General Recommendations For Ht
Current guidelines support the use of HT for the treatment of severe hot flashes that do not respond to non-hormonal therapies. General recommendations include:
- HT may be started in women who have recently entered menopause.
- HT should not be used in women who have started menopause many years ago.
- Women should not take HT if they have risks for stroke, heart disease, blood clots, and breast cancer.
- Currently, there is no consensus on how long HT should be used or at what age it should be discontinued. Treatment should be individualized for a woman’s specific health profile.
- HT should be used only for menopause symptom management, not for chronic disease prevention.
Before starting HT, your doctor should give you a comprehensive physical exam and take your medical history to evaluate your risks for:
- Heart disease
- Breast cancer
While taking HT, you should have regular mammograms and pelvic exams and Pap smears. Current guidelines recommend that if HT is needed, it should be initiated around the time of menopause. Studies indicate that the risk of serious side effects is lower for women who use HT while in their 50s. Women who start HT past the age of 60 appear to have a higher risk for side effects such as heart attack, stroke, blood clots, or breast cancer. HT should be used with care in this age group.
Women who should not take hormone therapy include those with the following conditions:
What Are The Health Risks For Smokers Who Use Birth Control
If you smoke and are 35 or older, you should not use hormonal birth control. Smoking tobacco and using hormonal birth control raises your risk for blood clots and high blood pressure. Smoking and high blood pressure are risk factors for a or . The risk for a heart attack or stroke also goes up as you age.
Whats The Medical Definition Of Poi
Primary Ovarian Insufficiency is the loss of eggs in the ovaries or abnormal function of the ovaries, so that periods and the entire menstrual cycle cease for large stretches of time or permanently before the age of 40, explains Dr. Shaun Samples, an OB-GYN in Nashville, TN. Its more common to experience POI in ones 30s than during ones 20s or adolescent years.
Heres how this works: Were born with approximately one million eggs. During our cycle, several ovarian follicles develop. During ovulation, just one of these follicles releases an egg. From there, the egg either gets fertilized by sperm or flushed out during menstruation.
What about those other developed follicles? They die off. So, you lose follicles as well as the eggs inside them each month. With POI, theres an insufficient amount of follicles to develop and eventually release an egg. Its therefore common to experience an absent or infrequent period and even infertility.
If youve ever heard of Premature Ovarian Failure , it refers to the same condition as POI. However, POI is now the preferred and accepted term. According to Dr. Millheiser, this is because spontaneous ovulation and pregnancy can occur for those with POI, but rarely. The ovaries arent technically a failure, but are rather insufficient. Dr. Millheiser adds that this is also why POI is different from premature menopause and menopause, which indicate an end to fertility and ovarian function.
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Birth Control And Menopause Which One Is Appropriate For You
So what forms of contraception are suitable for older women, especially those having wild hormone swings?
If you take some form of birth control pill, it might be fine to continue with that for quite a few more years if it suits you.
Thats if youve even noticed any symptoms the oral contraceptive pill can mask many signs of perimenopause including irregular periods, heavy periods and hot flashes.
Some doctors may suggest a very low dose pill containing less estrogen than regular contraceptive pills. As well as helping with perimenopause symptoms, modern oral contraceptives can protect against ovarian and uterine cancer. They can also guard against loss of bone density which can lead to osteoporosis.
However, like all birth control pills, women should always consult a doctor before starting them.
Contraceptive injections and implants can be safely used up to the age of 50, although anyone with implants or at risk for developing osteoporosis might want to consider a different form of birth control.
The intrauterine system can be a good choice for women in their 40s experiencing very heavy periods.
The progesterone element of the intrauterine system acts as hormone replacement therapy. You can keep it in for between 4-7 years. Chat with your OBGYN for more information about whether it might suit you.
The intrauterine system is not to be confused with the IUD which does not release progesterone.
Are There Side Effects Of Birth Control Pills
There are side effects of birth control pills, although most are not serious. Side effects include:
- Eye problems
- Swelling or aching in the legs and thighs
Birth control pills that have drospirenone, including Yaz and Yasmin, have been investigated by the FDA because of the possibility that they cause a higher risk for blood clots. Drospirenone is a human-made version of the hormone progesterone. Other brands with drospirenone include Beyaz, Gianvi, Loryna, Ocella, Safyral, Syeda, and Zarah.
The results of the investigation are inconsistent. Some studies showed a higher risk, but others didnât. The drugs are still available. A summary of the findings is on the packaging label. If youâre taking a pill with drospirenone, talk with your doctor about your risk.
The pill is not linked with an overall increased risk of cancer. Its use was tied to a lower risk of colorectal, endometrial, and ovarian cancers. A higher risk of breast and cervical cancers was seen in current and recent birth control pill users, but the risk went away within 5 years.
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Ovarian And Endometrial Cancer Prevention
As a result of reports that have appeared in the lay press over the past few years, ovarian cancer is a significant fear among perimenopausal and postmenopausal women, even though its actual incidence is very low. Unfortunately, no proven screening test for ovarian cancer exists, and neither CA-125 screening nor periodic pelvic ultrasound examinations have been especially helpful. Recent studies have indicated that the risk of developing ovarian cancer is reduced in women who have used oral contraceptives compared with women who have never used them.8 The largest investigation to date, the Cancer and Steroid Hormone Study , showed a decrease averaging 40 percent in the development of ovarian cancer in women who had taken oral contraceptives.9 A protective effect has been observed with as little as three to six months of oral contraceptive use, with further decreases in risk seen with longer periods of use. For example, use of oral contraceptives for seven years or longer confers about a 60 to 80 percent reduction in the risk of developing ovarian cancer.8
How Is Poi Diagnosed
Diagnosis of POI involves comprehensive medical history taking, including:
- Menstrual cycle
Your doctor may recommend one or more of the following tests depending on your history:
- Pregnancy test
- Follicle -stimulating hormone test. Abnormally high levels of FSH can suggest POI- which means that the growth of follicles in the ovaries is absent at that time it is checked.
- Estradiol test. Lower levels of estrogen suggest POI- which means that ovarian function is absent.
- Prolactin test. High levels of prolactin can lead to problems with ovulation.
- Karyotype test. This test examines your 46 chromosomes for abnormalities.
- FMR1 gene testing. The FMR1 gene is the gene associated with Fragile X Syndrome- an inherited disorder that could cause intellectual problems.
- Pico Anti-Mullerian Hormone Elisa test. This test helps to determine a womans menopausal status and ovarian reserve.
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Do Hormones Play A Role
You know it. Dr. James Wang, a Naturopathic Doctor , adds that with POI, A patients ovaries produce insufficient amount of estradiol, a hormone that helps follicles develop and eggs release. While estrogen levels tend to be low for those with POI, follicle-stimulating hormone levels are usually high, according to the Mayo Clinic. As you may have guessed, FSH stimulates the growth of ovarian follicles. While you might expect FSH levels to be low for POI, think of it this way: The body is having to work extremely hard to stimulate follicles , which results in high levels of FSH.
The Mayo Clinic adds that high levels of prolactin the hormone that encourages breast milk production are also typical in those with POI. Irregular or absent menstruation and issues with ovulation are often associated with high prolactin levels. This is similar to new mothers who are breastfeeding, which can cause similar menopause-like symptoms.
To summarize: Not only is there a lack of follicles to develop and release an egg, but theres also imbalanced levels of fuel to help the ovaries do so.
Bleeding If You’re On The Pill
If you’re taking the combined pill, you’ll have monthly period-type bleeds for as long as you keep taking the pill.
If you’re taking the progestogen-only pill, your bleeds may be irregular or stop altogether for as long as you keep taking the pill.
The combined pill may also mask or control menopausal symptoms, such as hot flushes and night sweats.
These factors can make it hard to know when you’re no longer ovulating and therefore no longer fertile.
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Can Birth Control Pills Cause Menopause Symptoms
Some of the symptoms of menopause, such as irregular periods, hot flashes, or night sweats, may be hidden by hormonal birth control. In the case of combination pills , even after menopause, you may bleed similarly to how you would during your period if you take them.
What Are Oral Contraceptives
Oral contraceptives are hormone-containing medications that are taken by mouth to prevent pregnancy. They prevent pregnancy by inhibiting ovulation and also by preventing sperm from penetrating through the cervix.
By far the most commonly prescribed type of oral contraceptive in the United States contains synthetic versions of the natural female hormones estrogen and progesterone. This type of birth control pill is often called a combined oral contraceptive. Another type of oral contraceptive, sometimes called the mini pill, contains only progestin, which is a man-made version of progesterone.
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Symptoms Of The Endometrial Hyperplasia In Menopause
In the period of menopause, endometrial hyperplasia can pass asymptomatically.
The main symptoms of endometrial hyperplasia in menopause are â proliferation of the endometrium more than 5 mm in height and an increase in the body of the uterus. During menopause, any uterine bleeding or spotting from the vagina, regardless of their volume , duration and frequency should be perceived as an alarm and a possible symptom of a malignant process.
Common comorbid symptoms include rapid fatigue, weakness, lethargy, frequent headaches, hypertension, disability. When the process is maligned, a sharp decrease in weight is possible.
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Side Effects Of Hormonal Contraceptives
The first hormonal pill was approved in the 1960s. Since then, oral contraception has been popular worldwide due to its relative ease of taking.
However, in addition to preventing a young womans normal accumulation of peak bone mass, hormonal contraceptives have demonstrated the following side-effects:
- Low libido
- Skin problems (including melasma , acne, eczema, urticaria
- Hirsutism .
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What Are The Symptoms Of Perimenopause
Although menopause is a normal, healthy part of life for individuals with a uterus, it typically entails symptoms that can become unpleasant. Some individuals may not notice any significant changes, but many will likely experience one or more of the following:
- Hot flashes and night sweats = a sudden feeling of warmth that spreads over the body
- Breakthrough bleeding and spotting = bleeding when not on your period
- Irregular periods = inconsistent timing and heaviness of periods
- Headaches and/or migraines = pain that occurs in one or more regions of your head
- Mood swings = intense and sudden changes in mood
- Insomnia = persistent difficulty falling or staying asleep
- Urine urgency and/or leakage = constantly feeling the need to go pee
- Vaginal dryness = lack of lubrication in the vagina
- Acne = blemishes that pop up on the skin
- Fatigue = feeling more tired than usual
- Breast tenderness = sore and/or swollen breasts
- Lower sex drive = lack of desire to have sex and/or pain during sex
Sometimes, the symptoms of perimenopause can cause significant problems in day-to-day functioning. Fortunately, there are various treatments that can be implemented to help provide some relief.
Benefits Of Hormonal Contraceptives
For some women, continuing with the same method they’ve always used may be a reasonable option. It may even offer health benefits.
In the past, it was commonly believed that birth control options for women over 40 were limited to non-hormonal methods such as condoms, diaphragms, and even tubal ligation. Those views have changed considerably.
Today, research has shown that the benefits of oral contraceptives outweigh the risks and that combination birth control pills are safe for most healthy women over 40.
In addition to preventing pregnancy, oral contraceptives can help:
- Reduce irregular bleeding during perimenopause
- Control hot flashes and other symptoms of perimenopause
- Reduce the risk of hip fracture in older women
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Oral Contraceptives And Stroke
Although it is known that oral contraceptive use increases the risk of venous thromboembolism, epidemiologic data on the possible association between oral contraceptives and the risk of stroke are now available.12 No substantial risk of ischemic or hemorrhagic stroke was found with use of low-dose oral contraceptives in healthy young women. In addition, no increased risk of stroke was reported in healthy nonsmoking women, regardless of age. Effective screening for smoking and untreated hypertension in perimenopausal women can limit, if not eliminate, the risk of arterial diseases associated with the use of low-dose oral contraceptives.
Calcium And Vitamin D
A combination of calcium and vitamin D can reduce the risk of osteoporosis, the bone loss associated with menopause. The best sources are from calcium-rich and vitamin D-fortified foods.
Doctors are currently reconsidering the use of calcium and vitamin D supplements. The U.S. Preventive Services Task Force advises that healthy postmenopausal women don’t need to take these supplements. According to the USPSTF, taking daily low-dose amounts of vitamin D supplements , with or without calcium supplements , does not prevent fractures. For higher doses, the USPSTF says there is not enough evidence to make a recommendation. In addition to possible lack of benefit, these supplements are associated with certain risks, like kidney stones.
However, calcium and vitamin D are important nutrients. Supplements may be appropriate for certain people including those who do not get enough vitamin D through sunlight exposure and those who do not consume enough calcium in their diet. They are also helpful for people who have been diagnosed with osteoporosis. Talk with your doctor about whether or not you should take supplements.
The National Osteoporosis Foundation recommends:
Vitamin D is necessary for the absorption of calcium in the stomach and gastrointestinal tract and is the essential companion to calcium in maintaining strong bones.
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When Should Women Not Take Birth Control Pills For Perimenopause
While hormonal birth control can be extremely beneficial, it can increase the risk of blood clots in some individuals with a uterus. More specifically, it is recommended that those with a history of blood disorders, heart disease, and/or cancer stop taking hormonal contraceptives as they enter their late forties. This also applies to individuals who smoke.
Instead of using high-dose hormonal birth control to alleviate the symptoms of perimenopause, individuals with a uterus can try hormone therapies or low-dose birth control pills. With that said, there are pros and cons to these methods, so individuals should consult a doctor in order to determine the best path for their lifestyle.
Making An Informed Decision
Armed with this new information, I decided to dig a little deeper. I put in a call to Draion Burch, DO, OB-GYN clinical assistant professor in the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine.
FAST FACT: 14% of pill users take the pill exclusively for non-contraceptive purposes, and 58% take it in part for reasons other than contraception. Among the latter group, the most common reason was to reduce cramps or menstrual pain.
Dr. Drai began by outlining some of the common short-term side effects of the pill: bloating, nausea, breast tenderness, and breakthrough bleeding. I was lucky never to have suffered any of those side effects. We then moved on to discuss more serious, long-term side effects like the risk of blood clots for women over 35, which he confirmed is true and is even more significant for women who smoke or who are overweight.
Since arrhythmias are linked to blood clots and have a strong genetic component, I asked Dr. Drai if this should factor into my decision about the pill. He said that at this point despite my family history I am at no greater risk of developing blood clots than anyone else over 40. But, he cautioned, if Im ever diagnosed with any type of heart condition, including arrhythmia, I should stop taking birth control pills right away.
- I now take the pill at night so it metabolizes while Im sleeping.
- I down it with a large glass of water.
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