As you age, significant changes occur in your ovaries, where the estrogens and progesterone that help to control your menstrual cycle and help you achieve pregnancy are produced. Years before menopause, the ovaries start shrinking and the production of these hormones substantially decrease. As a result your periods may become irregular and infrequent until they stop completely. Twelve months of absence from your period is what we call “MENOPAUSE”. It will naturally happen between the ages of 45 and 54.
As the body adjusts to this new stage, many organs are negatively affected by the lack of hormones, like the bones and skin, vascular and nervous systems. A variety of symptoms will appear, differing in intensity and duration form person to person.
The most common symptoms are hot flashes-night sweats, vaginal dryness and sleep disturbances. Symptoms may last for several months or years, or persist.
To relieve the symptoms of menopause, doctors may prescribe hormone therapy. This can involve the use of either estrogen alone or with another hormone called progesterone, or progestin in its synthetic form. Whether hormone therapy can be safely used is a question difficult to answer, or at least without a single correct answer. A large amount of scientific evidence suggests that it depends on the personal risk and the potential benefits.
WHAT ARE THE ESTABLISHED BENEFITS?
•Relief of menopausal symptoms.
•P rotection against osteoporosis (and bone fractures).
• Treatment of vaginal atrophy.
In addition some other benefits reported that estrogen could prevent overall mortality, colon cancer, cerebrovascular disease, dementia, Parkinson and Alzheimer’s disease. And of course very importantly, may lessen fat redistribution, tooth loss and wrinkling.
WHAT ARE THE RISKS?
•If started after age 60 or after 10 years from menopause there is less overall benefit.
•Increased risk of blood clots and stroke.
•Higher risk of heart disease.
•Higher rate of breast cancer.
Based on the re-analysis of vast data, the North American and the International Menopause Societies concurred that the risk-benefit ratio is in favor of prescribing hormone therapy. Recommending starting HT before age 60 or within 10 years of menopause, minimizing the dose and favoring non-oral preparations, in patients with no contraindications.
Estrogen is an FDA- approved treatment for the established benefits mentioned above. The replacement presentations are multiple (cream, gel, mist, vaginal rings, oral forms). These products are available with only estrogen, or in combination with progesterone and/or testosterone.
“Natural” personalized formulas to satisfy particular patient needs are offered by compounding pharmacies without evidence of added benefits over FDA-approved prescriptions and if used should be monitored closely because doses can vary among pharmacies.
If you are in this transition time and are interested in HT you can visit us for a risk-benefit assessment.