Dr. M.J. Bazos, Patient Handout
About Your Diagnosis
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 working.
Living With Your Diagnosis
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 lability.
The 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 are:
1. Cyclical: estrogen on days 1 through 25 of each month; progesterone on days 14 through 25 of each month.
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.
The DOs
•Do take your HRT as directed if it is prescribed. It can be taken anytime, i.e., in the morning or before bedtime.
•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.
•Missed 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.
•Women receiving 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 supplement.
•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.)
•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.
•Because 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.
•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 loss.
The DON’Ts
•Don’t stop 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 doctor.
When to Call Your Doctor
• If you have irregular or unexpected bleeding while receiving HRT.
• If your menopausal symptoms do not resolve with HRT.
• If you have persistent bothersome side effects.