Many changes happen to a woman's body during menopause. Unfortunately, as a result of the news media reporting on what sells, there is much disinformation floating around, rather than an in-depth discussion of these important issues. The ultimate goal of most women is to have a long life, while remaining healthy and active. There are many issues that a woman should understand in order to obtain these goals. The answer as to what is right, including estrogen replacement, is very individual, and varies for each woman. These decisions should be well informed and in line with a given patient's needs and beliefs.
Is This Menopause?
Menopause is the permanent end of the menstrual cycle and fertility, and is a normal natural event. But the physical signs of menopause begin many years before the final menstruation. In North America most women experience natural menopause between the ages of 40 and 58, with the average about 51. Some women may have permanently induced menopause by the surgical removal of both ovaries, or as a side effect of treatments used in cancer therapy, which may occur at any age. Vaginal dryness and vasomotor symptoms (hot flashes) are the most consistently associated symptoms with the menopause transition.
Perimenopause is the time period (years) prior to menopause (the end of menstrual periods) when hormone production fluctuates, resulting in episodic symptoms and often irregular periods. The most common symptoms of menopause or perimenopause include:
- Hot Flashes
- Vaginal dryness
- Mood Swings
- Insomnia (from hot flashes)
- Irritability
Should I take hormones after menopause?
What you choose should be based upon your health and personal history, as well as your symptoms, lifestyle concerns, and a discussion with your health care provider about the pros and cons. Many women choose hormone replacement therapy to control symptoms related to the erratic hormone changes. Estrogen, either balanced with progesterone or alone, is the most consistently effective therapy for hot flashes and vaginal dryness. Not all women are convinced that the benefits of hormone therapy outweigh the risks.
Current evidence supports the use of estrogen therapy and estrogen/progesterone therapy for menopause-related symptoms and disease prevention in appropriate populations. At present, recommendations by the American College of Obstetrics and Gynecology and North American Menopause Society are that should hormones be prescribed for menopausal-related symptoms, they should be used for the shortest time possible, at the lowest-possible dosage.
The Women's Health Initiative (WHI) Study
This was the largest scientific research trial ever conducted using the most widely prescribed hormone therapy at the time: Premarin a conjugated estrogen (estrogen only – ET group) and Prempro, conjugated estrogen with synthetic progesterone (estrogen and progesterone – EPT group). Neither one of these estrogens is bio-identical. The initial purpose of this study was an inquiry as to whether estrogen with or without progesterone had a cardiovascular benefit in post-menopausal women. The participants were in good health with an average age of 63. Two groups were studied: (1) those with a uterus received estrogen only (ET group), and (2) those without a uterus (who had had a hysterectomy) received estrogen and progesterone (EPT group). The EPT group study was stopped in 2002, when it was discovered there was a small increased risk of breast cancer, blood clots and stroke. The estrogen-only (ET) group was discontinued in 2004 because of an increased risk of stroke. Neither group showed reductions in coronary heart disease risk, which was the main purpose of the study. Both groups were found to reduce the risk of fractures from osteoporosis, while the EPT group also had a reduced colon cancer risk.
Bioidentical Hormones
When scientist and healthcare providers refer to "bioidentical hormones," they are usually referring to products that are chemically identical to those produced by a women's ovaries, including the natural estrogens estrodiol, estrone and progesterone. Some of these are available in FDA-approved products. Many of the topical estrogen hormones in the form of patches or gels are bioidentical hormones, in that they are estradiol and exactly the same as the estrogen hormone produced by the ovary. Bioidentical hormones are also available as custom-compounded formulations, sometimes referred to as BHT, or bioidentical hormone therapy.
Alternative Therapy for Menopause Symptoms
The German E Commission (The German regulatory agency for herbs) has shown that Black Cohosh is effective in reducing hot flashes.
According to the Agency for Healthcare Research and Quality, after a review of 192 randomized controlled trials they concluded the following: Trials of soy isoflavones and other complementary and alternative medicine therapies reported benefits in improving nonvasomotor symptoms, but studies have been small and there are varying results.
If needed, other prescription medications can be considered; some studies show that they may be helpful. These include prescription medications such as the antidepressant paroxetine, a medication used in epilepsy and pain management; gabapentin, and natural phytoestrogens. Some women also may benefit from neurotransmitter support and homeopathic treatment. A multi-disciplinary approach can help to maximize symptom relief while minimizing side effects.
Preventative Care
Until midlife, women may not think much about preventative care. But as they enter a more mature phase and face the aging process, their end becomes more real. Around 45 million American women will be entering menopause in the next decade, and the desire for quality of life will become more important. For these women, issues surrounding memory loss, loss of muscle tone, and slower physical and mental response times may become more of a concern.
Exercise, lifestyle, diet and stress management may be taken more seriously, as they are known to decrease the two main causes of mortality in this age group: cancer and heart disease. As risk for disease increases with age, every woman is at risk for developing a gynecologic cancer. It is estimated that there were about 78,000 new cases diagnosed and approximately 28,000 deaths of gynecologic cancers in the United States during 2007. Still, cardiovascular disease remains the leading killer of women who die suddenly with no previously recognized symptoms.
Standard Recommended Screening for the following conditions during menopause include:
- Osteoporosis
- Heart Disease
- Breast Cancer
- Colon Cancer
- Thyroid Disease
- Gallbladder Disease
- Cervical Cancer
- Uterine Cancer
A Proactive Comprehensive Approach to Menopause
Going through menopause is a significant life event. At menopause every woman will be faced with many health care decisions. At Vital Health Institute, we believe that a woman should take the time to consult, discuss and become educated about the issues relating to menopause. Only then can she make informed health care decisions that are philosophically right for her.
At Vital Health Institute, our philosophy is proactive, holistic and individualized. Other preventative and more holistic evaluations may include skin assessment, check of vitamin D levels, weight management, body mass index and waist circumference, detailed blood sugar levels, inflammatory markers, and transvaginal ultrasound of the pelvis. These are often integrated in the menopausal women's yearly evaluation at Vital Health.
As new information becomes available, we stay current on the latest treatments and recommendations. As professional members of the North American Menopause Society we receive monthly updates and are first to know regarding latest studies and recommendations. Linda Mavity, one of our nurse practitioners, is qualified for national certification by the North American Menopause Society.
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