Submitted by Advanced Women’s Healthcare
About 80 percent of women will experience hot flashes as they approach menopause. If you have never experienced a hot flash or aren’t sure what it feels like, you will know it when it happens! A hot flash may last only a few minutes, or as long as 30! After a hot flash, some women are sweating like they just finished running a marathon, while others may be a bit flushed with only slight perspiration on their face and neck. Hot flashes may also occur several times at night. If hot flashes, night sweats, or other symptoms of menopausal transition are more than merely uncomfortable — if they are interfering with your daily activities, you need to seek relief.
Last month’s article suggested some lifestyle changes for coping with hot flashes. This month, I’d like to delve a little deeper into the benefits and risk of Menopausal Hormone Therapy (MHT). A hormone is a chemical substance made by an organ, like the thyroid gland or ovary. Hormones control different body functions. Examples of hormones are estrogen, progesterone, testosterone, and thyroid hormone. During the menopausal transition, sometimes called peri-menopause, levels of several hormones, including estrogen and progesterone, go up and down irregularly. This happens as the ovaries begin working less and less well.
While menopause is a normal part of aging — it’s not a disease or disorder — women who have distressing symptoms may want to try Menopausal Hormone Therapy to seek relief. Estrogen is a hormone used to relieve the symptoms of menopause, including hot flashes and night sweats. A woman whose uterus has been removed can use estrogen only, but a woman who still has a uterus must add progesterone or a progestin (synthetic progesterone) along with the estrogen. This combination lowers the chance of an unwanted thickening of the lining of the uterus and reduces the risk of cancer of the uterus, an uncommon, but possible result of using estrogen alone.
Over the years, numerous research studies have led to a variety of positive, negative, and sometimes conflicting reports about the safety and effectiveness of Menopausal Hormone Therapy. Some studies have suggested that for some women, MHT may cause an increased chance of developing heart disease, stroke, blood clots, or breast cancer. Also, some women develop side effects such as cramping or bloating. By changing the type or amount of the hormones, the way they are taken, or the timing of the doses, your doctor may be able to help control these side effects. Over time, they may go away on their own. Studies have shown that women should not begin using MHT to protect their health — it does not appear to prevent chronic diseases such as heart disease or dementia when started several years after menopause.
There are more options now than when some of the studies were first done. More types of estrogens are available, and some of them come in a variety of forms. For example, synthetic estradiol, now available in several forms (pill, patch, cream, gel, etc.), is chemically identical to the estrogen most active in women’s bodies before menopause. If it is not taken by mouth, but rather applied to the skin or taken as a shot, estradiol appears to work the same way as estradiol made in the body. Lower doses of estrogen are available. Investigators are now studying a low-dose estradiol patch (transdermal estradiol) compared to a low-dose conjugated-estrogens pill to see whether either slows hardening of the arteries in women around the age of menopause and whether the estradiol patch is as effective and, perhaps, safer than the conjugated-estrogens pill. Besides a pill, some estrogens come in different and sometimes new forms — skin patch, gel, emulsion, spray, and vaginal ring, cream, and tablet. These forms work in the body somewhat differently than a pill by entering your body directly through the skin or walls of the vagina. Oral estrogen (a pill) is chemically changed in the liver before reaching your tissues. Some studies suggest that if estrogen enters through the skin and bypasses the liver, the risk of serious blood clots might be lower.
These alternatives are creating more choices for women seeking relief from their menopausal symptoms.
The form of MHT that your doctor recommends may depend on your symptoms. The dose can also vary, as can the timing of those doses. For example, some women take estrogen every day, but progesterone or progestin cyclically — for 10 to 14 straight days, every four weeks. A cyclic schedule is thought to mimic how the body makes estrogen and progesterone before menopause. This approach can cause some spotting or bleeding, like a light period, which might get lighter or go away in time. Alternatively, some women take estrogen and progesterone or progestin continuously — every day of the month.
The FDA now recommends that women with moderate to severe menopausal symptoms who want to try menopausal hormone therapy for relief use it for the shortest time needed and at the lowest effective dose.
This is the fourth in a series of articles on Menopause. If you missed previous articles on Peri-menopause and symptoms, you may read them online at HealthyCellsBN.com or call Cheryl at 309-664-2524 to request a copy.
Next Month: What about “Natural Hormones?”
Dele Ogunleye, M.D., and Lisa Emm, M.D., provide a full range of obstetric and gynecologic services. Brittany King is an advanced practice nurse specializing in women’s health. She works alongside Dr. Ogunleye and Dr. Emm to provide a full range of obstetric and gynecologic services. You may contact them at Advanced Women’s Healthcare, 309-808-3068 or www.awhcare.com. The office is located at 2111 East Oakland Avenue (Next to the Jewel-Osco Plaza).