Gynecology and Obstetrics

Menopause is a normal biological event that occurs in all persons with ovaries. The average age of menopause in the United States is 51 years old; however, this age varies and can occur between 40 and 60 years old. Menopause is diagnosed by the spontaneous loss of menstrual periods for 12 consecutive months.

The onset of menopause is affected by:

• Genetics
• Illness
• Smoking
• Surgical removal of ovaries
• Medically induced menopause (such as chemotherapy for breast cancer)

Estrogen and progesterone have effects on all organs in the body, but have especially critical effects on the reproductive system, urinary function, bone and mineral metabolism, cardiovascular function and memory and cognition.  Lower levels of these hormones in the blood can produce unpleasant symptoms and can be treated in appropriate patients.

Symptoms of menopause vary from person to person but will probably include any or a combination of the following:

• Hot flashes
• Libido or sexual health issues
• Vaginal dryness
• Mood swings
• Sleep disturbance
• Fatigue
• Brain fog

Perimenopause can cause symptoms that are due to changes in estrogen and progesterone produced by the ovaries. During this time a person might experience the following symptoms:

• Irregular menses
• Vaginal dryness
• Decreased libido or sexual health issues (link to that page)
• Mood swings
• Depression
• Insomnia
• Hot flashes
• Night sweats

Treatments are available for these symptoms, but they are not for everyone and must be discussed individually with a provider in menopause health. These treatment options include:

• Hormone therapy
• Lower dose oral contraceptive pills
• Life style changes
• Non-hormonal prescription medications
• Integrative medicine practices including acupuncture.

There are also ongoing clinical trials that address specific menopause symptoms.

Sometimes, in the course of medical treatment, physicians may induce artificial menopause in a patient. Gynecological cancers and autoimmune diseases are among those conditions for which treatment may involve artificially induced menopause.

Our experts treat these patients as well as people who have menopausal symptoms superimposed on other chronic medical problems. We work with a patient’s primary physician and will recommend non-hormonal therapies and possible alternative options to treat the symptoms when possible.

Consultations take place at Johns Hopkins at Green Spring Station or via telemedicine.

1. You will be asked for your complete medical history.
2. Your doctor will ask you about your symptoms; how often they occur, their severity and how you are currently managing them.
3. Your doctor will also discuss the many different parts of menopause and clarify which symptoms are related to menopause, and those that may be related to the natural process of aging. 
4. We will work with you to develop a treatment plan. Depending on your symptoms, this plan may include:
   • Hormone therapy or non-hormonal therapies, like SSRI’s
   • Acupuncture
   • Other homeopathic remedies
5. In those patients for which menopause has affected their sexual health, your doctor may refer to a psychiatrist who specializes in couples therapy or a sex therapist.

Menopausal people are at increased risk for osteoporosis, coronary heart disease, breast cancer and Alzheimer's disease. Prevention and early detection of these conditions are essential.

Our doctors will only prescribe those treatments that have been clinically tested and proven to work.