Hormones and Menopause


"Doctor, I am 52 years old, my periods have stopped, and I am getting hot flashes. Should I take some hormones?"
Answer: Not necessarily

A woman is considered to be menopausal following the complete cessation of her menstrual cycle during a period of 10 to 12 months. The average age for entering menopause is in the early 50's and most women will have reached this stage when they are 45 to 55 years old. Menopause is nearly always preceded by a transition phase (often called premenopause) which can last from 24 to 36 months, during which cycles are irregular and hot flashes may or may not occur. During this time, some women may also experience problems with their affect, mood and sleeping patterns.

Once menopause occurs, 60% to 80% of women will present with hot flashes of varying degrees. In most cases, the flashes will decrease in intensity 3 to 5 years after they appear, even though 15% to 20% of women aged 60 and over still experience them. With age and, particularly, with the reduction in estrogen associated with menopause, other symptoms will gradually appear, such as decreased lubrication, a form of vaginal dryness and urinary problems.

Menopause is not a medical condition as such, but rather a stage in life that all women go through. Whether to take medication, particularly hormone therapy during menopause, therefore becomes an individual decision, based on a clinical approach that is intended to treat unpleasant symptoms that interfere with the quality of life. A change in lifestyle, better stress and sleep pattern management and moderate physical activity will often be enough to alleviate symptoms. The use of a lubricating gel or moisturizing cream will enable a very satisfactory sex life. Medication may prove very effective when symptoms are moderate to severe and interfere significantly with a woman's personal, social and professional quality of life.

For women who still have their uterus, hormone therapy is the most effective treatment for hot flashes and genital atrophy. The hormones can be taken by mouth, as a patch, in a gel or even applied topically to the genital area. Depending on which they choose, some women may experience menstrual bleeding because of the use of progestin. For women who cannot or do not want to use estrogens but who still have significant hot flashes, the doctor can suggest other drug treatments that do not contain any hormones. "Natural" products to relieve menopausal symptoms are far less effective and last only a very short time. Black cohosh, St. John's wort and phytoestrogens are among those that have been shown to have a positive clinical effect.

The doctor will always prescribe the lowest dose necessary to improve symptoms, with a periodic reassessment of both the indication and efficacy. In many cases, treatment can gradually be terminated after 3 to 5 years and a good quality of life still maintained. There is a great deal of debate in the medical press about the adverse effects of hormone therapy during menopause. These can include a slight increase in the risk of breast cancer (1/1000), an increase in the risk of uterine cancer for women who do not take progestin and an increased risk of cardiovascular, arterial and venous disease (8-10/1000 women), mainly in women already at risk for such complications. On the other hand, the consistent use of hormones during menopause decreases the risk of colon cancer and osteoporosis.

To sum up, for most women menopause represents a transitional stage that requires certain changes in lifestyle. Medical treatment can be provided, mainly based on symptoms, with the smallest possible dose being prescribed for a limited period. At this time, there does not seem to be any evidence that long-term hormone therapy during menopause can prevent chronic conditions, such as heart disease.

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