Menopause symptoms are infamous. Hot flashes, mood changes, and difficulty sleeping can create major issues in people’s lives. The treatment options for menopause can be confusing, especially sorting out the risks and benefits of hormone replacement therapy. Below is a brief guide on menopause and how hormonal therapy functions.
The Pathophysiology of Menopause
Menopause is when a person’s menstrual period stops or pauses, hence menopause. The ovaries have all of the eggs they will ever have from birth. From birth until puberty, the number of eggs in the ovaries stays the same. With the onset of puberty, the ovaries release one or more eggs with every menstrual cycle. In menopause, the ovaries begin to run out of eggs. This causes them to slowly dysfunction.
Ovarian dysfunction decreases the amount of estrogen and progesterone in the body. Specifically, estrogen and progesterone or two important sex hormones. Their presence – or absence – causes a cascade of changes in the body. In menopause, the lack of estrogen tells the body to change other hormones, beginning a cascade that causes the symptoms associated with menopause. Once the ovaries run out of all of their eggs, the hormonal changes stabilize.
The Timing of Menopause
The definition of menopause is when a person has not had a period for at least 12 months. The average age of menopause is 49-52 years old, but it can often occur anywhere between the ages of 45 and 55. Symptoms start years before the technical definition of menopause. The average duration of peri-menopause, meaning the time from when symptoms first start to 12 months after the last menstrual period, is 4 years.
There are certain factors that can change the age of onset of menopause. A large factor is a genetics. Often, a woman can predict her estimated menopausal age based on her mother’s age of onset of menopause. Other large factors that influence the age of menopause are based on lifestyle. Specifically, smoking and obesity are major lifestyle factors. Smoking causes earlier menopause by damaging the ovaries and causing earlier ovarian dysfunction. Obesity, on the other hand, causes delayed menopause. Fat tissue secretes estrogen, which can delay ovarian dysfunction and, therefore, menopause.
Common Symptoms of Menopause
When people think of menopause, they often think of the symptoms. Unfortunately, it is difficult to predict how long the symptoms will last. Some symptoms may appear 6 years before actual menopause in some people. They may also last several years or longer after their last menstrual period. It is different for everyone.
The common symptoms are listed below:
- Hot flashes
- Sweating/Night Sweats
- Difficulty Sleeping
- Depressed mood/mood swings
- Loss of a sex drive
- Tender and shrunken breasts
- Vaginal Itchiness
- Vaginal Itchiness
- Urinary symptoms and infections
Some of these symptoms are directly related to the loss of estrogen. Many of the urogenital symptoms, like itching and pain, are due to something called vulvovaginal atrophy. This is when, due to the loss of estrogen, the tissue in that area shrinks and becomes dry. It can also cause an increase in urinary tract infections.
Hormone Therapy Greatly Improves Hot Flashes
Many of the severe symptoms are related to estrogen loss. Therefore, the most effective treatment is hormone replacement therapy. Hormone replacement therapy can be estrogen alone, progesterone alone, or combination therapy.
Estrogen replacement therapies come in pills, patches, topical vaginal creams, and other forms. The systemic therapies, like pills or patches, can treat many of the symptoms concurrently like hot flashes, mood swings, and vulvovaginal atrophy. This is in contrast to the vaginal cream, which will only treat the vulvovaginal symptoms.
Progestogen therapy, the umbrella term for all progesterone-related hormonal therapy, is typically only used in people who cannot use estrogen due to their medical history. For example, those who have had certain types of cancer, heart disease, or blood clots typically avoid estrogen.
This combination therapy is common as it balances the risks versus the benefits of hormone replacement therapy. The estrogen replacement significantly reduces the classic menopausal symptoms. However, estrogen causes the lining of the uterus to grow, which is a risk factor for cancer. The progestogen acts as a counterbalance and reduces the growth of the uterus lining.
Risks of Hormone Replacement Therapy
As stated above, long-term hormone replacement therapy is associated with risk. Specifically, estrogen causes the proliferation of the lining of the uterus. If this continues unabated, it can cause endometrial cancer. Therefore, progesterone is needed to protect the uterus from endometrial hyperplasia. Progesterone acts as a counterbalance, decreasing the lining of the uterus.
Hormone therapy is also associated with other risks. Specifically, it is associated with an increased risk in heart disease, blood clots, and strokes. Combination therapy is specifically associated with breast cancer.
Menopause is a very disruptive time period. It can be confusing and, at times, disturbing, to experience so many changes in such a short time period. Hormone replacement therapy is the most effective treatment for many of the symptoms associated with menopause. However, hormone replacement therapy is not without its risks. At the Anti-Aging and Wellness Clinic, we follow the latest guidelines from physician organizations to help reduce the risks and maximize the benefits. Contact us to learn more about your hormone replacement options today.