Menopause and Hormone Replacement Therapy
October 2020
What is menopause?
Menopause marks the end of menstrual cycles for a woman. Diagnosis happens after 12 months without a period. Typically, menopause occurs in your 40s or 50s with an average age of 51 in the United States.
Although menopause is a natural biological process, it has some miserable symptoms associated with it. Some symptoms begin to occur while you are in perimenopause, which is the time (months or years) leading up to menopause. Symptoms can be physical like hot flashes or emotional like mood changes. Luckily, there are treatments available for symptomatic relief.
What are the symptoms of menopause?
• Irregular periods
• Vaginal dryness
• Hot flashes
• Chills
• Night sweats
• Sleep problems
• Mood changes
• Weight gain and slowed metabolism
• Thinning hair and dry skin
• Loss of breast fullness
• Low libido
Image Credit: https://www.webmd.com/menopause/guide/menopause-basics#1
Symptoms are different for everyone. During perimenopause, irregular periods are to be expected. Often menstrual periods will skip a month and return, or skip several months and then start monthly cycles again for a few months. Periods typically happen on shorter cycles meaning that they will be closer together. Even though periods are irregular, pregnancy is still possible. If you’ve skipped a period but aren’t sure if you have started the menopausal transition, consider taking a
pregnancy test.
What causes menopause?
• Natural decline of reproductive hormones – As you approach your late 30s, ovaries begin making less estrogen and progesterone and fertility declines. As you enter your 40s, menstrual periods will begin to change. They may become longer or shorter, heavier or lighter, and more or less frequent until they finally stop.
• Hysterectomy – A partial or full hysterectomy will make menstrual periods end, but only a full hysterectomy will send your body into immediate menopause. A partial hysterectomy leaves one or both of your ovaries intact, so your body is still producing hormones and releasing eggs.
• Chemotherapy and radiation therapy – Cancer therapies can induce menopause causing symptoms like hot flashes during or shortly after the course of treatment. However, changes to menstruation and fertility are not always permanent, so birth control methods may be necessary.
• Primary ovarian insufficiency – According to the Mayo Clinic, about 1% of women experience menopause before age 40. This may result from primary ovarian insufficiency, which means that your ovaries fail to produce normal levels of reproductive hormones. This can stem from genetic factors or an autoimmune disease. For these women, hormone therapy is recommended at least until the natural age of menopause is reached in order to protect the brain, heart, and bones.
What complications can arise after menopause?
Heart and blood vessel (cardiovascular) disease
When estrogen levels decline, the risk of cardiovascular disease increases. Heart disease is the leading cause of death in men and women.
Osteoporosis
Osteoporosis causes bones to become brittle and weak, which can lead to an increased risk of fractures. During the first few years of menopause, bone density may drop at a rapid rate.
Urinary incontinence
The tissues of the vagina and urethra lose elasticity which can make you experience
frequent, sudden urges to urinate, followed by an involuntary loss of urine, or the loss of urine with coughing, laughing, or lifting. You
may experience an increase in urinary tract infections.
Sexual function
Vaginal dryness is a common symptom associated with menopause. It occurs from decreased moisture production. Between dryness and the loss of elasticity, you may experience discomfort or slight bleeding during intercourse.
Weight gain
Metabolism slows during menopause, so many women gain weight. Increased exercise and decreased caloric intake may be necessary to maintain your current weight.
What is Hormone Replacement Therapy (HRT)?
Hormone replacement therapy is supplementation of specific hormones to alleviate menopausal symptoms. It is called by many names including HRT, bioidentical hormone replacement therapy (BHRT), and ET (estrogen therapy) to name a few. At Compounding Solutions Pharmacy & Wellness, we use BHRT to match the hormones that your body produced. Bio-identical hormones are made from yam-derived steroids that are chemically altered to exactly match the hormones produced by the body. Using hormone levels from lab tests, we can customize a formulation to alleviate your specific symptoms. We recommend tracking your symptoms.
What are the hormones are used in hormone replacement therapy?
Our bodies have multiple hormones that have lots of jobs in our bodies. We work with your doctor to find the right balance for you. Let's explore the different types of hormones.
Estrogen (Estrone, Estriol, & Estradiol)
Estrogen is prescribed in multiple ways. Most women take a combination of Estriol and Estradiol known as Bi-est. Sometimes, a combination of
all three is warranted and is called Tri-est. Symptoms of low estrogen include hot flashes, night sweats, irregular periods, mood swings, and vaginal dryness. Estrogens may also be used to prevent osteoporosis and to maintain bladder and urinary tract function. If your estrogen levels are out of balance, then you may experience nausea, stomach upset, bloating, headache, dizziness, breakthrough bleeding, breast tenderness, fluid retention, weight gain, and mood swings.
Progesterone
Progesterone is used to treat many conditions, including symptoms of menopause, symptoms of PMS, abnormal periods, maintenance of pregnancy, endometriosis, and osteoporosis. Progesterone functions in the body as a mild diuretic and a natural antidepressant. It also helps the body to use fat for energy; normalizes blood clotting, thyroid hormone action and blood sugar; and counteracts estrogen side effects. Progesterone is also a precursor to other hormones including cortisol and corticosteroids and is through to help build bone and improve libido. If your progesterone levels are out of balance, you may experience excessive sleepiness, dizziness, bloating, susceptibility to yeast infections, and functional estrogen deficiency.
Testosterone
Testosterone is not only in men. It is also produced in the female body but at much lower levels. Testosterone can be helpful for increasing sex
drive, energy, and muscle strength. If your testosterone levels are too high, you may experience oily skin, acne, coarsening of body hair, and deepening of the voice.
DHEA
DHEA, or Dehydroepiandrosterone, is a precursor for many other hormones in the body. In cells it can be converted to testosterone or estrogens. DHEA may enhance the immune system to help protect against infection, injury, and illness. It may also be helpful in enhancing energy and muscle strength. If your DHEA levels are too high, you may experience acne, oily skin, agitation, and possible hair loss.
What dosage forms are available?
Topical Creams and Gels
Topical Solutions
Troches
(dissolved between the cheek & the gum)
Miniserts
(small vaginal tablet)
Capsules
Vaginal Suppositories
Vaginal Creams
Injectables
Implantable Pellets
(implanted at a doctor's office)
What are non-hormonal options for menopause?
• Vitamin E cream or suppositories (available with a prescription)
• Hyaluronic Acid, Vitamin A, and Vitamin E suppositories (available with a prescription)
What supplements are available for menopausal symptoms?
• Estrosense - A blend of vitamins and herbs designed to promote natural hormone balance.
• Menopause Support - A blend of vitamins and herbs like black cohosh, isoflavones, and dong quai to help relieve symptoms of declining estrogen levels.
• BioDIM I-3-C Complex - This unique formulation may help support healthy estrogen metabolism in men and women.
• Black Cohosh - Black Cohosh, a plant in the Buttercup family, was traditionally used by Native Americans to relieve a variety of ailments including menopausal symptoms.
• Ginseng - Ginseng hasn't been proven to improve physical symptoms of menopause, but it may help boost your mood and improve your sleep.
• DHEA - DHEA is a precursor to many other hormones like estradiol and testosterone.
• Vitamin D - Vitamin D is essential for calcium absorption. This will help keep bones strong. Bone density can drop during the first few years of menopause.
Ask you doctor or pharmacist if BHRT is right for you!
Sources:
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401
https://www.webmd.com/menopause/ss/slideshow-menopause
https://my.clevelandclinic.org/health/articles/15223-menopause-non-hormonal-treatment--relief-for-hot-flashes
https://www.healthline.com/health/menopause/alternative-treatment#vitamin-d
https://womensense.com/en-us/products/estrosense-en-us/3
https://www.nccih.nih.gov/health/black-cohosh