Have you found yourself wishing 16:24 that you could shed a few pounds? 16:25 Have you been on a diet for most of your life, 16:27 but not found anything that will really keep the weight off? 16:30 If you've answered "yes" to any of these questions, 16:33 then we have a solution for you that works! 16:36 Dr. Hans Diehl and Dr. Aileen Ludington 16:39 have written a marvelous booklet called... 16:41 "Reversing Obesity Naturally" 16:43 and we'd like to send it to you FREE of charge. 16:46 Here's a medically sound approach successfully used 16:49 by thousands who were able to eat more and lose weight 16:52 permanently without feeling guilty or hungry 16:55 through lifestyle medicine. 16:57 Dr. Diehl and Dr. Ludington have been featured on 3ABN 17:00 and in this booklet, they present a sensible approach 17:03 to eating, nutrition and lifestyle changes 17:06 that can help you prevent heart disease, diabetes, 17:08 and EVEN cancer. 17:09 Call or write today for your free copy of... 17:12 "Reversing Obesity Naturally" 17:14 and you could be on your way to a healthier, happier YOU! 17:18 It's absolutely free of charge, so call or write today. 17:27 Welcome back, we've been talking about women's health issues. 17:30 We've been talking about menopause really, 17:32 an exciting subject or a subject that a lot of people deal with. 17:36 We've talked about hot flashes. 17:38 We've talked about when we know we're having that; 17:41 what we should be looking for. 17:43 We've talked about the fact that a hot flash 17:45 at the right time in life is really, what would you say... 17:49 no big deal but it tells us that menopause is occurring, 17:52 but if it's happening at other times, 17:54 we may want to look and see what is really occurring. 17:58 We wanted to talk a little bit more about the health issues 18:03 that occur during or after menopause with ladies that 18:08 maybe they don't occur before that time. 18:10 And one of the things we have down here is about 18:12 urinary problems - talk with us a little bit about that. 18:16 Well, several urinary problems that seem to be directly 18:20 related to an estrogen deficiency. 18:23 The base of the bladder and vaginal tissue have 18:27 a high number of estrogen receptors, 18:30 and when estrogen is not binding to those receptors, 18:35 then we lose elasticity not only in the vagina, 18:40 but in the base of the bladder as well. 18:42 It also, those estrogen receptors, increase the amount 18:48 of glycogen in those cells. 18:50 It helps maintain vaginal pH as well as the pH in the bladder 18:57 and thus it can decrease the number of bladder infections, 19:01 and it can decrease the, what we call, vaginal prolapse 19:07 or symptoms of vaginal relaxation. 19:13 Okay, so after menopause these things then start to occur, 19:16 you have problems with all those things; 19:20 maybe urination, maybe leakage, 19:22 all those different kind of things. That's right 19:24 The leakage - there are 2 main types of urinary leakage 19:29 that we find... 19:30 One is what we call "stress incontinence" 19:32 and that's due to not only that loss of elasticity, 19:39 but it's also due to the fact that there's an angle 19:43 between where the bladder and the urethra join 19:46 and that angle needs to be at the proper angle or 19:52 else there can be - when you cough or any increase in 19:56 intraabdominal pressure will cause a loss of urine. 19:59 So when the elasticity changes, then the angle changes 20:04 and then things that wouldn't have caused that before 20:06 start to cause that. That's right 20:08 The other type of urinary leakage, 20:11 we call "urinary incontinence" would be what we call 20:15 "urge incontinence" and so the bladder as it gets full 20:20 but maybe not as full as it should be to be able to 20:23 cause those symptoms, the woman then has to 20:27 get to the bathroom and go right away; 20:29 otherwise, the urine comes out. 20:31 And these are good things to know because 20:34 I mean, look - you're going through this and you've never 20:37 been able to talk to someone like you, 20:38 and you can understand what's happening. 20:43 You know, are there any other significant medical problems 20:47 that occur after or... you know, 20:50 I guess it would be after menopause? 20:53 Yes, there are 3 main concerns, serious medical concerns 20:59 that we have... 21:06 Well let's talk about those a little bit. 21:08 What about the osteoporosis, why is this a problem? 21:11 It is a huge problem in this country. 21:16 It involves over a million women and it is a problem where 21:23 up to 1 to 5% of bone is lost each year. 21:27 Wow - that's a lot of bone. 21:28 That's a lot of bone and women seem to be losing 21:33 more bone after the menopause or during those years 21:37 after age 50 or so. 21:39 So we have to look at that and that's something that seems to 21:42 accelerate then after our periods stop or after menopause. 21:46 Then what about heart disease? 21:48 Heart disease also increases dramatically after a woman 21:52 goes through menopause. 21:54 Before that time, her incidence of heart disease is 21:59 quite a bit less than men, and then after menopause 22:03 her incidence starts rising rapidly to get to about 22:09 the same level as men. 22:10 So there's some kind of protective element 22:12 that seems to go away. 22:13 That seems to go away - at least that's one of the 22:16 theories that we have that it's easy for us to 22:19 try to draw that conclusion based upon this 22:22 menopausal timeframe. 22:23 And then probably, one of the things that causes the most 22:26 fear in women is when you say "breast cancer" - That's right 22:29 And that seems to occur more after menopause? 22:32 Breast cancer incidence does rise with age whether it's 22:37 due to something in the menopause or whether it's 22:41 just an age-related phenomenon... 22:43 And one could say the same with the others that 22:46 we just talked about - osteoporosis and heart disease 22:49 as well because that may be more of an age-related issue 22:54 though we see a big rise at the menopause making us 22:57 wonder if there's a specific cause related to the menopause. 23:02 I know that this subject of estrogen and heart disease 23:05 is pretty controversial and maybe we'll talk about 23:08 that more some other time, but there seems to be 23:12 a real focusing in on the things that are secreted 23:15 by the body and before menopause and then afterwards 23:18 saying - Hey, this must have something to do with it. Yes 23:21 Okay, let me ask you this question... 23:23 I know you're a Christian physician, 23:25 and you practice not only as a physician but also you've 23:32 done some pastoring as well. 23:35 And this is kind of a philosophical question too, 23:38 I would imagine - Is menopause a natural thing? 23:40 Did God create us to be that way or women to have 23:44 menopause? 23:45 Is it a natural state? 23:46 I believe that menopause is a natural state, 23:49 and we know that in Biblical times, early on, 23:53 we know Sarah must have had concerns about menopause, 23:57 and not being able to have children. 24:00 The child of promise - That's right! 24:01 So it's not something that is new. 24:04 It's not something that we've seen just in the last 100 years. 24:07 I think it's something that's been there 24:10 whether it came as a result of sin is certainly 24:15 open to debate, but it is something that every woman 24:20 goes through. 24:22 It's hard for me to define something as a disease 24:27 if 100% of the population has it. 24:30 We generally think of a disease as something that is different; 24:33 something that has a specific cause, and when you have 24:39 menopause, this is a condition that every woman goes through. 24:43 So really, the way you relate to patients then is not a disease 24:47 model that says - This is something wrong with you; 24:49 we're going to fix it, but this is something that... 24:53 This is something that's natural. 24:54 This is something that every woman goes through, 24:57 and we need to individualize as to what type of 25:01 treatment would be appropriate; 25:04 what is the best for a particular woman based upon 25:07 her own specific symptoms as well as 25:11 her own lifestyle patterns; 25:13 what type of diet is she eating; 25:16 what type of exercise; 25:17 what kind of stress is in her life, 25:19 and what has been in her life for the 50 years or so 25:22 before she goes through the menopause. 25:24 So in other words, looking at a natural state then would 25:27 cause them to actually look at all these things 25:29 throughout their life rather than - 25:30 Okay, we could do whatever we want until we get to 25:33 that state... Is that what you're saying? 25:34 Absolutely... I think that what we find is that in 25:38 Western society, in the United States in particular, 25:41 we find that we live almost unnaturally, I would say. 25:47 We eat foods that stimulate. 25:50 We keep hours that stimulate. 25:53 We have lifestyles that stimulate. 25:56 We have a lack of exercise. 25:58 And all these things create tremendous stress on the body 26:02 that when a woman then goes through the menopause, 26:05 she starts feeling things being out of balance, 26:10 and all of a sudden, it starts clicking for her. 26:13 There is something not right here. 26:15 There is something out of balance, 26:16 and so she comes to me to say - Help me get back into balance. 26:20 And what she's really looking for is a pill. 26:23 And so it's very easy to give her estrogen, for example, 26:26 because what we've thought is that she's estrogen-deficient 26:29 So it makes some sense to give her estrogen, 26:33 but MAYBE that's not why she's out of balance. 26:36 Maybe she's out of balance because of her diet. 26:38 Maybe she's out of balance because 26:40 there is stress in her life... 26:41 And, I think we need to look at those underlying causes 26:45 that are impacting her at the menopause. 26:48 As a Christian physician, all of these stages of transition... 26:52 Do you find that at these times, 26:54 people are very open spiritually? 26:56 Do you have these kind of conversations ever with them, 26:58 or do you see that as an opportunity for us to 27:01 maybe reevaluate our lives in that way? 27:04 Absolutely - Anytime we have big changes, 27:07 we go into transition, we're open to other changes 27:13 because we're searching. 27:14 I think health is related to spiritual things in that 27:22 to be healthy, we need the spiritual side of life. 27:26 I really think that that is important; I mean, 27:30 what a time of transition and 27:32 what an opportunity that you have. 27:33 We're glad that men like you are there to be able to 27:36 help us and help the ladies with these different problems. 27:40 You've been looking at "Health for a Lifetime" 27:42 and we hope that you have enjoyed this program. 27:44 We hope that it will help you in the different 27:46 transitions in your life. 27:48 We hope that, as a result, you'll have 27:50 Health that Lasts for a Lifetime! |
Revised 2014-12-17