Hormone testing is a staple when it comes to menopausal therapy, but unfortunately, blood tests do a poor job of differentiating active hormone levels from inactive forms.  Also, the lab tests are designed to check for much higher hormone levels than are present in post-menopausal women.  For these reasons, we prefer saliva hormone testing for estrogen and progesterone.  Thyroid hormone is also important and we always check a full thyroid panel with reverse T3.

If hormone replacement is needed, we recommend bioidentical hormones in either creams, vaginal suppositories, or troches.  We work with several compounding pharmacies in the area to get the best treatment for our patients.  

We refer for bone density scanning for our patients over 65 and for those with risk factors for osteoporosis.  

Vaginal dryness can be a significant problem for menopausal women.  Although estrogen replacement therapies can help, it often requires a specific low-dose estrogen cream 1-2 times per week in order to completely eliminate this common menopausal symptom.  Even if you have no other symptoms, vaginal estrogen cream is safe and effective and is not significantly absorbed into the bloodstream.

Pessaries are a great minimally invasive treatment for pelvic organ prolapse that is safe and effective.  Modern pessaries come in many shapes and sizes and can be left in or removed and replaced daily.  Although surgery is also an effective treatment, it may not last forever and may have some unpleasant side effects.  Ask us about pessaries as well as physical therapy as an alternative approach to prolapse.

After 65, many women can go to their PCP for annual exams.  However, not all PCPs do breast and pelvic exams.  If you need a good gynecologist just for an annual exam, don’t hesitate to call us.  Dr. Podraza and Hannah both take Medicare and would be happy to take care of you for an annual examination.  

Premenopause starts at about 37 years old (on average) and is characterized by a decrease in fertility, lower progesterone levels, and an increase in PMS and other cycle-related symptoms.  Around age 50 (on average) women begin to skip cycles and experience an increase in hot flushes and other menopausal symptoms.  This is called perimenopause.  These changes are natural but can be effectively managed for nearly all women.  Please call and make an appointment if you need help during this difficult transition.