Menopause is the time at which a woman has not had a period for one year. This is due a decline in ovarian production of estrogen leading to low blood estrogen levels. The average age of menopause is between 51-52 years. The period of time leading up to the cessation of menses is referred to as perimenopause and can last for several years. Perimenopause can be challenging for women who experience hot flashes, irregular, unpredictable, and prolonged bleeding, or vaginal dryness. These symptoms are similar to the symptoms women in menopause face. Both women in menopause and perimenopause can experience relief with hormone replacement therapy.
Following a major study, popular views on hormone replacement therapy changed leading to the present climate where hormones are only advocated for symptom control for the shortest period of time possible. Prior to that study hormone replacement therapy was thought to contribute significantly to cardiovascular health and actively used for the prevention of heart attacks. Other benefits of hormone replacement therapy include maintenance of bone health. While these benefits are may not be perceived, the benefit of the treatment of symptoms of menopause which can include hot flashes, vaginal dryness, mood changes, insomnia, and mental clarity is known. Still the official recommendation concerning hormone replacement therapy is that it is to be used for the shortest duration possible.
Of note, re-evaluation of data from the Women’s Health initiative demonstrated a cardioprotective (heart protection) benefit to women in their 50’s on hormone replacement therapy. This recalls the memory of hormones being used for the prevention cardiovascular disease. Officially, hormones are not indicated for the prevention of cardiovascular disease.
Options for hormone replacement therapy are wide and varied. The variety isn’t just the many forms of hormone replacement, but also the different routes. Now there is availability of hormones which can be administered: orally in pill form; through the skin via gel, lotion, spray, or patch; vaginally; and via injections. Individual evaluation with a physician is necessary to determine which of these options is best.
An exciting new avenue of hormone replacement is that of bio-identical hormone therapy. In using bio-identical hormone therapy, medication is dosed individually so that the hormone therapy is specifically tailored for the individual. The hormone dosage can then be adjusted as necessary based on the patient’s desires and symptoms – still in a dose that is specifically designed for the individual. This is a very useful tool in women who do not respond to traditionally mass produced hormone replacement therapy and can be very effective in the complete treatment of symptoms associated with menopause which may range from hot flahses to decreased libido.
In our office we work with a compounding pharmacy to provide this service to patients who are interested in plant derived, bio-identical hormone replacement and women who do not respond to manufactured hormone replacement therapy regimens.
If you would like to learn more about menopause and hormone replacement therapy options, I encourage you to visit the website http://www.knowmenopause.com/. It is an excellent and thorough resource for women seeking more information about menopause.