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Managing the Far-Reaching 
Effects of Menopause

Andra was 52 when she started having severe hot flashes. Then came the panic attacks. “At the time, I thought I was having a heart attack,” she recalls. She saw a cardiologist who put her through a series of tests, but found nothing wrong with her heart. Over the next several months, she went to an endocrinologist, an OB/GYN and her family doctor to find relief for her uncontrolled symptoms.

“I didn’t feel like myself,” Andra says. “I was gaining weight, feeling a little depressed and I was scared to do anything for fear of bringing on a panic attack. I tried yoga, meditation, exercise. Nothing helped. Each doctor I saw was treating just one symptom.”

Maryann was in her early 40s when she experienced extreme hot flashes and night sweats after a hysterectomy. “All of a sudden, I was sweating profusely,” she said. “I couldn’t even sit next to a lamp. I had night sweats to the point of having to change the sheets. I couldn’t sleep.”

In near desperation, Andra and Maryann went online and typed in “menopause.” Their search took them to the non-profit North American Menopause Society (NAMS) (www.menopause.org). The organization certifies physicians as NAMS Certified Menopause Practitioners (NCMP), designating that they have received advanced education and demonstrated competency in the field of menopause management.

As a result, Andra and Maryann found Terri Remy, MD, FACP, NCMP, an internist with Primary Care Alexandria of the Virginia Hospital Center Physician Group.

Dr. Remy decided to become a certified menopause practitioner because she treats so many women in her practice — some have been patients for over 20 years. “We’re all aging together,” she says.

“At my first appointment, Dr. Remy listened to me for a solid 45 minutes and asked questions,” Andra recalls. “I felt she was actually listening to me and getting a picture of my entire health.”

Dr. Remy told Andra that it’s not unusual for women to have anxiety as a result of the hormonal changes that occur in menopause. In addition to hormone replacement therapy, she prescribed a serotonin inhibitor to treat her anxiety that also had benefits for menopausal symptoms.

“Within two weeks, I felt like myself again,” Andra said. “No hot flashes and no panic attacks.”

Maryann talked extensively with Dr. Remy about her hot flashes, which were still uncontrolled, despite being on a low dose of hormone replacement therapy. She also had concerns about this medication. Dr. Remy suggested increasing her dose, explaining that using hormone replacement therapy for the initial five years of menopause has been proven safe and effective for most women. It is not appropriate for anyone with a personal history of breast cancer or blood clots.

“Dr. Remy gave me very good feedback and information about medications that work,” Maryann says. “She gave me the whole picture so I could make an informed decision.”

Giving women the “whole picture” is important, Dr. Remy says. “There are a lot of changes in women’s lives when they enter menopause. It’s not just the end of your period.”

Suddenly, joints hurt because women’s joints need estrogen. Vision changes can accelerate. Bone mass can decrease by up to 20 percent. Hair loss can occur. Plus, sexual function changes. Many women experience vaginal dryness and a decrease in their libido.

“Women will talk about hot flashes and night sweats with their husband and friends,” Dr. Remy adds, “but what they won’t talk about is how uncomfortable intimacy with their partner has become. Having the opportunity to have an open discussion with a physician about intensely private issues is a real relief for many patients. We can make a lot of their symptoms better.”

Dr. Remy’s patients know how much better life can be once their symptoms are under control and properly managed. “Before I met her, my whole life revolved around menopausal symptoms,” Maryann says. “I’m now living instead of existing.”

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