How Should Women Cope with Midlife Crisis?

By Jack Etzel

Since the beginning of humankind, women have had to confront an unfortunate combination of menopause and misery. Taking the misery out of that equation would appear to be the goal of a special program at Magee-Womens Hospital of UPMC known as the Women’s Midlife Health Center. Dr. Mary Peterson is the director and is the subject of this month’s Perspective.

Dr. Mary Peterson joined the staff at the Women’s Midlife Health Center at Magee-Womens Hospital of UPMC as a gynecologist and gynecologic surgeon. She received her medical degree from the University of Virginia School of Medicine, and completed her residency at the Medical College of Virginia in Richmond. She first joined UPMC in 1998 practicing at UPMC Community Medicine, and then joined the Magee-Womens Hospital of UPMC Womancare Associates practice. She is a fellow of the American College of Obstetrics and Gynecology, and is certified as a menopause practitioner by the North American Menopause Society.

North Hills Monthly Magazine: Dr. Peterson, what’s the first thing you would want a woman reading this to know about Magee’s Midlife Health Center?

Dr. Mary Peterson: The patient taking advantage of this very narrowly focused health care will find access to a multidisciplinary team of experts, based around an experienced, core group of clinicians practicing in the treatment areas of gynecology, internal medicine and reproductive endocrinology. All of that is in addition to other complementary and alternative medicine.

We offer consultative as well as ongoing care for women at midlife and beyond. A patient could see us one time for a specific problem or a second opinion. A patient could also see us for her regular gynecological care. We approach menopause as a natural change in a woman’s life and as a chance to optimize health.

NHMM: While we realize that the vast majority of women go through menopause, I’m questioning the very title of this Perspective article that refers to a midlife crisis. What are your thoughts on that?

Dr. Peterson: There is a difference between midlife crisis and midlife. Menopause is not necessarily a time of crisis. It is a time of vast hormonal changes. Perimenopause is the time a few years prior to and year after a woman’s last menstrual period. During this time, a woman can get wide swings in hormone levels which lead to a variety of symptoms including mood swings, bloating, headaches and so on. Menopause begins at one year after a woman’s final menstrual period.

So, when women refer to ‘going through menopause,’ it usually refers to perimenopause and the year or two after their final period. The steady decline of ovarian hormone levels is the hallmark of menopause, as opposed to the wide swings in levels during perimenopause. The low estrogen levels are what cause the classic menopause symptoms such as hot flashes, night sweats, vaginal dryness, abdominal weight gain, etc.

NHMM: Can you address some of the treatments for relieving these symptoms?

Dr. Peterson: Treatment options include lifestyle changes, hormone and medical therapies, acupuncture and relaxation therapy. Which therapy works for a patient depends on her medical history and symptoms that are bothering her as well as her personal preferences.

NHMM: You mentioned, of course, hormone and medical therapies. From what I’ve read, hormone replacement therapy can be confusing and a little controversial.

Dr. Peterson: Depending on the patient’s history, we may recommend hormone therapy, or HT. We don’t use the term hormone replacement therapy, HRT, much anymore. In all patients we recommend lifestyle changes.

Patients who should not take HT are women who have abnormal uterine bleeding. They need to have their problem diagnosed first and rule out cancer or precancerous cells in the endometrium. Also women who have breast cancer, who have had a stroke or heart attack, a history of clotting disorder, as well as women with liver disorder, pregnancy or an estrogen-dependent neoplasm are not good candidates for HT.

NHMM: What about the women who cannot take hormone therapy?

Dr. Peterson: If they have severe symptoms, there are other medications which can be used. Antidepressants have been shown to help some. Gabapentin and clonidine have been shown to help, but do have more side effects. The alternative of acupuncture may also help in these women. If a woman has a contraindication to HT, I would not recommend herbs aimed at treating symptoms. The reason some of these work is because they have an estrogen-like effect, and if it helps symptoms of menopause it may have an effect on the bad things that estrogen affects, too. Plus, there needs to be many more studies on herbs to establish their true effectiveness, the proper dosing and the side effects and risks.

NHMM: What else would you like to add?

Dr. Peterson: With all of our patients we want them to concentrate on an overall healthy lifestyle. This includes regular exercise, achieving a normal body weight, having lipid levels and blood sugars in the normal range, getting enough calcium and vitamin D, having regular mammograms, colonoscopies and checkups with their PCP and gynecologist.

NHMM: Does participation in the Magee Women’s Health Center require another physician’s referral?

Dr. Peterson: No. A woman does not need a referral from a physician to be seen at the MLHC.

Note: To schedule an appointment with the Women’s Midlife Health Center at Magee, call 412-641-8889.