Menopause and Hormone Therapy

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As you age, significant internal changes take place that affect your production of the two female hormones - estrogen and progesterone. The hormones, which are important in regulating the menstrual cycle and having a successful pregnancy, are produced by the ovaries, two small oval-shaped organs found on either side of the uterus.

During the years just before menopause, known as perimenopause, your ovaries begin to shrink. Levels of estrogen and progesterone fluctuate as your ovaries try to keep up hormone production. You can have irregular menstrual cycles, along with unpredictable episodes of heavy bleeding during a period Perimenopause usually lasts several years.

Eventually, your periods stop. Menopause marks the time of your last menstrual period. It is not considered the last until you have been period-free for 1 year without being ill, pregnant, breast-feeding, or using certain medicines, all of which also can cause menstrual cycles to cease. There should be no bleeding, even spotting, during that year. Natural menopause usually happens sometime between the ages of 45 and 54.

You also can undergo menopause as the result of surgery. A surgical procedure, called a hysterectomy, removes the uterus. This surgery puts an end to your menstrual cycle but does not affect menopause, which still occurs naturally.

You go through menopause immediately if both of your ovaries are also removed at surgery. Whether you go through menopause naturally or surgically, symptoms can result as your body adjusts to the drop in estrogen levels. These symptoms vary greatly - one woman may go through menopause with few symptoms, while another has difficulty. Symptoms may last for several months or years, or persist.

The most common symptoms are hot flashes or flushes, night sweats, and sleep disturbances. (a hot flash is a feeling of heat in your face and over the surface of your body, which may cause the skin to appear flushed or red as blood vessels expand. It can be followed by sweating and shivering. Hot flashes that occur during sleep are called night sweats.) But the drop in estrogen also can contribute to changes in the vaginal and urinary tracts, which can cause painful intercourse and urinary infections.

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. The two hormones normally help to regulate a woman’s menstrual cycle. Progestin is added to estrogen to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to uterine cancer. If you haven’t had a hysterectomy, you’ll receive estrogen plus progesterone or a progestin; if you have had a hysterectomy, you’ll receive only estrogen. Hormones may be taken daily (continuous use) or on only certain days of the month (cyclic use).

They also can be taken in several ways, including orally, through a patch on the skin, as a cream or gel, or with an IUD (intrauterine device) or vaginal ring. How the therapy is taken can depend on its purpose. For instance, a vaginal estrogen ring or cream can ease vaginal dryness, urinary leakage, or vaginal or urinary infections, but does not relieve hot flashes.

Hormone therapy may cause side effects, such as bleeding, bloating, breast tenderness or enlargement, headaches, mood changes, and nausea. Further, side effects vary by how the hormone is taken. For instance, a patch may cause irritation at the site where it’s applied.

There also are non-hormonal approaches to easing the symptoms of menopause.

Tags: Menopause