Menopause: Hormones and Other Therapies
Sorting Out The Options

Date: 04/23/2000

What is menopause?

• Menopause is the time in a woman's life when menstruation stops. Menopause is usually a gradual process. The ovaries begin to produce lower amounts of hormones. The reduced amounts of hormones cause menstrual periods to become irregular and eventually to stop completely. This process of irregular menses and fluctuating hormone levels can take several months to 5 years and is often called "perimenopause" or "transition."
• Most women go through menopause between ages 45 and 60. In the U.S. the average age for menstrual periods to stop completely is 51. There may be a genetic link for the age of onset. Smoking lowers the age at which menopause begins.
• Menopause can also occur when the ovaries are surgically removed.
• The hormonal changes often cause other symptoms.

What are the symptoms?

• You may have both physical and psychological symptoms during menopause. Symptoms may occur for a few weeks, a few months, or sometimes over several years. Your symptoms may come and go, or they may occur regularly.
• These physical symptoms are common during menopause:
  • Irregular menstrual periods
  • Hot flashes- flushing of face and upper trunk; may occur with heart palpitations, dizziness, headaches
  • Night sweats
  • Disturbed sleep patterns- depression and irritability may result from insomnia
  • Vaginal dryness and shrinkage of genital tissues, sometimes resulting in discomfort or pain or bleeding during sexual intercourse, itching
  • Dry skin- facial hair growth and wrinkles
  • Cold hands and feet
  • More frequent urination, burning, or leakage of urine (urinary incontinence)
  • More frequent minor vaginal and urinary infections.
• Menopause usually occurs at a time in life when other dramatic changes take place. Some of these changes may include loss of parents, adjustment to children growing up and leaving home, becoming a grandparent, retirement, or career changes. These changes, in addition to the changes in your body, may result in psychological or emotional stress. Psychological symptoms of menopause may include:
  • Anxiety
  • Depression
  • Tearfulness, irritability
  • Sleeplessness
  • Less desire for sex
  • Lack of concentration
  • More trouble remembering things.
• Medical conditions that can results from menopause include
  • Osteoporosis-bone breaks become more likely
  • Coronary heart disease (CHD)-twice as many women die from CHD than cancer

How is it diagnosed and what tests can be ordered?

• Menopause can often be diagnosed through your medical history.
• A pelvic exam and Pap smear may show effects of decreased estrogen.
• Traditional blood tests to confirm menopause is an elevated LH or FSH.
• A few, but growing number of physicians, may order estrogen, progesterone, testosterone and DHEA levels in order to best individualize a women's hormone replacement therapy. This can be done by blood or saliva measurements. Some feel that saliva measurements better reflect tissue levels of hormones. Saliva hormone tests are very new and therefore not covered by some insurances.
• Furthermore, there is now available urine estrogen metabolite testing that can assess estrogen metabolite patterns that may put a woman at higher risk for breast cancer.
• There are advantages and disadvantages to each of these methods that can be discussed in more detail by your health care provider.

How is it treated?

• Menopause is a natural part of a woman's life cycle. It is not a disease and does not necessarily require any treatment. However, certain health problems, such as osteoporosis and increased heart disease, are associated with low estrogen. To help prevent such problems, many women choose to take estrogen to replace what their body is no longer producing. This treatment is called estrogen replacement therapy (ERT), or hormone replacement therapy (HRT).
• You and your health care provider should discuss the pros and cons of hormone replacement therapy for you. Factors such as your age, race, family history, and health history will be considered in the discussion. Hormone replacement therapy is effective for treatment for preventing and treating osteoporosis (loss of bone density). ERT also has heart protective effects and possibly brain protective effects. The benefits and risks (pros and cons) of HRT are discussed in detail later in this monograph.
• However, it is not the right treatment for every woman. Women who have had some types of breast cancer or other cancer, blood clots, or certain liver disease should not take estrogen.
• There are additional non-hormonal drug and non-drug therapies that can address the issues of menopause and will be discussed after hormone therapy is reviewed in detail.
• Before you read any further, it is important to emphasize the following aspects concerning hormone treatment for menopause. In our opinion, a women has the following options:
  
  
  • Standard prescription estrogens and progesterones, which are commonly prescribed by the majority of physicians. This includes both synthetic hormones and bio-identical hormones, which are the exact same molecular structure as a woman's own natural hormones.
  • Compounded "natural" estrogens and progesterone made from yam and soy. These are "bio-identical" hormones and usually must be obtained from a special "compounding pharmacy." However, "progesterone creams" are included here and are available at many health food stores.
  • Herbal (Phyto) hormones: Cohosh, Red Clover, Soy and others. These natural items contain natural compounds that act like hormones but do not contain the actual hormones.
  • No hormone treatment at all

Each of these hormone options has their own pluses and minuses, risks and benefits. The details of such discussion will be the topic of the rest of this monograph.