Latest information: Menopause

January 21, 2008 5:10:35 PM PST
The latest information about hormone replacement therapy; what every women needs to know!

Did you know that the average age for women getting menopause is 51? If you're getting nervous about your body adapting and changing during this time you don't have to be! Dr. Leah Millheiser instructor at Stanford University's obstetrics and gynecology department is here with some advice on how to deal with "the change."

Dr. Leah Millheiser Web site:
http://womenshealth.stanford.edu/femalesexualhealth
You can reach her through her clinic at: (650) 725-6079

Menopause:
"Don't Sweat the Small Stuff: Latest recommendations on hormone replacement therapy"
The average age of menopause in the United States: 51
Most common symptoms of menopause:

  • Menstruation stops
  • Hot flushes
  • Night sweats
  • Irritability
  • Insomnia
  • Depression
  • Weight gain
  • Vaginal Dryness
  • Loss of libido
Perimenopause:
This is the period of time leading up to menopause and can last several years. Women oftentimes feel like they are "going crazy" due to the changes in mood, irritability, depression, and insomnia. This period is associated with declining ovarian function. Women can have irregular menstrual periods during this time. Women should not ignore these symptoms and should address them with their physician, as there is treatment available. Oftentimes, women in perimenopause are incorrectly given a diagnosis of depression.

How the Women's Health Initiative Study Changed Women's Lives:
Prior to the Women's Health Initiative (WHI) study published in 2002, postmenopausal women would stay on hormones (estrogen and progesterone) indefinitely. Women believed that hormones were the fountain of youth. It kept skin looking young, sex more enjoyable, bones strong, prevented chronic diseases, and relieved menopausal symptoms. However, the WHI study changed the way the medical community viewed hormone therapy. The findings from the study were actually the opposite of what we believed.

WHI findings:
Hormone therapy (estrogen and progesterone) may cause:

  • heart disease in older women
  • breast cancer
  • mild dementia
  • blood clots/pulmonary embolus
  • stroke
Hormone therapy may prevent:
  • hip fractures
  • colorectal cancer (however, if this type of cancer did occur, it was more advanced)
However, the benefits of taking hormone therapy do not outweigh the risks, such as breast cancer!!

Current Recommendations for Hormone Therapy:
As a result of these findings, hormone therapy is only recommended for short-term symptom relief (moderate-to-severe hot flashes, night sweats) for women in the early phases of menopause. It is not recommended for chronic disease prevention such as coronary heart disease. Women who are not candidates for hormone use: history of breast cancer, history of coronary heart disease, history of or high risk for blood clotting disorders, or stroke.

Compounded Hormone Therapy:
This is different from hormone therapies that are regulated and approved by the FDA. Compounded hormones are "tailored" to each woman, often based on salivary testing, and have become very popular. Women believe that they are safer than traditional hormone therapies. However, there is limited evidence showing the safety or efficacy of these types of compounded hormones to recommend its use over government-approved products.

Alternatives to Hormone Therapy:
Herbs: have minimal benefit in the treatment of hot flushes and night sweats. In fact, soy has estrogen-like properties and may in fact be dangerous for women with estrogen-dependent breast cancers if taken in large quantities.

  • SSRI antidepressants
  • Effexor (antidepressant)
  • Neurontin (anticonvulsants)
  • Behavioral changes : decreased caffeine intake, avoid stressors, avoidance of heat, wear layered clothing

    Menopause and Sex:
    Menopause frequently causes vaginal dryness and irritation. This can safely be treated with vaginal estrogen therapy.


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