Health Talk
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With this hormonal change, a woman's body and mind respond in a way that is unique to her.
Hormonal change is a part of life, starting with the onset of puberty and its accompanying nuances to the state of pregnancy.
Most women can attest to those shifts in hormone levels and tolerate the symptoms because they are overshadowed by the anticipation of a new baby.
With menopause the anticipation is quite different. Women undergoing natural menopause often do so with trepidation. For with menopause comes one of the manifestations of the aging process, confirming that childbearing is no longer a potential function.
This decrease in hormone levels brings on a multitude of changes in the body and mind.
This is supposed to occur gradually. The perimenopausal phase is about a seven-year process during which time the body is supposed to acclimate to the diminishing levels of hormones.
The remaining eggs are subject to maturation only when enough hormone is present to allow for follicle development. This in turn causes infrequent and irregular menses.
The diminishing levels of hormone are responsible for symptoms such as hot flashes, night sweats, insomnia, libido changes, irregular bleeding, increased or decreased menstrual flow, vaginal dryness, irritability, anxiety and depression, just to name a few.
The diminishing level of estrogen results in decreased elasticity of the skin and decreased suspension of the internal organs so the bladder and uterus may suffer the plight of gravitational pull.
Women tend to follow the path of their older siblings and mother, so they might have an idea what to anticipate in terms of symptoms.
The exception to this is a woman who has had a hysterectomy with complete removal of uterus, fallopian tubes and ovaries. If the uterus is removed, and fallopian tubes and ovaries are spared, the woman will continue to have adequate levels of estrogen and progesterone until she undergoes menopause.
Women frequently ask for a blood test to diagnose menopause. Although FSH and LH are helpful markers in menopause, they are not used as diagnostic tools for identifying the state of menopause.
The levels of estrogen and progesterone vary greatly in a 28-to-30-day cycle so they are not helpful in determining the menopausal state.
Women may accept the changes gracefully, but there are options that can help combat symptoms of this inevitable state of hormone flux. We know that there is not a standard approach to this dilemma. Some treatments help some women and others do not respond in the same manner.
Concerns over the true benefits of hormone replacement therapy (HRT) were raised in 2002, forcing physicians to seek safer methods of treatment.
In smaller doses most commonly used in postmenopausal women, its effects are primarily to limit post-menopausal symptoms such as hot flashes.
Up until the Women's Health Initiative Study, physicians were using HRT for the purpose of decreasing menopausal symptoms. In 2002, the combined (estrogen and progesterone) HRT branch of the study was halted because the hormones appeared to increase a woman's risk of breast cancer, heart disease, blood clots and stroke.
These findings were obviously not worth the risk to continue the clinical trial for these women, so they were told to promptly discontinue the HRT. This set a new precedence for the medical community and the use of combined HRT has decreased among physicians for the sole purpose of managing postmenopausal symptoms.
Upon doing so, many patients were taken off HRT and left with no recourse for symptom relief. There are some medications for treatment of hot flashes, but some of these drugs have side effects of their own.
Options available include hormone-based and nonhormone-based prescriptions.
Nonhormonal medications used are antidepressants, blood pressure medications and gabapentin, which is an anti-seizure medication.
Birth control pills are often useful in some women, but should not be used after menopause and in women with other health problems.
Low-dose estrogen cream or tablets can be used intra-vaginally for localized symptoms of vaginal dryness.
Progesterone alone may help reduce heavy or irregular menses during the perimenopausal years. Testosterone is also used in some women to relieve some of the symptoms that occur. Due to the risks, these treatments are usually recommended for as short a term and as low a dose as possible.
Another category of medications is bisphosphonates. These are used in treatment of osteopenia and osteoporosis. Women need estrogen to be present in order to absorb calcium and vitamin D to effectively replenish bone strength. Naturally, a decrease in estrogen will result in bone thinning and increase likelihood of fractures.
Natural options available over the counter include botanicals, such as black cohash to relieve sweats. Dietary soy is another option. Soy contains a plant-based estrogen, which relieves sweats to some degree in some women.
Bioidentical HRT is plant-extracted natural forms of estrogen, progesterone and testosterone.
These are compounded by pharmacists and often given in a cream form for topical use. Women can combat these changes by adding soy to the diet. Exercise is beneficial to combat fatigue, bone loss and weight gain. It can also improve the mind and attitude. Avoiding alcohol may decrease hot flashes. Calcium and vitamin D supplements are helpful for bone loss.
The symptoms may last longer in some women than in others. Unfortunately, there is no real way to know how long the symptoms will continue. Treatment may only be needed for a short period of time. Women should seek the advice of a health care provider to determine what, if any, treatment is best for their needs.
This week's Health Talk was written by Carleen Messina, DO, family practice, Rutland.
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