Maria Sophocles, MD: Treating Symptoms of Menopause

The most treatable symptoms of menopause are the ones on the surface—the symptoms patients are quick to present to their physician or a gynecologist. It's the debilitating symptoms, such as osteoporosis, that Maria Sophocles, MD, advises physicians look out for.

In an interview with MD Magazine®, Sophocles, medical director of Women's Healthcare of Princeton, explained that it's often not until later in life that a woman considers the symptoms of osteoporosis to be taking place. But there are signs to look out for its development as menopause begins in their 40s and 50s.

MD Mag: What are the most difficult-to-treat symptoms within menopause?

Sophocles: So menopause is a big topic. We get asked all the time to treat hot flashes and night sweats—these are called vasomotor symptoms. These are not difficult to treat. These are easily treated with hormone replacement therapy or with an FDA-approved SSRI, or with what I call complementary and alternative medical therapies: acupuncture, herbal medicine, paced respirations.

There are lots of ways to treat many of the most bothersome symptoms of menopause. The trickier symptoms to treat are the ones the patients may not know they're having, and what I mean by that are the silent pathologies that develop and accelerate after menopause. Once we lose the benefit of estrogen, we don't just get hot flashes. We lose it in the genitourinary tract. We call this genitourinary syndrome of menopause.

That's easy to treat as well, and I'll discuss that in a minute. But what women may not realize is there is an acceleration in atherosclerosis and in loss of bone mass. These are silent. Women aren't going to feel this, but we know it because we see an increase in cardiovascular events. We see when we measure a rapid loss of bone mass in the first 3 years after menopause.

Nobody at 50 thinks of themselves as suddenly becoming osteoporotic—you think of a woman with osteoporosis as an 85-year old woman hunched over who's lost her height. But that woman didn't just get there at 85. It's a slow, insidious process and it begins when we go through menopause.

So, it's hard to treat these early, because OB/GYNs are busy in general. They're not really thinking about this. They're thinking about what can they treat that the patient's asking, but they should be thinking about screening for cardiovascular disease—making sure that patient doesn't also have other risk factors for cardiovascular disease, such as family history of osteoporosis or other risk factors for osteoporosis, such as an eating disorder.

But genetics play a big role. So when you take a genetic predisposition for osteoporosis or heart disease and you add menopause into the picture, you have treatable, preventable pathologies that are very common in America that, in my opinion, aren't really getting addressed early enough. They're sort of addressed when someone comes in at 70, and they've fallen and broken a wrist, and the doctor says, ‘Hey, we should look at osteoporosis for you. You know that gets worse after menopause.’

Well, that woman's been 20 years out. So those are the hardest things, in my opinion, to treat because they're not getting addressed.