Menopause & Osteoporosis

Menopause

The OBGYNs at Princeton Medical Group take care of women from their teenage years through menopause. Menopause is a natural part of the aging process that usually occurs between 45 and 55 years of age. Menopause occurs as a woman’s estrogen levels decline.

The menopausal transition (“perimenopause”) can be a challenging time as you adjust to your changing body. Many women start this transition with skipping periods. Other women can experience hot flashes, night sweats, memory problems, vaginal dryness, low libido, and/or trouble sleeping. This transition can take months and sometimes years before your periods actually stop. When you stop having periods for more than a year, you are considered to be “in menopause.”

Women’s health care needs change throughout their life, and aging well is an important part of health and happiness. The physicians at Princeton Medical Group can help navigate you through your menopausal transition and can offer treatment for your symptoms if they are affecting your quality of life. Please call 609-924-9300 to schedule a consultation with your PMG OBGYN physician.

Helpful Resources

Menopause.org

Women’s Health on Menopause

FDA Information on Menopause

Menopause Services

We offer gynecological services specific
to menopause and healthy aging, including:

Hormone replacement therapy (HRT)
Strategies and options for coping with menopausal symptoms
Evaluation and treatment of postmenopausal vaginal bleeding
Screening for osteoporosis
Evaluation of and treatment for urinary incontinence and pelvic organ prolapse

Menopause FAQ

What is menopause and how do I know I am in menopause?

Menopause is defined as an interval of 12 consecutive months with no menstrual cycle. It represents a time in a woman’s life when the egg supply or reserve in the ovaries has completely depleted, therefore there is a decline in natural estrogen stores. During this “menopausal” period, women can undergo many changes, and some may experience symptoms such as hot flashes, vaginal dryness, low libido, changes in mood, etc.

All of our providers have experience with menopause and managing menopause symptoms, if something is concerning you, please call to schedule an appointment.

What are hot flashes? What are some signs and symptoms of hot flashes?

When women experience menopause and the body’s natural estrogen levels decline, the natural thermostat or body temperature slightly decreases. To compensate for this, many women experience a hot flash or hot flush – which is usually a sudden sensation of warm in the face or bodily, usually followed by chills or sweats. This can be a very normal “vasomotor” symptom of menopause that many women experience.

If your hot flashes are bothering you and negatively affecting your daily life, please talk to one of our OBGYN physicians about treatment options.

What are some treatments available for hot flashes?

There are both easy behavioral modifications as well as medication options available to treat options. Some easy remedies include cutting back triggers of hot flashes (coffee, caffeine, cola, chocolate, alcohol, liquor). Others include using a bedside or ceiling fan, sleeping with loose, 100% cotton clothing, purchasing cool sheets/mattress, etc. There are also both hormonal and non-hormonal medication options to treat hot flashes if they are VERY bothersome and behavioral modifications do not work. Read here about some options and talk to your doctor about the benefits/side effects of the different drug therapies.

I have vaginal dryness due to menopause, what are some recommending treatments I can do to improve this?

Vaginal dryness is an extremely common symptom of menopause. The decrease in your body’s estrogen hormone causes the vagina to lose its local estrogen. Normally estrogen helps keep the vagina strong, lubricated, and healthy. Dryness can cause pain with sex, discomfort, higher susceptibility to vaginal infection and urinary infections, and problems with activity/exercise. There are over the counter vaginal moisturizers you can use daily to start with (Luvena, Replens, Aquaphor, Coconut oil, etc.).

If this does not work, talk to your doctor about possible prescription vaginal estrogens to help with your condition.

Are there any treatments for women who have decreased libido?

Unfortunately, there is no “female Viagra” or quick fix medication to improve libido. However, there are many other remedies to help improve libido. Female sex drive is closely tied in with other physical, emotional, and psychologic factors.

Common causes of decreased libido can be depression, anxiety, difficulties with your partner, stress, vaginal dryness, pain with sex, lack of energy, fatigue, or other health problems.

Talk to your doctor if your lack of libido is distressing you and/or affecting your relationship.

I have gone through menopause but am experiencing vaginal bleeding, spotting or staining. What should I do?

It is not normal to have vaginal bleeding after menopause. Please call our office at 609-924-9300 to schedule an appointment.

I have gone through menopause and now I am leaking urine when I cough or sneeze. Is this normal?

Women commonly develop stress urinary incontinence (urine leakage) and overactive bladder (the urge to go to the bathroom frequently) in menopause. This can be a source of embarrassment and can be treated.

The Simon Foundation for Continence

What treatments are available for urinary incontinence or urgency in menopause?

Stop / decrease alcohol & caffeine
Stop drinking liquids close to bedtime
Wear a disposable pad or reusable underwear designed to absorb urine
- Speax Underwear for Bladder Leak Protection
- Modibodi Underwear for Bladder Leak Protection
Wear a vaginal insert that decreases leakage
- Poise Impressa
Maintain a healthy weight
Learn Pelvic floor strengthening exercises
- Kegel Exercises
Purchase a “biofeedback device” to learn how your pelvic muscles are contracting. This device also helps teach you how to control your pelvic floor muscles.
- Innovo Trainer Shorts
- Elvie Trainer
Pelvic Floor Physical Therapy
Prescription medication from your physician
Surgery with a trained pelvic floor surgeon
Please contact the office if you wish to set up a consultation to discuss urinary incontinence with one of our providers.

What is pelvic floor physical therapy?

Pelvic floor PT involves exercises and feedback to encourage relaxation and strengthening of the muscles of the lower pelvis. A physical therapist places biofeedback sensors on the vaginal wall to measure muscle tone and the strength of muscle contractions, which are then printed on a machine for you to see.

After practicing your exercises at home, you can see your improvement on the machine the next time you visit the physical therapist. Sometimes the therapist will use a massage-like technique called myofascial release to help stretch and release the connective tissue between the skin and the muscles and bones in your pelvic region.

Pelvic floor physical therapy can help address sexual problems by improving chronic vaginal or pelvic pain and urinary incontinence. Typically several sessions of pelvic floor physical therapy are needed to achieve satisfactory results.

I need pelvic floor physical therapy. Where can I find information on the Center for Pelvic Wellness at Princeton Medical Center?

Center for Pelvic Wellness

I have gone through menopause and now I am leaking urine when I cough or sneeze. Is this normal?

The Simon Foundation for Continence

Osteoporosis Management at Princeton Medical Group

Osteoporosis is a progressive disease in which bones become weaker and the risk of fracture increases. Bones in the hip, spine, and wrist are especially prone to fracture. Osteoporosis usually occurs “silently,” meaning it is not painful.

As your body’s natural estrogen declines, bone loss accelerates. This means that bones break down more quickly than new bone being formed. Menopause is the most common cause of osteoporosis: up to 20% of bone loss occurs after menopause and approximately 10% of postmenopausal women suffer from osteoporosis.

Princeton Medical Group is a multispecialty group. Your OBGYN or internal medicine provider can send you for osteoporosis screening. If you are diagnosed with osteoporosis, PMG offers both endocrinology and rheumatology services to provide you with treatment options.

Osteoporosis FAQs

What is osteoporosis and when should I get a bone density (DEXA) scan?

Osteoporosis is a common but serious problem that is most prevalent in postmenopausal women. Osteoporosis means that the bone becomes more porous (has more holes) and becomes weaker. This is a painless problem that happens over time. As the bone becomes fragile, it is more likely to fracture, especially if you trip and fall.

Screening for osteoporosis typically starts 10 years after menopause. However, some women have additional risk factors for osteoporosis that cause their bones to weaken prior to age 60.

If you have questions about your risk, please ask your physician at your gynecologic office visit.

A “DEXA scan” is a low radiation X-ray capable of detecting small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton. This scan is performed at a radiology facility. Please make sure the radiology facility you choose accepts your insurance.

What are the daily recommended doses of calcium and vitamin D?

Adults under the age of 50 should get 1,000 mg of calcium every day. Over the age of 50, the amount goes up to 1,200 mg. The best way to get your calcium is in your food. If you cannot get enough calcium in your diet, you can take a supplement.

Adults should get at least 600 IU of Vitamin D daily.

Vitamin D and calcium work together. When food that contain calcium are digested, it interacts with vitamin D to get absorbed into the blood stream. Without sufficient Vitamin D, you will not absorb the calcium you eat.

Institutes of Medicine Recommendations for calcium & Vitamin D (RDA is recommended daily allowance)

Life Stage Group	Calcium RDA (mg)	Calcium-rich food servings	Vitamin D
9-18 years old	1,300	4	600
19-50 years old	1,000	3	600
51-70 years old	1,200	4	600
71+ years old	1,200	4	800

What foods are rich in calcium?

There are many foods that are rich in calcium. It is important to space out these foods to allow proper absorption.

List of Calcium Rich Foods

My doctor told me to do weight bearing exercises to help prevent osteoporosis. What does this mean?

Weight-bearing exercises force you to work against gravity. They include walking, hiking, jogging, climbing stairs, playing tennis, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Other exercises such as swimming and bicycling can help build and maintain strong muscles and have excellent cardiovascular benefits, but they are not the best way to exercise your bones.

Weight-Bearing Exercise

Weight-bearing exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss whether you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your bones strong.