Menopause is a natural part of aging that typically affects women between the ages of 45 and 55, and is triggered as a woman’s estrogen levels begin to decline.
The average age for a woman affected by menopause is 51. However, it has been known for women to experience it before they reach 40 years of age.
Figures suggest that 1 in 100 women suffer from this early menopause which is also known as premature menopause or premature ovarian insufficiency.
Menopause can be a controversial subject, particularly with regard to hormone replacement therapy. A certain large-scale study reported that HRT does not shorten lifespan and that the benefits of HRT outweighed the risks. The Women’s Health Initiative trial found that HRT was not associated with risk of all-cause, cardiovascular, or cancer mortality in postmenopausal women during an 18-year follow-up of 27,000 women.
Menopause affects every woman, and for many this natural stage in life can become a time of physical and emotional discomfort. The most common symptoms include hot flashes, night sweats, insomnia, anxiety, mood swings, and weight gain, which are in part caused by the diminishing levels of estrogen.
Longer-term concerns can include osteoporosis, cancer, dementia, and heart disease. The average age for a woman to reach menopause is 51 years and with an aging population, it is predicted that the number of post-menopausal women will increase to over 1 billion by 2025.
Menopause Transition
Perimenopause or ‘menopause transition’ is the time when the ovaries will start to decrease the amount of estrogen they produce and physiological changes first become noticeable, usually beginning on average 3-4 years before the menopause. During menopause, the ovaries no longer release ovicells, and estrogen production slows drastically.
Menopause occurs when there has been a permanent cessation of menstruation for 12 months. The majority of menopausal symptoms usually improve within 5 years of the final menstruation.
It is estimated that around 80% of women will experience symptoms and for 10% of women, symptoms can last for up to 12 years.
Women have a hard decision to make therefore with regard to menopause, and for many, the risks of HRT may still outweigh the benefits.
Whichever decision women choose to make, menopause can become less overwhelming if we gain an understanding of the hormonal changes that occur during this time, their effect on the body, and what we can do to support the body to adapt to these changes – by doing so we can help to make the menopause a positive experience rather than one to fear.
Menopause and Osteoporosis
Estrogen helps to prevent deterioration of bone tissue and maintains bone density. The long-term effects of low estrogen levels can therefore increase the risk for postmenopausal osteoporosis.
It is estimated that women lose on average 10% of bone mass within 5 years of menopause. It is important therefore to maintain a healthy bone density with correct nutrition before, during, and after menopause.
Healthy bones need specific nutrients, and without these, the cycle of bone formation and bone resorption is disturbed, resulting in alterations in bone mass, distribution of bone, etc.
HRT for Menopausal Women
Our clinic helps you take back your comfort and vitality with specialized care, and hormone replacement therapy is our focus. It’s what we do, which means we have developed a base of knowledge and experience, a record of success, and a number of key efficiencies that other providers can’t claim.
In fact, we treat a number of women sent to us by their doctors, who recognize the need for more informed, nuanced care.
Individualized attention is backed by a detailed understanding.
When it comes to hormones, “nuance” is the right word. And particularly so for women, whose treatment with hormone replacement therapy is not as straightforward as it tends to be for men. This is where our experience and knowledge are important.
Every woman is unique, meaning one of a kind. At the same time, symptoms can be the result of low levels of a hormone, or two hormones, or three, or the result of imbalances.
In addition, levels can be affected by the stress and toxins that we normally encounter as we live our lives. Our experienced, compassionate medical professionals evaluate and carefully consider all of the many factors involved, including:
- estrogen (estradiol) and progesterone levels;
- testosterone levels (free and total);
- human growth hormone;
- DHEA-S hormone;
- cortisol levels;
- thyroid function;
- symptoms;
- lifestyle;
- health history.
Lab Testing and Diagnostics for HRT
At our clinic, we run bloodwork and conduct a thorough evaluation and history, then take the care and time necessary to create a treatment plan that will work for you.
One important consideration is the fact that “normal” hormone levels are not the same as optimal levels. Whereas many other providers are looking to bring hormone levels back to normal, our objective is to get you to where you’re feeling significantly better, like you remember.
Treatment is designed specifically for your needs and the best results.
Hormone replacement therapy is not one-size-fits-all care. Not even a little bit. We continually watch and adjust for changes in hormone levels and symptoms in order to ensure you’re always receiving the right dose for you.
This is also how we’re able to minimize the risks associated with HRT. Not everyone does this, but we feel it’s vitally important.
Types of HRT Available
There are more than 50 types of HRT available: HRT can be given orally (tablets), transdermally (through the skin); subcutaneously (a long-lasting implant); or vaginally.
- Cyclical HRT mimics the normal menstrual cycle. Estrogen is taken every day and progestogen for 12 to 14 days. At the end of each course of progestogen, there is some bleeding as the body “withdraws” from the hormone and the womb lining (endometrium) is shed. Progestogen regulates bleeding and protects the endometrium from harmful pre-cancerous changes.
- Estrogen-alone HRT is normally prescribed to women who have had their womb removed (hysterectomy). The benefits of all HRTs are derived from estrogen; progestogen is only necessary to protect the womb lining.
- In continuous combined therapy HRT (CCT) combinations of estrogen and progestogen are prescribed continuously to achieve period-free HRT. Usually, women start on cyclical HRT and change to CCT later.
- Tibolone is a synthetic form of period-free HRT which may have similar benefits to CCT. It is taken continuously in tablet form.
- Long-cycle HRT uses a formulation that causes withdrawal bleeds every three months instead of every month, and is most suited to women who suffer side effects when taking a progestogen.
- Local estrogens, such as vaginal tablets, creams, or rings, is used for treating local urogenital problems, such as dry vagina, irritations, bladder problems, or infections.
- Testosterone, in the form of a gel or subcutaneous implant, is indicated for women with decreased libido. It should be used in conjunction with conventional estrogen-containing HRT and women with a uterus require progestogens to protect the endometrium.
If you need some additional consultation or want to apply for starting HRT in our clinic, get in touch here!