Ask the expert – Questions about menopause

Nieca Goldberg, MD, is clinical associate professor of medicine and medical director at the New York University School of Medicine’s Women’s Heart Program, and author of Dr. Nieca Goldberg’s Complete Guide to Women’s Health (Ballantine Books, 2008).

Q: I’ve gained a lot of weight in the past few years, but I’m not eating any more than I used to. Why is this happening, and what should I do about it?

A: As we get older, our metabolism slows, and we may not be able to eat as much as we used to without gaining weight. We also may not be balancing our eating with calorie-burning exercise. Additionally, as hormone levels decrease, women become more carbohydrate intolerant and tend to gain weight around the middle. So I recommend that women cut back on simple carbs, including sugar and white-floured foods.
I suggest you get a checkup and also have your doctor do a blood test for thyroid function because an underactive thyroid causes weight gain. Beta-blockers, antidepressants, and some diabetes medications can also be contributing factors.

Q: I’m 45. How will I know when I’ve started perimenopause, and how long after that will menopause arrive?

A: Night sweats, hot flashes, irregular menstrual periods, and changes in menstrual flow often signal perimenopause. Some months you may have a normal flow, other months you may have a heavier or longer flow. It can take five years before menopause arrives.

Q: My sex drive plummeted at menopause. Will it ever come back?

A: That could depend on why it’s decreased. One symptom of menopause is loss of libido. However, depression, certain medications, and medical illness can also cause this. Your doctor should perform a thorough evaluation to help determine what’s causing your problem. Hormone replacement therapy may help, but it isn’t indicated for every woman. Testosterone has been shown to improve libido in menopausal women, but hasn’t been approved yet by the Food and Drug Administration (FDA) for this purpose. And the long-term risks of testosterone therapy in women aren’t known at this time.

Q: I’m 50. How often should I get Pap tests?

A: After you’ve had three consecutive normal Pap tests, you should have a Pap every two to three years. If your Pap test results are abnormal, you should have the test more frequently. Talk with your doctor about how often you should be tested.