Dr. M.J. Bazos,
Menopause is the phase of a
woman’s life when her ovaries stop producing hormones. This event occurs
because the ovaries run out of eggs. Most women will go through menopause at an
average age of 50 or 51 years. However, some women will go through menopause
earlier, as early as 40 years, and others later, as late as 60 years.
(Occasionally, women can go through menopause at even younger or older ages, but
this is less common.) Usually the diagnosis is made by the presence of
“hot flashes” and the cessation of periods for approximately 6
months. If it is unclear whether a woman is going through menopause, a blood
test can be done to determine whether the ovaries are slowing down or no longer
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The most common symptoms are
hot flashes and the periods stopping. Hot flashes can be very mild, just feeling
a little warm in the face, to very severe, appearing red in the face and
sweating profusely. But the key characteristic of a hot flash that makes it
different from other temperature-regulating problems, such as thyroid problems,
is that a hot flash only lasts a few minutes. Often women may feel a slight
chill after the hot flash stops. Hot flashes can wake a woman up from sleeping,
and so some
women may feel very fatigued
during the day. Other symptoms include vaginal dryness, vaginal sensitivity,
discomfort with intercourse, exacerbation of bladder control problems, weight
gain, loss of libido (sex drive), and possibly, increased emotional
most effective treatment for the symptoms of menopause is hormone replacement
therapy (HRT). If you still have a uterus, you will need to take estrogen and
progesterone. Both of these hormones were produced by your ovaries, so taking
the hormones is simply supplying your body with hormones your ovaries no longer
produce. Estrogen relieves the symptoms and will decrease your risk of
developing coronary artery disease (clogged blood vessels) and heart attack.
Taking HRT will also decrease your risk of developing osteoporosis (fragile
bones). Progesterone decreases the risk of developing uterine cancer while
taking estrogen. If you do not have a uterus, you do not have to take
progesterone. Because taking hormones may increase the risk of developing breast
cancer slightly, prescribing HRT should be individualized. Women who may benefit
from HRT are those who may be at increased risk of coronary artery disease
(i.e., those women who smoke, have hypertension, have high cholesterol levels,
or a family history of coronary artery disease), and women who may be at
increased risk for developing osteoporosis (i.e., those women who have a history
of low calcium intake, who are small boned or have a small frame, who have a
family history of osteoporosis, or are smokers). There are several ways to take
HRT. The two most commonly prescribed regimens
1. Cyclical: estrogen on days 1
through 25 of each month; progesterone on days 14 through 25 of each
2. Continuous: estrogen and
progesterone are taken every day. With cyclical HRT, periods will usually occur
every month, whereas with continuous HRT, all bleeding will usually stop after
3–4 months. At first the bleeding may be very irregular but generally not
heavy. After starting HRT, breast or nipple tenderness may occur and may last
3–4 months. After this period, the tenderness will usually decrease and
not be bothersome. Some women may feel mildly bloated, irritable, or depressed
when taking progesterone. Sometimes adjusting the dose or trying a different
regimen or different type of progesterone can help. If your doctor prescribes
HRT, he may recommend that an endometrial biopsy be performed if you start to
bleed irregularly while receiving cyclical HRT, or if you start to bleed while
receiving continuous HRT, especially if you continue to bleed beyond the
expected 3–4 months. An endometrial biopsy is an office procedure in which
a small plastic tube is placed into the uterus to obtain a sample of
endometrium, the lining of the uterus. This procedure only takes a few minutes
to do and can be done under local anesthesia or without any anesthesia. The
biopsy is performed to make sure there is no precancerous tissue
(“hyperplasia with atypia”) or cancer.
•Do take your HRT as directed
if it is prescribed. It can be taken anytime, i.e., in the morning or before
•If you are experiencing
more hot flashes during the day, you may want to take the HRT in the morning.
•If you are experiencing more hot
flashes during the night, you may want to take the HRT before bedtime.
•If you miss a dose, you can take it
as soon as you remember.
•If you do
not remember until the time of your next dose, do not take the missed medication
and the usual medication at the same time. It would not be harmful, but it will
not do much good either.
doses of HRT will only result in bleeding or hot flashes. To slow down the
development of osteoporosis (fragile bones), you should make sure you are taking
in enough calcium.
HRT should take in 1,000 milligrams of elemental calcium; women not receiving
HRT should take in 1,500 milligrams.
•Calcium can be taken in either
through the diet or by taking a calcium supplement.
•It is usually very difficult to get
enough calcium in the diet, so most women need to take some type of calcium
•The best absorbed and
usually the best tolerated calcium supplements are calcium citrate (Citracal D)
and calcium phosphate (Posture D). (The “D” in the brand names means
it includes vitamin D.)
is also necessary for the body to maintain bone strength. You cannot get vitamin
D through any type of food, only by exposure to sunshine. •Postmenopausal
women should make sure they take in 400 IU of vitamin D daily.
•If you are older than 65 years, you
should take in 800 IU daily.
the metabolism slows down with menopause, many women gain weight during this
time, so it becomes increasingly important to eat healthy, low-fat foods and
•Exercise is very
important because it helps to maintain bone strength and muscle mass (in
menopause, muscle tends to turn into fat), and it helps to burn up calories
during exercise. In addition, exercise will boost the body’s metabolism
for several hours, which will help to keep the weight off or help with weight
your HRT without letting your doctor know.
•If you are having side effects from
the HRT, an adjustment or a change in the type of HRT can usually be made so
that you can continue to take the HRT comfortably.
•If you have a uterus, don’t
take estrogen without progesterone because it may significantly increase your
risk of uterine cancer, unless you have specifically discussed this with your
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• If you have irregular or
unexpected bleeding while receiving
• If your menopausal symptoms do
not resolve with HRT.
• If you have
persistent bothersome side effects.