In the early 50's (in North America).
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Estrogen.
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Menopause itself is not necessarily a reason for all women to take hormones. The decision regarding hormone therapy is up to the woman and should take into consideration the menopausal age, whether it occurs naturally or is due to a surgical procedure, the severity of the symptoms and the medical condition of the woman concerned. In many cases, when menopause occurs naturally, lifestyle changes will be enough to alleviate the symptoms.
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No natural product covers the whole range of menopausal symptoms. Some are effective against hot flashes, while others improve sleep quality. On the other hand, a good number of natural products now marketed for menopause do not appear to be any better than a placebo ("sugar pill"). Generally speaking, clinical experience and research have shown that women experiencing hot flashes or affective sleep problems may note a minor improvement in their symptoms over a short period. Then, the beneficial effect seems to disappear. You should also remember that a number of natural products are, in fact, active pharmacological substances that can have definite side effects. You should therefore consult your doctor if you have to take medicine for a particular condition before taking any such product.
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It is estimated that around two-thirds of women who become menopausal naturally will experience hot flashes for a period of 3 to 5 years. The symptoms may, however, last longer. It has been noted that 20% of women aged 60 and up, as well as 8% to 10% of women of 70 and over can still have hot flashes. The situation is different for women who start their menopause at a young age, particularly when it is induced prematurely because of medication or surgery. Most of these women will present with severe hot flashes for a period that lasts more than 8 to 10 years.
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Not necessarily. If you had a hysterectomy while you were still having your periods and your gynecologist did not remove your ovaries, you will continue to produce sex hormones in the usual way even if you do not menstruate. You will become menopausal at a normal age, which will depend on your family history (mother, sisters) and personal factors.
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Taking hormones to prevent cardiovascular diseases (infarction or stroke) is not recommended. Indeed, hormones during menopause can increase the incidence of these conditions in women already at risk for them.
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Yes. All studies show that estrogens at the doses usually prescribed during menopause maintain a woman's bone structure and prevent fractures caused by osteoporosis. Estrogens are therefore first-class therapy for women presenting with menopausal symptoms who are also at risk of developing osteoporosis.
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The answer is "No" in the case of women who take hormones for a short period (3 to 5 years). If they continue hormone therapy beyond that point, there is a very slight additional risk of developing breast cancer when compared with women not taking hormones. The risk is estimated to be 1 or 2 for every 1,000 women taking hormones. The periodic examination of the breasts by a health professional, together with a screening mammography every 18 to 24 months, will help minimize this risk. There is no change in risk for women who have had their uterus removed and are not taking estrogen.
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It all depends on why you chose this treatment. In theory, if you selected hormone therapy to improve your quality of life (in particular, hot flashes), your doctor can recommend you reduce the dose or even stop the hormones temporarily to evaluate whether the symptoms continue or disappear. On the other hand, the situation is more complicated if you chose hormone therapy to improve your bone health or treat a problem with genital atrophy (dryness), because the hormones will have to be replaced by alternative medication.
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In menopausal women who still have their uterus, the estrogens taken to treat the symptoms of menopause should be accompanied by a progestin which prevents uterine cancer. The ratio of estrogen to progesterone hormones is very important in stabilizing the inner membrane lining the uterus (the endometrium). The ratio changes with each woman and so dosage has to be individualized. Your doctor should prescribe the smallest dose of hormones to treat your symptoms and will be able to offer you a choice of sequential or combined treatment. If abnormal bleeding persists, your doctor will assess your endometrium to make sure that there is no organic reason for the bleeding (polyp, fibroma or, more rarely, endometrial cancer).
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To avoid stimulating the endometrium (the inner lining of the uterus) and thus endometrial cancer.
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Yes. There are some well-designed medications to relieve hot flashes that contain neither estrogen nor progesterone. They have been widely studied and shown to be clinically effective against hot flashes, although their effect is less than that obtained with estrogens. Like any other pharmaceutical product, these medications can cause side effects. You should therefore discuss them with your doctor.
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