Featured Physician: Soma Mandal, MD

Featured Book: Dear Menopause, I Do Not Fear You

Dr. Soma Mandal is widely regarded as one of America’s top physicians in midlife women’s health. She earned her MD at New York University School of Medicine and completed a prestigious research fellowship at Oxford University in England. Dr. Mandal is board certified in Internal Medicine and authored her book to bring a fresh perspective to the topic of menopause and provide a much-needed, easy-to follow process to make the forties and fifties plus fabulous.  She shares her thoughts on some hot topics in menopause with myDoqter below.

What Is Menopause And When Does It Start?

myDoqter: Dr. Mandal, you are an expert in menopause and women’s health. Can you tell us what is menopause and when does it typically start and occur?

Dr. Mandal: Menopause is the end of menstruation. It is when the ovaries stop producing eggs and hormone levels, specifically estrogen, decrease. True clinical menopause is when a woman has been without a menstrual cycle for twelve months. The average age of menopause in the United States is 50.

Menopause and Hormone Replacement Therapy

myDoqter:  What is bioidentical hormonal replacement therapy and what are the potential benefits and side effects?

Dr. Mandal: When estrogen levels decrease during the menopausal and post-menopausal years, women can suffer from fatigue, skin and hair changes, mood disorders, decreased libido, hot flashes, night sweats and weight gain. Bioidentical hormones are man-made hormones which are derived from plant estrogens that are chemically identical to those that the human body produces. There are various forms of bioidentical hormones including pills, patches, creams, gels  and injections. Bioidentical hormones are used to increase the levels of hormones that have decreased and reduce the menopausal symptoms. Like any other medication, bioidentical hormones are also associated with side effects, including acne, bloating, weight gain, fatigue, mood swings, and increase facial hair in women.

Hair Loss and Menopause

myDoqter: Hair loss in women is an extremely common complaint and is possible in menopause. What can you tell us on its presentation and treatment when associated with menopause?

Dr. Mandal: One of the most important things you can do during menopause is to take care of your hair. What you do and how you do it can have a profound effect on the health of your hair. Your hair follicles are where your live hair cells reside, so it makes sense that what you do for your inside will help to nourish them. When patients consult with me about hair loss related to menopause, I tell them to maintain a healthy diet, hydrate, exercise and get lots of fresh air, manage stress levels, quit smoking, go easy on flat irons and hair dryers, use products that moisturize your hair and comb or brush your hair gently.

There are a few treatments for hair thinning that have had some success including minoxidil, spironolactone, finasteride and estrogen therapy.

Low level laser therapy (LLLT) is a newer technology that uses low level laser light. This is delivered to the scalp to stimulate hair growth. It has shown to be effective, especially for people who have not had success with or cannot tolerate standard treatments.

In more extreme cases, hair transplantation remains an option. It has come a long way since the days of visible hair plugs and painful surgeries. Less invasive options include hair enhancements and extensions or restoration.

Menopause and Weight Loss

myDoqter: It seems like everyone today is seeking fast solutions to weight including weight loss pills, weight loss surgery, weight loss programs.  What can you tell us specifically about weight loss and/or gain and menopause?

Dr. Mandal: There is a kind of resignation that many women have that menopausal weight gain is just something we have to deal with. It is true that as we age, managing our weight becomes harder. Metabolisms slow down, appetites change, the ability to exercise changes and energy levels change. Enter menopause and we are faced with challenges we may have not had before. We’re dealing with hot flashes, mood disturbances, sleep problems, and more. Menopause can also be accompanied by metabolic problems such as risks for increased body weight, especially around the midsection, insulin resistance and glucose and lipid metabolism disturbances. As a result, the risk of Type 2 diabetes, osteoporosis, cardiovascular disease and cancer increase.

It is at this time that you have to make a strong commitment to yourself and to your plan

  • Keep a diary for a week. Record what you’re eating, when and where you’re eating and how you’re sleeping. Record your exercise habits. Take a good hard look at what seems to be working and what isn’t. Those are your change points.
  • Weight management is about 80% of what you eat and 20% exercise. Cut out the things you already know didn’t help your weight loss efforts- packaged/ processed foods, cookies, chips, sweets, soda.  Maintain a sustainable plan that fits your lifestyle. A visit to a nutritionist can be worth is weight in gold, especially if you struggle with metabolic issues.
  • Build regular exercise into your days.  Start with something you’re comfortable with and slowly build on it.
  • One of the strongest predictors of weight gain is lack of sleep. The hormones that regulate your appetite, leptin and ghrelin, are influenced and set by your sleep time and quality. When your sleep is poor, you are more likely to be hungry and crave things like carbs and sugar. The craving can be downright overwhelming.
  • Stress is linked to overeating. There’s also a neurochemical thing that happens in your brain that makes these stress-foods irresistable when we’re under pressure.  Release and let go of the stressors and worries that drag you down and keep you tense. .Exercise, walking, yoga, massages, journaling are some of the ways I encourage women to release their stress.
  • Consider HRT. The thinking has changed on HRT and now doctors are more willing to help their patients weigh the risks and benefits of HRT. The general rule seems to be the lowest dose for the least amount of time necessary. HRT may even help you shed a few pounds if your diet and exercise are on point. HRT is not for every woman, but if you’re struggling, ask your doctor if it’s an option for you.

The Do’s and Don’ts of Menopause

myDoqter:  If you had to give us your top 3 Do’s and Don’t when it comes to menopause, what would they be?

Dr. Mandal:  Here are my top Do’s and Don’ts:

  1. Menopause is not the end of life as you know it .It’s actually a perfect opportunity to reinvent yourself. It is the beginning of the next part of your journey. For many women, the freedom and sense of empowerment that come with this time in their lives is some of the most fulfilling they will experience.
  2. Don’t brush off your own symptoms. Seeking help is not a sign of weakness, but a sign of strength. You cannot be at your best for others if you are not at your best. Seeking help and support is the most loving thing you can do for those you care for and the best gift you can give yourself.
  3. Menopause is not just a women’s issue. It is important that the man and children in a woman’s life pitch in and support their wife/ mom during this time. This can be done in many ways including pitching in, trying to understand the physiology behind menopause, allowing your wife/ mom to have some quiet time to relax, and being more patient with her.