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Menopause

Menopause is the cessation of menstruation. The average age that a woman stops menstruating is 51; however, many women begin to worry about this inevitable event even before they notice any symptoms. Their concerns are understandable considering the wide variety of effects that menopause has on a woman's body. Women who go through ‘the change of life' may experience one or more of the following symptoms as the body adjusts to the declining estrogen levels:

•  Hot flashes
•  Vaginal dryness
•  Insomnia
•  Migraines
•  Depression
•  Mood swings
•  Weight gain
•  Body aches
•  Urinary incontinence
•  Hair thinning
•  Increased bladder infections
•  Facial hair
•  Pain during sex
•  Impaired memory

The most common treatment for a woman experiencing menopausal symptoms is hormone replacement therapy, or HRT. As women approach menopause, the ovaries begin to produce less estrogen. This decline in estrogen is responsible for the unpleasant symptoms listed above, and HRT can be a very effective way to decrease these symptoms and ease the transition to menopause. Because there are many different approaches to HRT, it is important to consider all treatment options before beginning hormone supplementation, including alternative therapies.

Overview of HRT:
Hormone replacement therapy involves giving exogenous hormones (or hormones from outside of the body) to offset declining estrogen levels due to menopause. HRT is believed to offer certain protective effects, such as slowing bone density loss, decreasing the risk of fractures, and reducing vaginal atrophy. However, HRT does carry potential side effects and risk factors.

Estrogen alone vs. estrogen plus progesterone:
Until many years ago, HRT consisted of estrogen-only formulations. However, after studies showed that unopposed estrogen replacement increases the possibility of developing endometrial cancer, doctors began prescribing progesterone along with estrogen to offset the risk. Progesterone seems to afford a patient the desired protection against cancer of the endometrium. Women who have had their uterus removed in a hysterectomy are the exception; they may use estrogen alone.

Conventional HRT:
Synthetic and conjugated estrogens, including Premarin, are the most common forms of hormone replacement therapy used by medical doctors. Although these hormones typically reduce or alleviate menopausal symptoms, there are often unwanted side effects associated with their use. Some common complaints include: uterine bleeding, mood swings, depression, breast tenderness, bloating, and weight gain. Furthermore, synthetic and conjugated estrogens have been linked to ovarian and breast cancer. Women with a family history of these cancers should use extra caution when considering these types of HRT.

Natural HRT:
Natural hormones are derived from a plant (usually soybean or Mexican wild yam root) and are bio-identical. Not only do they have fewer or no side effects, natural hormones are processed much more quickly by the body. While most women agree that natural hormones are better than synthetic, many patients are unaware that animal-derived hormones are not bio-identical. For example, a commonly used estrogen, Premarin, is made from pregnant mare's urine. Premarin contains 200 components which the human body recognizes as foreign. These extra properties may cause disruption in a woman's hormonal system, as they are not bio-identical. Hormones that are bio-identical can be formulated from a compounding pharmacy and ordered by a doctor.

Bio-identical debate:
While the term bio-identical sounds good, there is no proof that this form of HRT is the better choice. The Endocrine Society issued a Position Statement which reports that no scientific research supports the claim that bio-identical hormones are safer or more effective. This means that bio-identical hormones could carry the same risk for side effects as their non-bio-identical counterparts. Because they are not regulated by the FDA, bio-identical hormones can vary in purity and potency and may even contain unknown contaminants. Whichever form of HRT a woman chooses, it is always best to use the lowest dose possible for the shortest period of time, typically 1-5 years.

Oral vs. other routes of administration:
Because hormones act throughout the entire body, HRT can produce more than just the desired outcome when taken by mouth. When oral supplements get into the bloodstream, they are carried to all areas of the body, where they exert their influence. One way to avoid these systemic effects is to use hormones locally. For example, vaginal suppositories and creams containing hormones can be used in order to avoid or decrease wide-spread consequences.

Alternative therapies:
Natural medicine offers a wide variety of ways to treat menopausal symptoms without using exogenous hormones. Botanicals, such as black cohosh, have long been used in the treatment of hot flashes. This herb is just one of many phytoestrogens, which work to balance the body's estrogen levels naturally. Women who do not benefit from herbal supplements may not be taking the therapeutic dosage, or the amount required to have an effect. Other important factors that can play a role in the types or severity of menopausal symptoms include: exercise, water intake, alcohol consumption, dietary habits (sugar, spicy foods, caffeine), and stress. Doctors should work with each patient on an individual basis to discern which type of treatment is most appropriate.


Article aurthored by Dr. Cherie Minette, Naturopathic Physician


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