Menopause marks the end of a woman's menstrual cycles and fertility. It is diagnosed after 12 months of no periods. The average age of menopause is 51, but it can occur earlier or later.
As estrogen levels decline in perimenopause and after menopause, women may experience unpleasant symptoms like hot flashes, trouble sleeping, vaginal dryness, and mood changes. Hormone therapy can provide relief by replacing hormones the body no longer makes.
Menopause happens because ovaries slow production of estrogen and progesterone. These are key hormones that regulate menstruation and support functions like bone health and temperature regulation. As hormone levels decline, periods become less frequent and eventually stop. Menopause is diagnosed after 12 months without periods.
Common signs and symptoms of menopause include:
Symptoms vary widely among women. They can impair quality of life by causing discomfort, embarrassment, and relationship strain. Some women have mild symptoms that come and go while others have severe, relentless ones. Symptoms may start in the years leading up to menopause (perimenopause) and can last over a decade after periods end.
Treatment is available to relieve symptoms and help women feel like themselves again.
Hormone therapy (HT) replaces estrogen alone or estrogen plus progestin to alleviate troublesome menopause symptoms. Benefits may include:
Symptoms may recur if hormone therapy is stopped. So, treatment is often continued at least until the late 50s.
Estrogen plays an important role in maintaining vaginal and urethral health. After menopause, low estrogen can cause thinning tissues. This raises UTI risk due to easier transfer of bacteria to the bladder.
Multiple studies show HT significantly cuts UTI rates in postmenopausal women. It helps avoid the pain and inconvenience of recurrent infections.
Estrogen depletion accelerates bone loss after menopause. This raises risks for osteoporosis and dangerous bone fractures later in life. HT preserves bone mineral density to lower fracture risks. It may reduce spray fractures by 30-50%.
HT is approved to prevent bone loss in women with low bone mineral density or high fracture risk. But it should not be used solely for bone protection if no menopause symptoms are present.
If initiated before age 60 or within 10 years of menopause, estrogen therapy cuts risks for heart attacks and heart disease deaths by about 50%. It also lowers chances of dying from any cause.
Estrogen helps keep arteries flexible and clear of plaque buildup. It raises HDL "good" cholesterol while lowering LDL "bad" cholesterol. This adds cardiovascular benefits.
Heart protective effects are seen primarily with estrogen-only therapy, not combination HT. The Women's Health Initiative found estrogen-progestin therapy did not cut heart risks in older women. In fact, it slightly raised heart attack rates in the study's first year. But this risk declined in later years of use.
Low-dose vaginal estrogen creams, tablets, or rings effectively treat genitourinary symptoms like vaginal dryness, pain with intercourse, recurrent UTIs, and urinary incontinence without raising risks of cancer coming back (recurrence).
Even for women previously diagnosed with estrogen-sensitive breast cancers, vaginal estrogen is considered safe to use. However, patients should discuss options with their oncologist.
There are a few main types of approved hormone therapy:
The best choice depends on a woman's symptoms, medical history, uterus status, and preferences. The lowest dose needed to manage symptoms is recommended.
Benefits and risks vary for different therapies. A clinician can help determine the optimal type and dose. Annual safety assessments are advised.
Hormone therapy is available in various formulations and doses including:
Low doses are recommended to start. Adjustments can be made based on patient response and blood level monitoring. Pellet implants and injections may permit lower total doses due to avoidance of first pass liver metabolism.
Finding the optimal dose and delivery method is key for the best balance of symptom relief and safety. This requires an experienced hormone specialist guiding therapy choices.
If women begin HT in their 50s or within 10 years of menopause for moderate to severe symptoms, treatment often continues at least until the normal age of menopause (up to age 51-52). Some women may benefit from continued therapy in their 60s.
Estrogen alone may be used at least until age 60 by women without a uterus. Combination therapy with a progestin should not extend past age 60 due to breast cancer risks.
Individual factors determine appropriateness of longer duration therapy. Women with early menopause before age 45 may consider hormone therapy until at least the average age of menopause. Continuing 5 or more years is associated with reduced risks for diabetes, joint disorders, mood disturbance, Parkinsonism, and ischemic stroke.
Vaginal estrogen can be used as long as needed to manage urogenital symptoms if low-dose formulations do not adequately relieve symptoms.
Some women may try slowly tapering HT doses before discontinuing. Recurrence of symptoms indicates ovaries are still not producing adequate hormones naturally.
Blood tests help determine hormone needs and fine tune doses. Testing may include:
Estrogen (estradiol) level - Checks current level to see if in target range for symptom relief and safety. Helps adjust dose.
FSH (follicle stimulating hormone) level - Pituitary released hormone that stimulates ovaries. Level rises as ovarian function declines. Helps confirm menopausal status if periods are irregular.
Progesterone level (and progestins) - Ensures adequate progestin for uterine protection with estrogen therapy. Confirms hormone absorbing properly.
Testing is typically done about 6 weeks after starting or changing therapy to allow levels to stabilize. Routine monitoring every 6 to 12 months helps assure proper dosing. Testing may be covered by health insurance with the appropriate diagnosis and procedure codes.
The Vital Hormones Clinic specializes in helping women navigate the changes of perimenopause and menopause smoothly. We take time to understand your unique situation and needs.
Our compassionate, board-certified women's health nurse practitioners have over 20 years of experience caring for women at all stages of life. We develop customized treatment plans you can truly feel good about.
We offer cutting-edge hormone therapies to optimize relief of symptoms while balancing safety. Treatments are tailored to your needs and preferences with careful monitoring. Annual reassessment ensures therapies remain appropriate as women transition through menopause stages.
The latest bioidentical hormones can be formulated identically to what your body makes. This allows precision dosing and good tolerance. Convenient creams, tablets and slow release pellets help maintain steady hormone levels in the blood around the clock.
For women unable to take systemic hormones, specialized ultra-low dose vaginal estrogen tablets, inserts or creams target local tissues. This avoids risks of cancer recurrence or cardiovascular effects.
Nutraceutical supplements and customized nutrition plans can provide added support for resilient mood, memory, bone health, sleep and energy levels. We help you implement holistic lifestyle approaches for amplifying hormone therapy benefits. Our goal is supporting optimal vitality during the menopausal transition and beyond.
We partner closely with our patients to achieve their therapeutic goals while making sure treatments remain safe. We take time to answer all your questions.
The Vital Hormones Clinic offers personalized care with:
We strive to make your experience as relaxed and comfortable as possible while providing highest quality care.
Meet with our clinician to discuss your situation and health goals.
We will take the time to listen and then tailor a treatment plan to help you feel your best again. Get ready to embrace the next exciting chapter of womanhood with grace, ease and wisdom informed by nature.
A little-known alternative therapy for managing menopause symptoms is acupuncture. Recent research found that acupuncture significantly reduced the frequency and severity of hot flashes in menopausal women. This suggests acupuncture could be a drug-free way to help alleviate troublesome menopause symptoms for some women.
