Menopause Overview

What Is Menopause?

Menopause is a normal part of life.  It is a transition during which hormonal changes occur as the ovary is diminishing its function.  Menopause is defined by not having a period for one year. Perimenopause is the time frame prior to menopause in which your hormone levels are fluctuating. The rise and fall of hormones can cause significant symptoms in some women.  Hormonal changes can cause variations in your menstrual cycle including heavy, crampy periods, or less frequent, lighter periods.  Hot flushes and night sweats can disrupt your daytime routine and your sleep patterns. Mood changes, including depression and anxiety, can become more common.  

You may try to write these symptoms off as stress, but often, they are related to hormonal issues.  Menopause is also associated with foggy thinking, abdominal weight gain, loss of clarity of thought, vaginal dryness causing painful intercourse and urinary tract symptoms, decreased libido and muscle aches and pains.  

The average age of menopause is 51, however, perimenopausal symptoms can start as early as your late 30’s and you may continue to have periods into your late 50’s.  

What are my options for dealing with perimenopausal or menopausal symptoms?

If you are perimenopausal, having symptoms, but are still having regular or irregular menses, your body is still producing estrogen, but the fluctuations in estrogen are causing symptoms.  Often, the initial treatment of perimenopausal symptoms are a low dose birth control pill.  The problem is hormonal fluctuation and the treatment is giving your a hormone in a steady state dose to balance your symptoms.  Hormone replacement therapy dosing often will not be a high enough dose of hormone to balance symptoms if you are still having periods.

What treatment options are available in menopause?

Phytoestrogens and Lifestyle changes

There are multiple options for treatment once your are menopausal.  Phytoestrogens are plant based estrogens sold as nutriceutical supplements to helps with symptoms. We carry a product, called Estrovera, a phytoestrogen from the Siberian rhubarb plant, that can reduce hot flushes and night sweats by up to 75% in some patients.  Some women will choose to manage their symptoms with lifestyle changes such as dressing in layers, and removing layers when they are warm, drinking cold liquids and keeping room temperatures cooler.  A certain percentage of women will manage menopause quite well with these minor changes in lifestyle.  Other therapies include seeing an acupuncturist or a homeopathic practitioner to explore these alternatives. 

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy, or HRT, consists of treatment with a form of estrogen, progesterone and/or testosterone.  There are multiple different alternatives including bio-identical creams and pellets, as well as prescription medications in the form of pills, patches, and gels.  There are pros and cons to each method and the process to optimize hormone balance takes time to find the right fit for each individual.  For this reason, it is important to pay attention to your symptoms and meet with your health care practitioner to find out which option might be best for you.

HRT Risk Factors

HRT is currently recommended on an individualized basis based on a patients’ personal health and family history.  HRT has been associated with an increased risk of breast cancer after five years of use, however, with ongoing use of HRT after 5 years, the risk is increased by 1/10 of 1% for each additional year of use. It is thought that the progesterone type used in this study may have been a contributing factor for the increased risk of breast cancer, as the women in the estrogen alone arm of the study did not have an increased risk of breast cancer.  For that reason, we utilize a bio-identical progesterone in our therapy recommendations.

HRT has been associated with increased risk of heart disease in the first year of use, however, the average age of women in that study was in their early 60’s, where there may be an age related increased risk of heart disease.  Estrogen alone therapy is associated with an increased risk of uterine cancer.  In order to mitigate that risk, women with a uterus need to take progesterone to counterbalance the effect of estrogen on the uterine lining.  Oral estrogen therapy has a potential to increase risk of blood clot and stroke as they affect clotting factors in the liver.  Transdermal estrogen therapy in the form of patches, creams, gels, and pellets are not metabolized in the liver and are thought to help minimize this risk. 

 HRT is protective against hip fracture and is associated with a reduced risk of colon cancer.  

As you can see, the issues related to HRT and menopause are complicated and definitely require you and your practitioner discussing your symptoms and concerns to find the right options for you.