Menopause is diagnosed once periods have stopped for more than 12 months in women over the age of 40. The average age of natural onset is 51 although surgical removal of the ovaries can lead to sudden onset. The most disturbing symptom associated with menopause is “hot flashes” and this is also the primary reason for prescribing estrogen replacement therapy. Once you become menopausal the decision to start estrogen replacement therapy is up to you based on the known risks, benefits and the severity of your symptoms.
Despite the results of the Women’s Health Initiative (WHI) released in 2002, the benefits of hormone therapy for hot flashes, night sweats and vaginal dryness generally outweigh the risks for healthy women at the beginning of menopause. The reported risk of heart disease is noted primarily in older women several years after menopausal onset. The increased risk of breast cancer according to the WHI was associated with long-term use. Therefore, hormone therapy is an option for short-term use in a healthy woman just entering menopause with hot flashes affecting her quality of life and ability to function normally.
Most women experience hot flashes for 6 months to 2 years although they may last for many years. Hormones are certainly the most effective treatment option but should only be used at the lowest effective dose for the shortest period of time. We are happy to discuss alternative options at your appointment.
An alternative made popular by the media is “bioidentical” hormones. Bioidentical is not an actual medical term but is used to describe hormones structurally identical to “natural” hormones produced by the ovary. There are a variety of “bioidentical” hormones FDA approved with known safety profiles which we prescribe. There are no known benefits and there could be significant risks associated with “custom” made formulations from compounding pharmacists. The purity, concentration and dosages are untested and inconsistent. There is no evidence to support adjusting dosage on blood levels of hormone.
Hormone therapy is not recommended if you have had or have
…Active liver or gallbladder disease