What Is The Menopause
Simply, the menopause is when the ovaries no longer respond to the hormonal messages sent from the pituitary gland in the brain. Eventually, this leads to the end of ovulation and the menstrual cycle.
During the build-up to the menopause, known as perimenopause, our hormones go through a transformation process. Their levels fluctuate and can alter our physical, mental and emotional wellbeing. Im feeling hormonal can sometimes be bandied about to describe how we feel at a given moment in time, but that feeling can soon become a reality for many women entering the menopausal transition.
Hot Flashes During Perimenopause
Most women don’t expect to have hot flashes until , so it can be a big surprise when they show up earlier, during perimenopause. Hot flashes sometimes called hot flushes and given the scientific name of vasomotor symptoms are the most commonly reported symptom of perimenopause. They’re also a regular feature of sudden menopause due to surgery or treatment with certain medications, such as chemotherapy drugs.
Hot flashes tend to come on rapidly and can last from one to five minutes. They range in severity from a fleeting sense of warmth to a feeling of being consumed by fire “from the inside out.” A major hot flash can induce facial and upper-body flushing, sweating, chills, and sometimes confusion. Having one of these at an inconvenient time can be quite disconcerting. Hot flash frequency varies widely. Some women have a few over the course of a week others may experience 10 or more in the daytime, plus some at night.
Most American women have hot flashes around the time of menopause, but studies of other cultures suggest this experience is not universal. Far fewer Japanese, Korean, and Southeast Asian women report having hot flashes. In Mexico’s Yucatan peninsula, women appear not to have any at all. These differences may reflect cultural variations in perceptions, semantics, and lifestyle factors, such as diet.
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Prescribing Hormone Replacement Therapy
It is important that an individualised approach is undertaken at all stages of diagnosis, investigation and management of menopause.
The dose, regimen and duration of HRT need to be individualised. There is no maximum duration of time for women to take HRT. Discussion with women who continue to have symptoms generally show their benefits from HRT usually outweigh any risks. Systemic HRT should not be arbitrarily stopped at age 65 years instead treatment duration should be individualised based on patients’ risk profiles and personal preference.
Micronised progesterone is a natural, ‘body-identical’ progestogen, devoid of any androgenic as well as glucocorticoid activities but being slightly hypotensive due to anti-mineralocorticoid activity. It may be the optimal progestogen in terms of cardiovascular effects, blood pressure, VTE, probably stroke and even breast cancer but this evidence is only from observational studies. There is only one currently available to prescribe in the UK.
As transdermal oestrogen is associated with fewer risks than oral HRT, a transdermal route may be preferable for many women. This route is also advantageous for women with diabetes, history of VTE and also those with thyroid disorders. In addition, transdermal HRT is preferable to those women with a history of migraine or gallbladder problems.
Information For Your Doctor To Read Includes Ams Information Sheets:
If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.
NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individuals personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information must be agreed to and approved by the Australasian Menopause Society.
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Signs You Need Hormone Replacement Therapy
Hormone replacement therapy is not for everyone, but some people find the treatment provides relief from the symptoms of menopause.
Signs that you may need hormone replacement therapy include:
Other conditions caused by hormone deficiency may also benefit from hormone replacement therapy.
Hrt: What Are You Risking Without It
Weighing the risks of hormone replacement therapy as well as considering alternative treatments may help with your menopause treatment decisions.
Much has been made about the risks of menopausal hormone therapy MHT when it comes to relieving menopause symptoms, but what about the risks of not using it?
Women may experience hot flashes, night sweats , sleep disorders, vaginal dryness, depression, and trouble concentrating or remembering things, says Robert Tomaro, Jr., MD, a physician in the department of obstetrics-gynecology at Jersey Shore University Medical Center in Neptune, N.J. and immediate past president of the Monmouth County Medical Society.
Also, during menopause a womans sex drive may decrease, while intercourse becomes more painful. She may be exhausted due to trouble sleeping and night sweats, and may experience mood swings. With age women are also at risk for heart disease and osteoporosis which can lead to broken bones. Women who choose not to use HRT may or may not have any or all of the above signs and symptoms at varying degrees of severity, says Dr. Tomaro. Every woman is unique and each body reacts in its own way to the changing hormones.
Is HRT Right for Anyone?
As a result of those findings, doctors recommend that most women should avoid using HRT because of a higher risk for breast cancer, strokes, blood clots, and heart attacks.
What Are Some Alternatives to HRT?
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Oestrogen And Progesterone Therapy
Oestrogen is the main hormone prescribed to relieve menopausal symptoms, and for women who have had a hysterectomy, this may be all they need.
In women who still have their uterus, oestrogen alone can overstimulate the cells lining the uterus, causing an increased risk of endometrial cancer .
To remove the risk of overstimulation, women who have not had a hysterectomy need to take progesterone, or a synthetic form known as ‘progestin’, together with the oestrogen. ‘Progestogens’ is the name used to refer to both the natural form of progesterone and the synthetic form, ‘progestin’.
Evaluation For Hormone Therapy
All candidates for HT should be thoroughly evaluated with a detailed history and complete physical examination for a proper diagnosis and identification of any contraindications.
Baseline laboratory and imaging studies before administering HT include the following:
Fasting lipid profile
Blood sugar levels
Serum estradiol levels: In women who will be prescribed an implant and in those whose symptoms persist despite use of an adequate dose of a patch or gel
Serum follicle-stimulating hormone levels: To monitor women taking oral preparations for symptomatic control, especially those with premature menopause
Ultrasonography: To measure endometrial thickness and ovarian volume
Mammography: Performed once every 2-3 years and annually after the age of 50 years
Endometrial sampling is not required in routine practice. However, the presence of abnormal bleeding before or during HT should prompt consideration of ultrasonography to check endometrial thickness , followed by outpatient Pipelle sampling and hysteroscopy. In women with a tight cervix, formal hysteroscopy and dilation and curettage under general anesthesia are advised.
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What Can Be Done About The Decline In Hormones
Empowering yourself with information about yourself is key. This especially applies to menopause. In the first instance knowing that you are not feeling 100% is due to your changing hormones, gives you understanding. In turn, this provides an opportunity to consider your options. These options can range from changes in lifestyle such as increasing exercise to protect bone health, paying extra attention to nutrition and considering pros and cons of HRT, says Dr Keay.
She adds, Despite recent reports, HRT is safe in those who are not contraindicated. Although there is a slight increase in the risk of breast cancer, it is nowhere near as high as the risk associated with suboptimal lifestyle factors such as being overweight, smoking and drinking excessive alcohol. As with any medication risk/benefits must be weighed up for the individual. For many HRT improves quality of life.
What Are The Risks Of Mrt
When assessing the risks associated with MRT, remember that not all women have the same risk of these effects.
- Risks vary based on how old you are, when you start MRT and how long you take it for.
- Short-term use in early menopause has fewer risks than when it is started later in menopause.
- Risks generally increase as you get older.
- The risks of developing blood clots while taking MRT is much higher for women who are obese, have severe varicose veins or have a close family member who has had deep vein thrombosis or pulmonary embolism.
|Women who take MRT have slightly higher rates of the following conditions:|
For most women with moderate to severe symptoms, the benefits appear to outweigh the risks for those who are less than 10 years out from menopause or aged less than 60.
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Choosing The Right Hrt For You
Finding the right type of HRT can be tricky.
A low dose of HRT hormones is usually recommended to begin with. It is best to start with the lowest effective dose, to minimise side effects. If necessary, you can increase your dose at a later stage.
Persevere with HRT and wait a few months to see if it works well for you. If not, you can try a different type or increase the dose. Talk to your GP about any problems you have with HRT.
While there are more than 50 different preparations of HRT, the three main types are discussed below.
How To Reduce The Risks Associated With Mht/hrt
You can minimise the risks associated with MHT by:
- taking it for less than 5 years and at the lowest effective dose. Review the dose regularly with your doctor and stop as soon as you donât need it any more
- exercising regularly, not smoking, limiting alcohol consumption and keeping to a healthy weight
- carefully managing your high blood pressure and diabetes, if these affect you
If you are interested in taking MHT, please talk to your doctor to see if it is right for you.
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Menopause Symptoms And Hrt
Menopause symptoms that may be relieved by HRT include:
- hot flushes and night sweats
- vaginal dryness
- hair loss or abnormal hair growth
- dry and itchy eyes.
Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor.
What Do Estrogen Pills Do
In fact, it is necessary to go back to the basics of estrogen pills. One should know that doctors do not prescribe them as the only possible solution. Usually, gynecologists insist that forehanded care of your body is key to comfortable living. Nevertheless, such a thing as a genetic or predisposition can radically disappoint you with the results. So, what are the estrogen pills benefits and functionalities?
The synthesis of estrogens in the female body usually starts during puberty. And, it may last until the onset of menopause or else called perimenopause. Estrogens are responsible for a womans youth and beauty, her emotional state and, of course, libido. Besides, estrogens are responsible for bone strength, good memory, blood cholesterol, skin condition and more. Accordingly, the use of estrogen pills for menopause will be directed on helping memory, overall health condition, and preventing any injuries.
The use of estrogen and progesterone pills for menopause helps to keep the skin and mucous membranes moist. Moreover, estrogens support the functioning and integrity of the stratum corneum.
At last, estrogen pills for menopause, acting on receptors, promote faster growth of vascular endothelial cells, help the endothelium to recover faster after damage. When estrogen is low, endothelial function is impaired. And as you know, the good blood supply is the key to beauty and youth.
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Can Fibroids Grow After Menopause
Particularly noteworthy are patients with fibroids after menopause. First of all, it should be mentioned that menopause in such cases occurs 1-3 years later than in women without fibroids.
The content of female sex hormones that are produced by the ovaries becomes so low that all proliferative processes normally stop in the body. The menstrual cycle stops, and with it, cyclic hormonal changes. The size of the uterus and ovaries gradually decreases, the endometrium of the uterus becomes thinner and does not grow.
Along with the processes of extinction of the ovaries, uterine fibroids after menopause decrease and disappear. Risk factors for the absence of a decrease in fibroids after menopause are the presence of ovarian cysts and endometrial hyperplasia. If uterine fibroids do not regress to postmenopause and the first 1-2 years of postmenopause, then its further existence is accompanied by the risk of endometrial cancer, ovarian cancer, and uterine sarcoma!
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Does The Uterus Shrink After Menopause
Whether you have the condition yourself and are looking for answers, or if you are just curious about what an atrophic uterus is, we will provide you with all you need to know.
This is a serious condition which does not get the coverage it deserves, but luckily we are here to shed light on everything there is to know about having an atrophic uterus.
The first thing we will look at is what an atrophic uterus actually is. Then, we will look at what causes it, its symptoms and what you can do to about it.
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Who Can Take Hrt
Most women can have HRT if they’re having symptoms associated with the menopause.
But HRT may not be suitable if you:
- are pregnant it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Does Hrt Work Straight Away
That depends. For some women, their sweats or flushes reduce quickly, within a few days, but if often takes three to four weeks, though the maximum effect can take up to three months or so. Other symptoms such as insomnia tend to improve within three months of starting. You may also find that any initial side effects settle down within three months. In general, a preparation will be used for three months before changing.
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Does It Cause Weight Gain
Some people worry that hormone treatment might lead to weight gain, but there is no evidence to support this.
Eating a healthful diet and getting plenty of exercise can help manage the weight gain that commonly affects both females and males in midlife.
There are various ways of delivering hormone therapy, and the different types provide different combinations and amounts of hormones.Common types include:
Estrogen-only HRT: A doctor may recommend this if a person has had their uterus and ovaries removed, in which case progesterone is not necessary.
Cyclical, or sequential, HRT: This may be a good option if symptoms occur before menopause the dosage can align with the menstrual cycle.
Continuous HRT: After menopause, a doctor may prescribe a continuous combination of estrogen and progesterone.
Local estrogen: Vaginal tablets, creams, or rings can help with urogenital symptoms, including vaginal dryness and irritation.
The doctor will prescribe the lowest possible dosage that addresses the persons symptoms, and arriving at this dosage may take some trial and error.
Ways of delivering HRT include:
- vaginal rings
- skin patches
When a person no longer needs the treatment, the doctor will describe how to stop it gradually.
Various lifestyle adjustments can help manage the symptoms of menopause.
Also, it is a good idea to ask the doctor about nonhormonal treatment options.
Always speak to a doctor before using any supplements.
Estrogen Pills Side Effect: Is There Any
Like any other possible and available medications, estrogen pills for menopause cannot be considered a 100% safe option. Most of the time, side effects bear temporary character and are provoked by exceeding the dosage or incorrect application. As of now, the following are the most common signs you take this medication wrong:
- Nausea and vomiting
- Severe diabetes mellitus
- Melanoma, meningioma.
Anyway, no hormone therapy is possible without the supervision of a doctor. So, he will make sure you are tolerant of their intake, and you wont have any health contraindications.