Submitted by Dele Ogunleye, MD, Advanced Women’s Healthcare
Some women begin experiencing menopausal symptoms as young as the mid-thirties, while others may be closer to 50. The years leading up to menopause, which is defined as going 12 consecutive months without a period, is often called peri-menopause or the menopausal transition. Because symptoms usually come on very gradually, women often don’t recognize the symptoms or realize that they are connected.
Previous articles have discussed different ways to alleviate the discomfort of menopausal symptoms such as hot flashes, night sweats, vaginal dryness, mood swings, and fatigue. Menopausal hormone therapy (MHT), which we discussed last month, is one option for women whose symptoms are interfering with their everyday activities. However, MHT has some risks and side effects that women need to carefully consider to determine if this is the right approach for them.
Some women believe that they are not at risk for serious side effects from menopausal hormone therapy because they use “natural” hormones to treat hot flashes and night sweats. However, there is very little reliable scientific information from high-quality clinical trials about the safety of “natural” or compounded hormones, how well they control the symptoms of menopause, and whether they are as good or better to use than FDA-approved estrogens, progesterone, and progestins.
The “natural” hormones are estrogen and progesterone made from plants such as soy or yams. Sometimes they are known as bioidentical hormones because they are supposed to be chemically the same as the hormones naturally made by a woman’s body. These “natural” hormones are put together by a compounding pharmacist. The pharmacist follows an individualized formula decided on by a doctor familiar with this approach. Compounded hormones are not regulated by the FDA. So, extra care must be taken to be sure these are from a reputable pharmacist who is skilled in the art of compounding.
Some drug companies also make estrogens and progesterone from plants like soy and yams. Some of these are also chemically identical to the hormones made by your body. These other forms of MHT are available by prescription. These estrogens and progesterone made by drug companies are regulated and approved by the FDA.
Many women wonder if a dietary supplement, such as soy, black cohosh, or wild yam, can help relieve hot flashes instead of using menopausal hormone therapy. While dietary supplements may seem safe because they are purchased over-the-counter, come from plants and are “natural,” the truth is we don’t know enough about these supplements to know whether they are indeed safe and if they have any effect on easing menopausal symptoms. Plants like soy contain estrogen-like substances called phytoestrogens. Currently, we don’t know whether phytoestrogens carry the same benefits and risks as prescription estrogens, some of which are made from plants like soy. Some herbal substances can have very serious side effects, like liver damage, and some supplements can change how other medicines work by increasing or weakening their effect. And some just don’t work as they claim. Learn as much as you can about a dietary supplement before trying it and talk to your doctor before using any supplements.
There is no single answer for all women who are trying to decide whether to use hormones. You have to look at your own needs and weigh your own individual risks. Here are some questions you can ask yourself:
- Do menopausal symptoms such as hot flashes or vaginal dryness bother you a lot? MHT usually helps relieve troubling symptoms. However, hot flashes or night sweats often go away over time.
- Are you at risk for developing osteoporosis? Estrogen might protect bone mass while you use it. However, there are other drugs that can protect your bones without MHT’s risks.
- Do you have a history of heart disease or risk factors such as high blood cholesterol? If so, using estrogen and progestin can increase that risk even more.
- Do you have a family history of breast cancer? If you have a family history of breast cancer, check with your doctor about your risk.
- Do you have liver disease or a history of stroke or blood clots? MHT, especially taken by mouth, might not be safe for you to use.
In all cases, be sure to talk to your doctor about how best to treat or prevent your menopause symptoms or diseases for which you are at risk. Whatever decision you make now about using MHT is not final. You can start or end the treatment at any time. Each woman is different, and the decision for each one about menopausal hormone therapy will also be different.
This is the last of a series of articles on menopause. If you missed previous articles on Peri-menopause, symptoms, and hormone therapy, you may read them online at HealthyCellsBN.com or call Cheryl at 309-664-2524 to request a copy.
Dele Ogunleye, MD, provides a full range of obstetric and gynecologic services including hormone therapy and fertility issues. You may contact him at 309-808-3068 or www.awhcare.com. Advanced Women’s Healthcare is located at 2111 East Oakland Avenue (next to the Jewel-Osco Plaza).
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