Menopause

What is perimenopause?

Perimenopause is the gradual transition between the reproductive years and menopause. It is generally a transition that is many years long and can be associated with irregular menses, shorter menstrual intervals, and other symptoms. Symptoms in some women may be troublesome enough to require medical intervention.

What is premature menopause?

Whether natural or induced, premature menopause happens at age 40 or younger. This occurs in only about 1% of women in the United States. Premature menopause that isn’t induced can be autoimmune, genetic, metabolic, or result of other poorly understood conditions. Premature menopause should be evaluated thoroughly.

What is menopause?

It is not a disease. Menopause is a natural, normal event that is defined as the final menstrual period and is usually confirmed when a woman has missed periods for 12 consecutive months (absent other causes). Menopause can be associated with reduced functioning of the ovaries due to aging, resulting in lower hormone levels including estrogen. This marks the end of fertility. Menopause, on average, occurs around age 51. Most women will experience this between 45-55 years old.

What are hot flashes?

One of the most common menopause-related discomforts is the hot flash, also known as hot flush. While their cause isn’t fully understood, hot flashes are thought to be the result of changes in the hypothalamus. The hypothalamus is the part of the brain that regulates the body’s temperature. If the hypothalamus incorrectly senses that a woman is too warm it starts a series of events to cool her off. Blood vessels near the skin’s surface begin to enlarge which increases blood flow to the surface in an attempt to disperse body heat. This produces a red, flushed look to the face and neck in lighter complexioned women. This may also cause a woman to perspire to cool the body down. Heart rate may also increase, and women may sense the sped-up heartbeat. Often a cold chill follows the hot flash and some women will only feel the chill.

What is hormone therapy?

Hormone therapies are the prescription drugs used most often to treat hot flashes and genitourinary syndrome of menopause (GSM), which includes vaginal dryness, after menopause. For hot flashes, hormones are given in pills, patches, sprays, gels, or a vaginal ring that deliver hormones throughout the body—known as “systemic” therapy. For genitourinary symptoms, hormones are given in creams, pills, or rings that are inserted into the vagina. (An approved pill is also available to treat genitourinary symptoms that is not considered a hormone but does affect estrogen receptors, mostly in and around the vagina.)

Systemic hormones include estrogens—either the same or similar to the estrogens the body produces naturally—and progestogens, which include progesterone—the progestogen the body produces naturally—or a similar compound. Another approach to systemic hormone therapy is a pill that combines conjugated estrogens (those in the brand Premarin) and a compound known as a “SERM” (selective estrogen receptor modulator) that protects the uterus but is not a progestogen. Women who have had a hysterectomy (had their uterus or womb removed) can use estrogen alone to control their hot flashes. Women who still have a uterus or womb need to take a progestogen in addition to estrogen or the estrogen-SERM combination to protect against uterine cancer. Systemic hormones are very effective for hot flashes and have other benefits, such as protecting your bones. They also carry risks, such as blood clots and breast cancer. The breast cancer risk usually doesn’t rise until after about 5 years with estrogen-progestogen therapy or after 7 years with estrogen alone.

Vaginal estrogen therapy for GSM after menopause is administered in the vagina and is effective for both moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower.

You should discuss your individual risks and preferences with your healthcare team to determine whether hormone therapy or alternatives, including FDA-approved nonhormonal therapies, are right for you.

What are bioidentical hormones?

This term began as a marketing term for custom-compounded hormones. It is taken to mean hormones that have the same molecular and chemical structure as hormones produced by the body. Bioidentical hormones don’t necessarily need to be custom-compounded (meaning custom mixed). There are many well-tested, FDA-approved hormone therapy products that meet this definition and are commercially available in a variety of doses that can be customized by your doctor for your specific therapy needs. Custom-compounded hormones are not safer or more effective than approved bioidentical hormones. They are not tested for safety and effectiveness or to prove that the active ingredients are absorbed properly or provide predictable levels in blood and tissue. In fact, they may not even contain the prescribed amount of hormones which can be dangerous. For example, when progesterone levels are too low, you are not protected against endometrial (uterine) cancer. When estrogen levels are too high there can be risk of endometrial cancer and possibly breast cancer.

Joint pain

Osteoarthritis, the most common degenerative joint disease, is a predominant aging disease. Most often weight-bearing joints are affected, such as knees, hips, and feet. Apart from aging, risk factors include obesity, joint injury, and overuse. While there is no current way to prevent or cure osteoarthritis, maintaining a healthy weight and exercising to strengthen muscles has been shown provide pain relief. There are many over-the-counter and prescription options available to alleviate pain. Rheumatoid arthritis, a more serious autoimmune disease of the joints, should be ruled out before treatment.

Thinning hair

Common forms of hair loss after menopause are shedding and “female pattern hair loss.” This typically starts with a widening center hair part, and the hair loss is mainly near the top and crown of a woman’s head. Shedding typically resolves on its own within 6 months. While female pattern hair loss during this time is not well understood, a change in the balance between estrogen and androgens (male hormones) can be a cause.

Itchy or teary eyes

After menopause, some women can have chronic dry and scratchy eyes frequently alongside light sensitivity, swollen or red eyelids, or blurred vision. This is called chronic dry eye. Tearing can also be a symptom due to the eye producing more watery tears to compensate, though these tears will not lubricate the eyes the same way as healthy tears. There may be over-the-counter or prescription therapies to help provide relief.

Heart disease

Cardiovascular disease is the leading killer of women in North America. After age 55, more than half of all sudden deaths in women are caused by cardiovascular disease. Risks for this disease go up after menopause.

Osteoporosis

This is a loss of bone strength that can raise vulnerability to broken bones. Women start losing bone in their 30s, but this process speeds up after menopause. Osteoporosis is called “silent,” as you may not know you have it until after a bone fracture. Bone density testing is usually recommended for women at age 65. If younger than 65 and have what’s referred to as a “fragility fracture,” or a fracture caused by weakened bones, this indicates that you have osteoporosis.