Menopause & Osteoporosis


MENOPAUSE — “to infinity and beyond.”

Many women approach this stage in life as a curse or a time to fear or dread. This does not have to be the case. There are many ways to improve our quality of life during this “change in life.” Firstly the average age of menopause is 52 years old in the United States (only 5% of women will go through menopause between ages 40 and 45, another 5% of women will not go through menopause until age 55 or later. Menopause occurring prior to the age of 40 is abnormal. Smokers go through menopause on average 2 years early). Symptoms vary among women, including: irregular menses, fatigue, hot flashes, night sweats, mood swings, insomnia, and vaginal dryness. Some women do not experience any of these symptoms and only have cessation of menses. By definition, menopause occurs when the ovary stops functioning for 12 months as is evident by no menstrual flow for 12 months. This however, does not mean symptoms that occur before cessation of menses must go untreated for 12 months.

Hormone replacement therapy refers to the use of estrogen, progesterone and testosterone to replace the hormones previously produced by the ovary and the adrenal gland. The latest catch phrase in the industry is “bioidentical hormones.” This alludes to the presence of an all natural hormone replacement system. This is a misnomer. Any hormone therapy that is produced chemically is manufactured. One type is under the regulation of the FDA and the other is produced in the pharmacy and not screened by the FDA. We believe hormone replacement therapy is beneficial and is an individual choice. We use hormones most closely to the ones produced by the ovary and in that regard “bioidentical,” but we believe in having theses hormones approved by the FDA. We strive to individualize hormone replacement therapy and educate on the risks and benefits with the ultimate goal to improve quality of life and improve health. Please feel free to discuss your symptoms freely with your physician. You may think you are going crazy with the “menopause,” but we are here to offer healthy life styles and medical care – “to infinity and beyond.”

Menopause Definitions:
Menopause – 12 months of no bleeding after the final menstrual period
Perimenopause means “around the menopause”
Post-menopause –  the time period after 12 months of no bleeding
Postmenopausal hormone replacement therapy: Benefits and risks. Please click here to read more from UpToDate


  • Classic symptoms including hot flashes, night sweats, mood swings, insomnia and vaginal dryness
  • Bleeding patterns
  • During the transition from regular periods to menopause, the interval between periods will typically become longer
  • Irregular bleeding for greater than 6 months is an indication for evaluation by an M.D.
  • Part of the evaluation may include endometrial biopsy and/or saline infusion sonography
  • Low libido


  • There are blood tests such as FSH, estradiol and AMH (anti- müllerian hormone) that can be used to help diagnose menopause, but for most women these are unnecessary.
  • Bone density – usually first tested at the onset of menopause.


  • Estrogen replacement therapy
  • Hormone replacement therapy (estrogen + progesterone)
  • Low-dose birth control pills
  • Direct vaginal estrogen
  • Other therapies
    • Selective serotonin reuptake inhibitors (SSRIs)- Effexor, Paxil, Prozac are common brand names
    • Gabapentin- this medication is approved for the management of seizure disorders and pain syndromes after herpes or shingles; it can be used for control of hot flashes as well
    • Progestins alone- Megace, Provera, Aygestin, Prometrium are common brand names
    • Clonidine transdermal patch
      • originally approved to treat high blood pressure
      • Side effects including dry mouth, dizziness, constipation and sedation
    • Alternative therapies
    • Black cohosh, soy foods, isoflavone supplements (such as soy or red clover, black cohosh or vitamin E)


Osteoporosis is the deterioration of the body’s bone structure making it brittle and susceptible to fractures. Many women do not know that they have osteoporosis until they fracture or break a bone, at which time a bone density test is performed and x-rays taken (x-rays alone cannot diagnose osteoporosis). DEXA scans (specialized x-rays) can be taken to provide precise measurements of bone density at important bone sites (spine, hip and femur) to determine a patient’s risk level of osteoporosis. Bone mass (bone density) decreases in women after the age of 35 and decreases more rapidly in women after menopause.

Some of the key risk factors for osteporosis include:

  • genetics
  • lack of exercise
  • lack of calcium and vitamin D
  • personal history of fracture as an adult
  • cigarette smoking
  • excessive alcohol consumption
  • history of rheumatoid arthritis
  • low body weight
  • family history of osteoporosis.

What is the treatment for osteoporosis, and can it be prevented?

The goal of treatment of osteoporosis is to prevent future bone fractures by reducing bone deterioration and increasing bone density and strength. Although early detection and timely treatment can decrease the risk of future fractures, none of the treatments available are complete cures. It is difficult to completely rebuild bone that has already been weakened by osteoporosis. Therefore, prevention of osteoporosis is as important as treatment. The following are osteoporosis treatment and prevention measures:

  • Lifestyle changes: stop smoking, reduce alcohol intake, exercise and eat healthy, balanced diet including calcium and Vitamin D.
  • Medications that stop bone loss and increase bone strength: such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), zoledronate (Reclast), and denosumab (Prolia)
  • Medications that increase bone formation: such as teriparatide (Forteo)

To find out how much calcium you get from your , the following calcium calculator. A good vitamin company we recommend is Theralogix . You can order by phone or email and their prices are competitive with over-the-counter vitamins. They offer a calcium called TheraCal and a vitamin D called Thera-D. They also offer a good multivitamin and a prenatal vitamin.

To learn more about our menopause and osteoporosis services or to schedule an appointment, please call our main office at (404) 255-3633. You can also use our online Request an Appointment form. Our menopausal patients come to us from the area of Buckhead in Atlanta, Dunwoody, Roswell, Forsyth, Cumming, North Atlanta, Sandy Springs and Alpharetta in Fulton County, GA.

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