Published: Aug 19, 2008 06:00 PM
Modified: Aug 19, 2008 06:00 PM
Menopause is defined as the stage in a woman's life when she stops menstruating. It is a natural part of a woman's life cycle. The average age of menopause is 51 years old. Ninety-five percent of women will enter menopause between the ages of 45-55.
In addition to stopping menstruation, many women experience symptoms such as hot flashes, vaginal dryness, urinary symptoms, mood swings, painful intercourse, and sleep problems during their transition into menopause.
For some women, these symptoms are quite mild and cause little inconvenience or disturbance of their daily activities. For other women, these symptoms can cause significant discomfort and disruption of their daily lives.
Estrogen is the most effective treatment to alleviate the symptoms associated with menopause. It is often administered in combination with progesterone to prevent the estrogen from over-stimulating the uterine lining that, over time, can lead to pre-cancerous or cancerous changes.
The North American Menopause Society and the American College of Obstetricians and Gynecologists both counsel that women who are good candidates for hormone therapy should stay on it for the shortest time possible depending upon symptoms. A period of five years or less is a safe and reasonable option for women who are experiencing bothersome or debilitating menopause related symptoms.
Not all women are candidates for hormone therapy. A study called the Women's Health Initiative was released in 2002. This study suggested that women who had been in menopause for several years and were then exposed to estrogen and progesterone were at an increased risk of developing heart attacks, strokes, blood clots in large blood vessels, known as a deep vein thrombosis (DVT), and breast cancer.
Women who have been in menopause for several years should not be started on hormones. It is reasonable for women who are actively going through the transition into menopause to start hormone therapy to help with their symptoms.
A woman who still has her uterus should not receive estrogen alone without some sort of progestin to protect the uterine lining. Women should not take hormone therapy if they smoke or have a personal history of, or are at high risk of developing, the following conditions: breast cancer, stroke, coronary heart disease, DVT, or a blood clot in the lungs, known as a pulmonary embolism (PE). Women with unexplained or abnormal vaginal bleeding are not candidates for hormone therapy until the source of the bleeding can be investigated.
Hormone therapy can be delivered to the body via two main routes: ingestion of a pill or absorption through the skin or vagina. Topical preparations vary from transdermal patches that can be changed 2-3 times a week, estrogen preparations that are rubbed into the skin on a daily basis, or a vaginal ring that is used for three months at a time. In addition, there are vaginal preparations of estrogen that can be used for local treatment of vaginal dryness and other associated urinary symptoms. The dose, method and delivery system of hormone therapy is different for everybody and should be decided upon only after a conversation with your healthcare provider.
Like all medications, hormone therapy has the potential for interaction with other medications, herbs and supplements, so always be sure to tell your healthcare provider about any of these that you are taking.
The use of hormone therapy can help protect a woman against developing colon cancer and osteoporosis. Hormone therapy can potentially increase a woman's risk of breast cancer, blood clots in the legs, coronary heart disease and stroke.
Confining the use of hormone therapy to women who have just entered menopause and limiting hormone therapy to less than five years can help to reduce these risks. Hormone therapy affects the lining of the uterus and this can result in unanticipated vaginal bleeding. While often benign, your healthcare provider may want to evaluate the lining of the uterus with a biopsy to make sure you have not developed an overgrowth of the uterine lining.
Many different types of treatments have been suggested to help women cope with and manage the symptoms associated with menopause.
The first step is increased attention to diet and exercise. Certain anti-depressant medications can sometimes help with hot flashes. Simple lubricants can offer some relief with vaginal dryness. In addition, there are many herbal supplements and vitamins that have been advocated as therapies. For some women, these non-hormonal methods of treatment are sufficient to help them manage their symptoms.
If you are interested in learning more about these therapies, I suggest you begin your search at the National Center for Complementary and Alternative Medicine (< HREF="http://nccam.nih.gov/" TARGET="_blank">nccam.nih.gov/).
For the right woman whose life is altered by the severity of menopausal symptoms, hormone therapy can provide substantial relief of menopausal symptoms. As with all medication, the decision to start hormone therapy should be made in conjunction with your healthcare provider after an appropriate history and physical exam and a thorough discussion of benefits and risks.
Michael Evers is assistant professor of women's primary health in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill.