As a woman ages, the body stops producing certain important hormones, resulting in what is typically referred to as symptoms of menopause. During the menopause period, the levels of estrogen fall, causing vaginal dryness or hot flashes in some women. This period can be frustrating to women, primarily due to the discomfort. Hormonal replacement therapy (HRT) is a common and effective way to treat these symptoms and give women relief.
Before you settle on a hormone replacement therapy program, you must visit a doctor and discuss various options available and what suits you best. If you are in Los Angeles, get in touch with us at All Women's Care to discuss the best advice and treatment that works for you.
Overview of Menopause
Menopause happens when a woman goes for twelve straight months without menstruating and is unable to get pregnant naturally. Typically, women start experiencing menopause from 45 to 55 years, but can still experience it earlier or later than the said years. Menopause causes particular symptoms that are uncomfortable, such as sudden weight gain, hot flashes, and dryness of the vagina. Treatment for the symptoms is not necessary for some women, while others need medication to manage the symptoms.
A majority of women start developing menopausal symptoms approximately four years before experiencing their final period. These symptoms continue to be experienced until four years post the last period. A small number, however, experience these symptoms ten years before the onset of menopause, and one in ten women continue experiencing these symptoms twelve years from their final period.
Fifty-one (51) is the median age in menopause. However, it can occur two years earlier for some women. Many factors determine when menopause begins in women and include your genes and the health of your ovaries. Before the onset of menopause, some women experience perimenopause. This is the period when you begin experiencing changes in your hormones in preparation for the actual menopause.
This period varies in duration, with some women experiencing it for a few months while others for years. A majority of women start their perimenopause period past their mid-forties, while others skip it and enter directly into menopause.
A small percentage of women, however, begin to experience menopausal symptoms before they are forty. This condition is also referred to as ovarian insufficiency. About 5% of women experience menopause when aged from forty to forty-five. This is what is called early menopause.
During the perimenopausal period, your periods are irregular or get late, or in some cases, you skip one or more months without them. Sometimes, the flow becomes heavier, while for other women, it gets lighter. A woman will know she has reached her menopause when she goes for twelve straight months without experiencing her period. The years after the occurrence of menopause are referred to as postmenopause.
Symptoms of Menopause
Each woman has a unique experience with menopause. When a woman experiences sudden menopause, the symptoms are more severe than when it gradually happens. For women that experience shorter periods of menopause also go through harsh symptoms compared to those that experience prolonged menopause.
Some conditions, however, impact on how healthy your ovaries are. Cancer, hysterectomy, or lifestyle choices such as smoking are known to increase the severity of the symptoms and the length of menopause.
Aside from the changes in your menstruation, the signs you would experience prior, during, and after menopause are similar. Some of the common symptoms before the onset of menopause are:
- Your periods reduce in frequency
- You experience either lighter or heavier periods than usual
- Vasomotor symptoms. These include night sweats, flushing, and hot flashes
About 75% of women suffer hot flushes during menopause with other prevalent symptoms being:
- Dryness of the vagina
- Loss of sleep (insomnia)
- Increase in weight
- Concentration difficulties
- Memory challenges
- A reduction in sexual drive
- Dryness of eyes, skin, and mouth
- Increased frequency in urination
- Tender or sore breasts
- Frequent headaches
- Increased heart rate
- A reduction in muscle mass
- Stiff or painful joints
- Thinning of hair or its loss
- Hair growth at an increased rate on the face, upper back, neck or chest
- Reduced fullness of the breasts
Why Menopause Occurs
As a woman's ovaries age, their hormone production reduces, causing the condition referred to as menopause. When the body starts to experience reduced levels of the following hormones, it begins to undergo changes. These hormones that reduce production include:
- Luteinizing hormone
- Follicle-stimulating hormones
One of the changes that are easily noticeable is when a woman loses the active ovarian follicles. These are structures responsible for the production and releasing of eggs, and in effect, allowing menstruation. Fertility also comes as a result of this.
The standard first sign of menopause is a reduction in the frequency and consistency of period. The flow sometimes becomes more and stays longer than usual. This mostly happens when one is in mid-forties, and by 52, many women have experienced menopause.
Menopause can also be induced or can begin as a result of surgical removal or injuries to the ovaries and other pelvic structures. Some of the reasons for induced menopause are:
- Having your ovaries removed, also known as bilateral oophorectomy
- When the function of the ovaries shuts down, also referred to as ovarian ablation, this may happen through hormone therapy, radiotherapy techniques, or surgery.
- Pelvic radiation
- When one sustains injuries to the pelvic, which significantly causes damages to the ovaries
When you are within the menopause age bracket and begin to experience symptoms, you need to discuss it with a doctor. Your doctor, after listening to the symptoms you are experiencing will recommend specific tests to establish if you are in menopause. One of the ways is through a blood test known as PicoAMH Elisa diagnostic test. This was approved by the FDA recently. It helps in determining if one has entered or is about to enter menopause.
Additionally, your doctor may ask you to take another test that measures the hormone levels of particular ones in the blood, mostly estrogen hormone known as estradiol and FSH. When the FSH blood levels are consistently elevated, and you are experiencing a lack of periods for a year running, this is usually a confirmation of menopause.
When one is at menopause, the estrogen and FSH levels fluctuate daily. Due to this, health providers can diagnose menopause in women.
Types of Hormone Replacement Therapies Available
Because of the various symptoms and needs, different therapies exist to help women through the menopausal period. These include:
Estrogen Therapy. This kind of treatment is suggested by doctors to be taken in low doses to women that have had a hysterectomy done. Hysterectomy is the surgical removal of the uterus for one reason or another. Some women that have had bilateral oophorectomy are also recommended to use this kind of therapy. Bilateral oophorectomy involves the removal of both the ovaries and the uterus in women. This therapy is popularly administered through the taking of a pill daily or a patch. The hormone is also applied by a gel, spray, or virginal ring.
Estrogen pill-taking of tablets is the most popular method of treating the symptoms of menopause. Pills come in many forms, including conjugated estrogens. These include pills like Estratab, Femtrace, Cenestin, Premarin, and Ogen. Another type of tablet is Estrogens/Bazedoxifene.
Regardless of the pill kind, your doctor will advise on the best one for you and how to take it. Following your doctor's advice is critical in ensuring you benefit from the treatment. Although most of these pills are commonly taken once each day, and without food, others have a complicated way of having them.
Your doctor will discuss the various forms of medicines, even those that have a combination of progestin and estrogen, and how they will benefit you. The doctor’s advice is critical in hormonal therapy treatment.
Estrogen patch. Typically, this patch is placed on your stomach. Based on the prescribed dosage, some patches need replacement after a few days, while some are worn for seven days. Some of these patches include Climara, Estraderm, or Alora. Examples of patches that combine both progestin and estrogen are combi patch or Climara Pro. Some patches have lower levels of estrogen and are only used in the prevention of osteoporosis but not other symptoms of menopause. Getting your doctor to discuss all the available options is critical in your treatment.
Topical estrogen. These are often found in sprays, creams, and gels as another way of having estrogen administered in your system. Gels include Divigell and Estrogel; creams include Estrasorb, while sprays are like Evamist. Just like when one uses patches, the estrogen treatment gets to your bloodstream through your skin. Your doctor will advise on the various ways to use these options and are also typically used once every day. For instance, if using Estrogel, you will be instructed to apply it from your wrist to your shoulder, while those using Estrasorb will apply it to their legs.
Vaginal estrogen. This comes as a virginal ring, tablets, or cream. These are generally used by women that suffer from virginal dryness, burning sensation, itchiness, or discomfort during intercourse. An example of a vaginal tablet is Vagifem; a cream is Premarin or Estrace and rings is Femring or Estring.
Each product comes with varying dosage instructions, with most rings requiring replacement after three months. The tablets are, in most cases, used daily for some weeks and after that two times in a week. On the other hand, creams are used daily for some weeks.
Progestin or Progesterone or Estrogen Hormone Therapy
This is referred to as combination therapy because it has both progestin and estrogen doses. This is for women that still have a uterus. Taking a combination of both progesterone and estrogen reduces the risk of getting endometrium cancer. Generally, progesterone is used in birth control, but it is useful in treating some menopause symptoms like hot flashes. This therapy is administered in various ways.
Oral progestins come in the form of a pill, such as medroxyprogesterone acetate, commonly referred to as Provera. There are also synthetic pills such as norgestrel or norethindrone. However, most experts prefer using natural progesterone to treat their patients rather than synthetic progestin. This is because it contains no adverse side effects and is an excellent option for persons with elevated cholesterol levels.
Intrauterine progestin. This method is not approved in America. It is, however, sold as low-dose intrauterine devices (IUD) with different brands such as Skyla or Mirena. If, as you get to premenopause, you have an IUD, your physician may advise you to retain it until the menopause period gets completed.
Is Hormone Replacement Therapy Suitable for Everyone?
While HRT is helpful to women going through menopause, it is not suitable for everyone. Before you start any treatment, visiting your doctor to discuss your options and any underlying health conditions is crucial. If you suffer or have suffered from any of the below situations, HRT is not recommended for you. These include:
- Cancer especially endometrial, uterine or breast cancer,
- If you have blood clots
- Liver or heart disease
- Have suffered a heart attack previously
- If you suspect or know you are pregnant
- If you have suffered a stroke
When you have suffered from any of these conditions, having hormonal therapy treatment is detrimental to your health. If you suffer from these conditions during your treatment, you must discontinue the medication immediately and inform your doctor.
HRT also comes with various side effects. This is important to know so that you safeguard your life. If you notice any of the following symptoms, it is imperative to schedule an appointment with your doctor. These are:
- Tenderness or swelling of the breasts
- Feeling nauseated
- Constant headaches
- Bleeding from the vagina and
- Sudden mood swings
However, these side effects can be avoided by ensuring you get the right hormone replacement therapy for you. This is only achievable through visiting and discussing the options with your experienced doctor.
Benefits of HRT in Women
There are various benefits of hormone therapy, and they partly depend on whether one takes low-dose vaginal preparations of estrogen or systemic hormone therapy.
Systemic hormone therapy
This comes as skin patches, pills, sprays, creams, or gels and is reputed as the most effective way to relieve some of the menopausal symptoms such as night sweats or hot flashes. Estrogen also helps to ease other symptoms such as having a dry vagina, itchiness, discomfort during sex, and the burning sensation.
A combination of progesterone and estrogen also reduces the risk of getting colon cancer and heart disease. As a person ages, they get exposed to the risk of having their bones thin. Taking systemic estrogen helps reduce the risk of osteoporosis in women, although doctors would recommend other medications for the condition.
Low-dose vaginal products
The hormones, in this case, are administered as tablets, a ring, or cream. They are useful in treating urinary symptoms and vaginal symptoms while reducing their absorption in the system. These dosages, however, offer no help when it comes to night sweats, hot flashes, or prevention of osteoporosis.
For women that still have their uterus intact, your doctor typically recommends progesterone and estrogen or progestin. This is because administering estrogen alone stimulates the growth of the uterine lining, enhancing the risk of developing uterine cancer. Balancing estrogen with progesterone, however, reduces these adverse effects. If you have surgically removed your uterus, progestin is not necessary for your treatment.
Risk Factors of Taking Hormone Therapy
Although taking hormonal therapy to fight against the symptoms of menopause is beneficial, it comes with certain risks. Taking of Prempro, which is a combination of progestin and estrogen has been known to increase the risk of developing the following conditions:
- Heart diseases
- Breast cancer
- Blood clots
The chances vary with age. For instance, women who start hormone therapy many years from when menopause sets in are at a higher risk. However, for women who begin treatment before 60 or ten years from the onset of menopause, the benefits are higher than the risks.
When deciding if hormone therapy is suitable for you, you must exhaustively discuss the risk factors with your physician. If you feel confident about the treatment, then you can start it, but only after you have the necessary information from an expert.
Who is Hormonal Therapy most Suitable for?
Despite the risks to one's health, systemic estrogen remains one effective treatment in women experiencing menopausal symptoms. When one is healthy, the benefits of hormonal therapy outweigh the risks one may get exposed to. Aside from being healthy, when you experience the following, then you qualify for hormonal replacement therapy. These are:
- When you begin to experience hot flashes, whether moderate or severe, as well as other symptoms of menopause.
- You have experienced a loss of bone density, and the different forms of treatment don't go well with you or are not beneficial
- When you stop having your menses before you are forty, which is the onset of premature menopause. Also, when you experience premature insufficiency of ovaries typically before you are forty.
If you have experienced early menopause, especially if you had your ovaries removed, you are at risk of the following conditions unless you take estrogen therapy before you are 45. These are:
- Risks of osteoporosis
- High chance of developing heart disease
- Suffer from an earlier death
- Developing symptoms similar to Parkinson's
- Getting depressed or anxious
For women experiencing premature menopause, the benefits of hormonal therapy outweigh the potential risks. Most of the dangers in hormonal therapy are associated with when menopause began, the kind of menopause, and your age. Speaking with your doctor about the risks is important because they differ in women.
Reducing the Risk of Hormone Therapy
While you are taking hormone therapy, some ways can help you reduce your risk of the adverse conditions. These are:
Determining the best products for you and how to use it
This is best established after discussing it with your doctor. Explain your symptoms and their intensity to enable the doctor to advise the best therapy for your type of menopause. You may take estrogen in any form that works for you. Either as a gel, pill, vaginal cream, patch, or a vaginal ring that slowly releases the hormone into your system. For some people, using a patch or a vaginal ring works better than a pill, while for others, it is the opposite.
Reduce the intake of medication
It is advisable to use the most effective dose in the lowest amount and for a short period when the symptoms need treatment. This is more crucial for women above 45 years, but those younger can take more. If older than 45, you need sufficient doses of estrogen to protect yourself from long term effects of its deficiency.
In case you experience prolonged symptoms of menopause that significantly affect your enjoyment of life, a more extended treatment may be recommended. The key to better and effective treatment lies in your discussing all your symptoms with your physician.
Schedule frequent follow-up appointments
Investing in your health is one of the best things one can do. Visiting your doctor frequently is essential in ensuring that you benefit from hormone therapy and avoid associated risks. The regular visits should include specific procedures necessary for your health. These include regular pelvic exams, mammograms, and screenings.
Make better and healthier choices
Your lifestyle choices determine how healthy you are and the quality of life you lead. Including physical exercise regularly, maintaining a healthy eating plan, ideal weight, avoiding smoking, reducing your alcohol intake, managing stress, and chronic conditions are critical to your health.
When a woman has not had a hysterectomy and is using systemic estrogen as hormonal therapy, she will also require progestin. Speaking to your doctor is critical in establishing the best way to administer it and maximize the benefits while reducing the risks.
Find a Gynecologist Near Me
Women’s health issues can be sensitive, especially those dealing with hormones. The changes in women due to menopause can cause discomfort in the majority of us. While most women seek ways of coping with menopause symptoms without getting a doctor's advice, expert advice from an experienced gynecologist is the best thing to do. Your doctor will evaluate your symptoms, explore various treatment options, and advise you on how to maintain proper health. If you are looking for a Los Angeles doctor with a specialization in women’s health, get in touch with All Women's Care at 213-250-9461.