Hormone Treatment And Therapy
Estrogen and progesterone therapy
Hormone therapy , or menopausal hormone therapy , consists of estrogens or a combination of estrogens and progesterone . This was formerly referred to as hormone replacement therapy . Hormone therapy controls the symptoms of menopause-related to declining estrogen levels , and HT is still the most effective way to treat these symptoms. But long-term studies of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. These risks were most pronounced in women over 60 taking hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer in postmenopausal women who have not had their uterus surgically removed.
Hormone therapy is available in oral , transdermal forms . Transdermal hormone products are already in their active form without the need for “first pass” metabolism in the liver to be converted to an active form. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women.
Causes Of Early Menopause
Early menopause can happen if your ovaries stop making enough hormones, particularly oestrogen.
This is sometimes called premature ovarian failure or primary ovarian insufficiency.
The cause is often unknown, but can include:
- chromosome abnormalities, such as Turner syndrome
- autoimmune diseases, where the immune system starts attacking body tissues
- certain infections, such as tuberculosis, malaria and mumps in rare cases
Premature ovarian failure can sometimes run in families. This may be the case if a relative went through the menopause in their 20s or 30s.
How Does Menopause Affect My Bladder Control
Unfortunately, bladder control issues are common for people going through menopause. There are several reasons why this happens, including:
- Estrogen. This hormone plays several roles in your body. It not only controls your period and promotes changes in your body during pregnancy, estrogen also keeps the lining of your bladder and urethra healthy.
- Pelvic floor muscles. They support the organs in your pelvis your bladder and uterus. Throughout your life, these muscles can weaken. This can happen during pregnancy, childbirth and from weight gain. When the muscles weaken, you can experience urinary incontinence .
Specific bladder control problems that you might have can include:
- Stress incontinence .
- Urge incontinence .
- Painful urination .
- Nocturia .
How Is Early Menopause Treated Or Managed
Early menopause generally doesnt require treatment. However, there are treatment options available to help manage the symptoms of menopause or conditions related to it. They can help you deal with changes in your body or lifestyle more easily.
Premature menopause, however, is often treated since it occurs at such an early age. This helps support your body with the hormones that would normally be made until you reach the age of natural menopause.
The most common treatment includes hormone replacement therapy . Systemic hormone therapy can prevent many common menopausal symptoms. Or you may take vaginal hormone products, usually in low doses, to help with vaginal symptoms.
HRT does have risks though. It can increase your chances of heart disease, stroke, or breast cancer.
Talk to your doctor about the risks and benefits to your individual care before starting HRT. Lower doses of hormones may decrease your risk.
How Is Menopause Diagnosed
There isnt a specific test for menopause. Your doctor will help you determine if you are menopausal based on how frequent your periods are and what symptoms you are experiencing. Menopause is confirmed 12 months after your last period. Blood tests are unlikely to accurately predict menopause.
Seek medical advice if you are concerned about irregular cycles, heavy or abnormal bleeding, or symptoms that interfere with your daily life. Your doctor may also suggest other health checks such as a mammogram, or cervical screening.
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Can Menopause Be Treated
Menopause is a natural process that your body goes through. In some cases, you may not need any treatment for menopause. When discussing treatment for menopause with your provider, its about treating the symptoms of menopause that disrupt your life. There are many different types of treatments for the symptoms of menopause. The main types of treatment for menopause are:
It’s important to talk to your healthcare provider while you are going through menopause to craft a treatment plan that works for you. Every person is different and has unique needs.
What Are Other Treatments For Early Or Premature Menopause
If youre not able to go on HT because of estrogen, know that there are more safe and effective menopausal treatments not involving estrogen than ever before, so your NAMS practitioner can recommend a cocktail of treatments specifically to your needs.
Some of the most common include:
FDA-approved non-estrogenic medications, known as bioidentical hormones that are made from plants and are usually available at compounding pharmacies. The common ones are Remifemin or Estroven which are found over the counter), which are made with plant chemicals .
Lube! Make it your friend. It can help with vaginal dryness and pain during sex. Look for an over-the-counter lubricant or vaginal moisturizer whose label lists an osmalality of around 300 . It should have no fragrance or chemical additives.
Antidepressants, such as SSRIs, and other mental health medications that have recently been approved specifically for the treatment of hot flashes and psychological symptoms
It’s worth repeating: We know it can be scary to go through menopause before your body is supposed to. Its not something youd probably expected would happen, and the ramifications can throw certain life plans into a tailspin. But knowing what the heck is happening can help you feel less helpless and better prepped to find the right treatmentand get back to feeling like you again.
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Diagnosis Of Primary Ovarian Insufficiency
If you have irregular periods or have stopped your periods for more than three months, please see your doctor and make sure your doctor includes hormone tests to exclude early menopause.
Your doctor will need to do a full physical examination and investigate the cause of your symptoms.
The criteria for a diagnosis of POI are:
- at least three months without a period
- two blood tests to confirm whether the levels of follicle-stimulating hormone are more than 40IU/l the two tests need to be performed on the third day of your period and at least one month apart.
A doctor is likely to perform the following tests:
- pregnancy test, FSH and Oestradiol
- prolactin this is the hormone usually involved with breastfeeding, but when raised, it causes periods to stop
- transvaginal ultrasound this is an internal ultrasound of the vagina and uterus to check for evidence the ovary is functioning by:
- counting the number and size of the follicles or eggs in the ovary
- measuring the volume of the ovaries
- assessing the thickness of the lining of the uterus or endometrium
- checking for any blockage that is stopping menstrual blood flow.
An Early First Menstrual Period May Lead To Premature Menopause
How do you know if you’re starting perimenopause?
The most telling symptom is changes in your menstrual cycle, says psychiatrist Hadine Joffe, the executive director of the Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital in Boston.
“It’s the menstrual cycle pattern that really defines this lead-up to menopause,” she says. During perimenopause, periods “might be shorter, then a long one, or then a skipped one, or then the flow might be different,” says Joffe.
There’s no blood or hormone test that can “diagnose” perimenopause. Joffe says a hormone test isn’t helpful because hormonal cycles become erratic and unpredictable during this stage.
“There’s not really one point in time when a hormone test is done that can be definitive,” she says. Even if you took several tests over time, “you might get a very different readout.”
Surprisingly, sometimes doctors aren’t prepared to help women recognize the start of this life phase. Edrie was upset at her doctors’ responses â or lack thereof. “I felt so disappointed in the medical industry. How many women has my OB/GYN seen and not recognized the symptoms of perimenopause?”
What symptoms to expect
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How Do I Know If I Am Going Through Early Or Premature Menopause
You know you have gone through menopause when you have not had your period for 12 months in a row. If you think you may be reaching menopause early, talk to your doctor or nurse.
- Your doctor or nurse will ask you about your symptoms, such as hot flashes, irregular periods, sleep problems, and vaginal dryness.
- Your doctor or nurse may give you a blood test to measure estrogen and related hormones, like follicle-stimulating hormone . You may choose to get tested if you want to know whether you can still get pregnant. Your doctor or nurse will test your hormone levels in the first few days of your menstrual cycle .
How Do I Know If I’m In Menopause
You will know you have reached menopause when you have gone 12 consecutive months without a menstrual period. Contact your healthcare provider if you have any type of vaginal bleeding after menopause. Vaginal bleeding after menopause could be a sign of a more serious health issue like endometrial cancer.
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What Are The Symptoms Of Early Menopause
Symptoms of early menopause are similar to those of normal menopause:
- Changes to your menstrual cycle monthly periods become less frequent and stop.
- Hot flushes or night sweats a sudden feeling of heat in the neck and chest with changes to your heart rate.
- Problems sleeping and/or lower energy levels and tiredness.
- Pain in your muscles or joints.
- Vaginal and urinary symptoms as the vaginal lining becomes thinner and dryer, you may experience discomfort during sex and/or need to urinate more often.
- Mood changes you may feel anxious, upset, sad or angry in more situations.
When early menopause is due to surgery or cancer treatment, these symptoms may be more intense than normal menopause, and with a less gradual onset.
How Does Natural Menopause Occur
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For people undergoing natural menopause, the process is gradual and is described in three stages:
Perimenopause or “menopause transition”: Perimenopause can begin eight to 10 years before menopause when the ovaries gradually produce less estrogen. It usually starts when you’re in your 40s. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the drop in estrogen accelerates. At this stage, many people may experience menopause symptoms. But you are still having menstrual cycles during this time and can get pregnant.
Menopause: Menopause is the point when you no longer have menstrual periods. At this stage, your ovaries have stopped releasing eggs and producing most of their estrogen. Menopause is diagnosed when you’ve gone without a menstrual period for 12 consecutive months.
Postmenopause: This is the name given to the time after you have not had a period for an entire year . During this stage, menopausal symptoms, such as hot flashes, may ease for many people. However, some people continue to experience menopausal symptoms for a decade or longer after the menopause transition. As a result of a lower level of estrogen, those in the postmenopausal phase are at increased risk for several health conditions, such as osteoporosis and heart disease.
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On Average Menopause Begins Around Age 52
Kathi Valeii is a freelance writer covering the intersections of health, parenting, and social justice.
Menopause occurs after a person stops having their period for 12 consecutive months. It naturally happens for many people when they are between the ages of 40 and 58. In the United States, the average age for menopause to start is 52 years.
Certain factors, like never having children and smoking, can make it more likely that menopause will occur earlier.
Before menopause, declining estrogen levels can cause people who menstruate to experience premenopausal symptoms. Menstrual changes, hot flashes, vaginal dryness, sleep problems, and other symptoms are the result of hormonal shifts that are taking place during this time, which is called perimenopause.
Perimenopause can last from two to eight years. On average, people experience perimenopause for four years before menopause begins.
While many people go through menopause in their early fifties, there are a number of unique factors that determine at what age a person will start menopause, as well as what their experience will be like.
How To Deal With Early Menopause
If youre experiencing menopausal symptoms before the age of 45, its important to get to a doctor to rule out other health conditions, and to get the treatment you need in order to cope with symptoms.
If theyre bothered by it, then its time to seek medical care, says Dr. Minkin. When youre waking up every two hours sweating and youre not getting good sleep, that can be a drag.
The condition isnt reversible, but if youre experiencing early menopause and still want to have children, there is a chance for doctors to retrieve some of the antibodies left in your ovariesand the younger you are, the better fit youll be for a donor egg program. Whats more, there are some lifestyle changes that can make the entire ordeal more bearable.
Avoid hot flash triggers
Red wine, caffeine, or spicy foods will make things worse.
Pop a supplement
Dr. Dweck recommends Relizin, which targets menopausal symptoms. You can also try a calcium supplement to prevent bone lossjust be sure to check in with your doc to make sure youre taking an amount thats best for you.
Consider hormone therapy
Even if youre not having terrible symptoms, I encourage my patients who go through menopause early to take estrogen replacement therapy, says Dr. Minkin, which often comes in the form of pills, skin patches, creams and gels, or a vaginal ring.
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Vaginal Lubricants For Menopause Symptoms
In women for whom oral or vaginal estrogens are deemed inappropriate, such as breast cancer survivors, or women who do not wish to take oral or vaginal estrogen, there are varieties of over-the-counter vaginal lubricants. However, they are probably not as effective in relieving vaginal symptoms as replacing the estrogen deficiency with oral or local estrogen.
How Is Premature Menopause Early Menopause And Primary Ovarian Insufficiency Diagnosed
If you begin to have symptoms of menopause before the age of 40, your healthcare provider will do several tests and ask questions to help diagnose premature or early menopause. These tests can include:
- Asking about the regularity of your menstrual periods.
- Discussing your family history of menopause at an early age.
- Testing your hormone levels .
- Looking for other medical conditions that may be contributing to your symptoms.
Women who have not had a menstrual period for 12 straight months, and are not on any medication that could stop menstruation, may have gone through menopause.
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How Is Early Menopause Diagnosed
The time leading into menopause is called perimenopause. During this time, you may have irregular periods and other symptoms that come and go.
Youre generally considered to be in menopause if you go 12 months without menstrual bleeding, and you dont have another medical condition to explain your symptoms.
Tests arent usually needed to diagnose menopause. Most women can self-diagnose menopause based on their symptoms. But if you think youre experiencing early menopause, you may want to see your doctor to be sure.
Your doctor can order hormone tests to help determine whether your symptoms are due to perimenopause or another condition. These are the most common hormones to check:
- Anti-Mullerian hormone . The
As Menopause Nears Be Aware It Can Trigger Depression And Anxiety Too
“Technically, menopause is only one day in a woman’s life, which is exactly when she has not had a period for 12 months,” she says. “It’s the period of time leading up to menopause that causes all the trouble.”
And it can start earlier than you might think. Many listeners wrote to us in response to our call-out for individual experiences with menopause to say that they struggled to get medical support for perimenopause in their mid-30s and early 40s.
When Edrie went back to her OB/GYN with the fertility clinic’s conclusion, she says the doctor shrugged again and told her that menopause is a normal part of life. She wasn’t satisfied with that answer. “Yeah, it’s a normal part of life, but it would be great if we could talk about it and figure out strategies.”
With that spirit in mind, we reached out to endocrinologists, gynecologists and psychiatrists for advice about navigating this major life transition.
How early can perimenopause start?
It’s quite possible for women to start to notice things changing in their mid-30s. Most women arrive at menopause between the ages of 45 and 55, but perimenopause can start as much as a decade beforehand. And about 1% of women in the U.S. reach menopause at age 40 or younger.
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Treatments For Menopausal Symptoms
Your GP can offer treatments and suggest lifestyle changes if you have severe menopausal symptoms that interfere with your day-to-day life.
- hormone replacement therapy tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen
- vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness
- cognitive behavioural therapy a type of talking therapy that can help with low mood and anxiety
- eating a healthy, balanced diet and exercising regularly maintaining a healthy weight and staying fit and strong can improve some menopausal symptoms
Your GP may refer you to a menopause specialist if your symptoms do not improve after trying treatment or if you’re unable to take HRT.