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What is menopause?

Menopause SymptomsDuring the time of the menopausal transition (perimenopause), your periods can stop for a while and then start again. Therefore, the only way to know if you have gone through menopause is if you have not had your period for one year. (And it’s not menopause if your periods stop for some other reason, like being sick.) The average age of menopause is 51, but for some women it happens as early as 40 or as late as 55.

After you go through menopause, you are considered in the post-menopausal stage of your life. Your female hormones won’t go up and down the way they used to with your periods. They will stay at very low levels.

Some women worry about menopause, and it can cause uncomfortable symptoms. But there are many ways to treat symptoms and stay active and strong.

Usually, menopause is natural. That means it happens on its own, and you don’t need medical treatment unless your symptoms bother you. Sometimes, though, menopause is medically induced, which means it’s caused by an operation or medication. If so, you should work closely with your doctor to feel comfortable and take good care of your health.

What is perimenopause?

Did you know? If you’re still having periods, even if they are not regular, you can get pregnant. Talk to your doctor about birth control. Keep in mind that most methods of birth control will not protect you from sexually transmitted infections (STIs), including HIV.

Perimenopause, or the menopausal transition, is the time leading up to a woman’s last period. Periods can stop and then start again, so you are in perimenopause until a year has passed since you’ve had a period. During perimenopause a woman will have changes in her levels of estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE), two female hormones made in the ovaries. These changes may lead to symptoms like hot flashes. Some symptoms can last for months or years after a woman’s period stops.

There is no way to tell in advance how long it will take you to go through the menopausal transition. It could take between two and eight years.

Sometimes it’s hard to tell if you are in the menopausal transition. Symptoms, a physical exam, and your medical history may provide clues to you and your doctor. Your doctor also could test the amount of hormones in your blood. But because hormones change during your menstrual cycle, these tests alone can’t tell for sure that you have gone through menopause or are getting close to it. Unless there is a medical reason to test, doctors usually don’t recommend it.


Menopause affects every woman differently. Some women have no symptoms, but some women have changes in several areas of their lives. It’s not always possible to tell if these changes are related to aging, menopause, or both.

Some changes that might start in the years around menopause include:

Irregular periods

Your periods can come more often or less, last more days or fewer, and be lighter or heavier. Do not assume that missing a couple of periods means you are beginning the menopausal transition. Check with your doctor to see if you are pregnant or if there is another medical cause for your missed periods. Also, if you have not had a period for a year and start “spotting,” see your doctor. Spotting could be caused by cancer or another health condition.

Hot flashes

Also called hot flushes, these are a sudden feeling of heat in the upper part or all of your body. Your face and neck may become red. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow.

Trouble sleeping

You may find it hard to sleep through the night. You may have night sweats, which are hot flashes that make you perspire while you sleep. You may also feel extra tired during the day.

Vaginal and urinary problems

These problems may start or increase in the time around menopause. The walls of your vagina may get drier and thinner because of lower levels of the hormone estrogen. Estrogen also helps protect the health of your bladder and urethra, the tube that empties your urine. With less estrogen, sex may become less comfortable. You also could have more vaginal infections or urinary tract infections. Some women find it hard to hold their urine long enough to get to the bathroom (which is called urinary urge incontinence). Urine might also leak out when you sneeze, cough, or laugh (called urinary stress incontinence).

Mood changes

You could have mood swings, feel crabby, or have crying spells. If you had mood swings before your monthly periods or if you had depression after giving birth, you may have more mood issues around the time of menopause. Mood changes at this time also could be coming from stress, family changes, or feeling tired. Mood swings are not the same as depression.

Changing feelings about sex

Some women feel less aroused, while others feel more comfortable with their sexuality after menopause. Some women may be less interested in sex because sex can be more physically uncomfortable. Learn about what you can do to address any concerns about sex.

Osteoporosis (OS-tee-oh-poh-ROH-sis)

This is a condition in which your bones get thin and weak. It can lead to loss of height and broken bones.

Other changes

You might become forgetful or have trouble focusing. Your waist could become larger. You could lose muscle and gain fat. Your joints and muscles also could feel stiff and achy. Experts do not know if some of these changes are a result of the lower estrogen levels of menopause or are a result of growing older.

The symptoms that come with menopause can seem challenging. You can feel better, though. Call today to schedule a consultation.
As our bodies age, hormone levels decrease over time. By replacing the body’s natural hormones to achieve the normal, balanced levels we had in our youth, physicians have been able to turn back the clock on the aging process. Helping patients prevent age-related illnesses, reverse biological age, extend life expectancy, and significantly improve the quality of ensuing years is what has been accomplished through natural hormone replacement therapy. Both men and women are subject to these symptoms. In females it is known as menopause/perimenopause, and in males it is known as andropause.

(Note: Symptoms and results may vary between individuals)

Increased Body Fat, Mood Swing,Thinning Hair, Sexual Disinterest, Memory Loss, Irregular Periods, Headaches, Fatigue, Depression, Reduced Libido, Hot Flashes, Insomnia, Reduced Cognitive Functions, Erectile Dysfunction, Loss Of Muscle Mass, Osteoporosis

What Are Bio-identical Hormones?

Bio-identical hormones are hormones that are structurally identical to the hormones we produce in our own bodies. Because they are identical, these hormones mimic the exact chemistry occurring naturally in the body. The body produces (or previously produced) these same hormones, so there are much fewer, if any, negative side effects.

The term bio-identical has basically become a catch-all phrase for anything that is not a synthetic hormone. It is commonly applied to look-alike molecules derived from “natural” plants that are substituted for our own endogenously-produced hormone molecules. Natural or bio-identical hormones are made in a laboratory by converting natural plant compounds from wild yams and soybeans into chemical molecules identical to those made in the human body for 17-beta estradiol, progesterone, or testosterone.

These sources of plant hormones mimic the chemical structure of hormones produced by the human body. The premise is that the body cannot distinguish between synthetic bio-identical hormones and the hormones female ovaries produce naturally.

Bio-identical hormones are available in standardized tablets, patches, compounded creams, gels and injectable prescriptions.
What is hormone replacement therapy?

Hormone Replacement Therapy (HRT) provides women with the female hormones that decrease as they age. When the hormone estrogen is given alone, it is usually referred to as “ERT.” When the hormone progestin is combined with estrogen, it is generally called “HRT.” Estrogen is a female hormone that brings about changes in other organs in the body. Progesterone is a female hormone that prepares the uterus for a pregnancy each month. During the transition to menopause (“perimenopause”) these hormone levels start to fluctuate, causing some uncomfortable symptoms. When the ovaries stop producing estrogen and progesterone, menstrual periods cease and the woman has experienced menopause.

What are the benefits of HRT?

HRT has been used to relieve the short-term symptoms of menopause, such as hot flashes, sweats, and disturbed sleep. It is also believed to be useful in preventing or alleviating an increased rate of bone loss that leads to osteoporosis. In the recent past, HRT also was prescribed to help prevent heart disease, but new evidence shows that heart health should not be a reason to take HRT. New study results now show that HRT does not cut the risk of heart attack and death for women with established heart disease, and it is unclear whether HRT can help prevent the onset of heart disease in healthy postmenopausal women. Preliminary evidence shows that HRT may be helpful in preventing Alzheimer’s disease, colon cancer, and macular degeneration (age-related vision loss).

See also: Estrogen Information Center for the latest estrogen news and information. (7/15/03)

What are the risks of HRT?

Short-term side effects: Some women report side effects from taking HRT, including unusual vaginal discharge and bleeding, headaches, nausea, fluid retention and swollen breasts. Some women think HRT will make them gain weight while taking HRT, but research now shows this is not true. Some women do gain weight during menopause, but it is because their metabolism slows down as they age, and they may not be increasing their amount or level of physical activity. Short-term benefits or side effects should become apparent within weeks or months after treatment begins.

Long-term risks (These will not be readily apparent for each individual woman):


There is concern that HRT can increase the risk of some cancers. When estrogen is taken alone, it raises the risk of endometrial cancer (lining of the uterus). Adding progestin with estrogen (HRT) can dramatically reduce this risk. Progestin is added to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus, so women who still have an intact uterus are generally given this combined therapy.

There are some studies that suggest long term use of HRT (more than 10 years) increases the risk of breast cancer. While there is no definite proof that HRT increases the risk of breast cancer, two new studies that published in the winter of 2000, suggest that combined HRT (estrogen plus progestin) increases the risk of breast cancer more than taking estrogen alone. The National Cancer Institute (NCI) explains that in the first study, the risk for breast cancer among women who had used any form of HRT during the past 4 years was higher than the risk for women who did not use HRT. For women who had taken the combination HRT, however, the risk of breast cancer increased by 8 percent per year; compared to a one- percent increase for women taking estrogen alone. There was no increase in risk among women who had stopped using either type of HRT for 4 years or more. In the second study on HRT, the risk of developing breast cancer increased by 24 percent for every 5 years of use; compared to a 6 percent increase for estrogen-only therapy. Both studies reported that the increased risk of breast cancer associated with either ERT or HRT was higher in thin women. This is an interesting finding, since obesity is a risk factor for breast cancer.

The Hormone Foundation, part of the Endocrine Society and a recognized authority for endocrine-related consumer health information, explains the actual risks described in these studies as:

A woman taking estrogen replacement therapy (ERT) for less than 2 years for relief of menopausal symptoms has about a 1 in 10,000 chance of developing a breast cancer due to use of this hormone, compared to a 1 in 1200 chance for HRT for the same time period.
A 50 year old woman has about a 1 in 400 chance of developing a breast cancer that she would not otherwise have developed if she takes estrogen alone for a ten year period, compared to a 1 in 50 chance for HRT.

To make matters more confusing, recent research suggests that HRT might lower the risk of recurrence in breast cancer patients, but increase the risk of a new cancer in the other breast. The decision to take HRT should not be based on a single study, however, but on an overall look at the risk and benefits and how they fit with your personal health profile. It is important to note that these studies are not the last word on HRT and breast cancer risk. There is much more work ahead to clarify these results.

Breast Density

Taking both estrogen and progestin also can affect a woman’s breast density. Increased breast density from HRT makes it more difficult for a radiologist to read some mammograms, leading to the need for follow-up mammograms or breast biopsies. Increased density also is a concern because other studies have shown that women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk for breast cancer. However, it is not known if increased breast density due to HRT carries the same risk for breast cancer as having naturally dense breasts.

Data from the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial at NCI indicate that about 25 percent of women who use combined HRT have an increase in breast density on their mammograms, compared to about 8 percent of women taking estrogen alone. One study showed that stopping HRT for about 2 weeks before having a mammogram improved the readability of the mammogram. However, further research is needed to confirm the usefulness of this approach.

Heart Disease

Two studies released in July 2001 confirm a pattern of an early increased heart risk for women with established heart disease who take HRT. The American Heart Association (AHA) recommends that women should not be prescribed HRT for the sole purpose of preventing second heart attacks. Despite the early risk of heart attack and death found in these studies, there is not enough evidence to advise women with heart disease to stay away from HRT altogether. And heart disease patients who have been on hormones for a while and are happy with the therapy can continue taking it. Experts are still waiting for the results of trials looking at HRT and the prevention of heart disease, so for now AHA concludes that there is not enough evidence to recommend HRT for preventing heart disease.

Does the duration of taking HRT affect breast cancer risk?

There is considerable uncertainty about the relationship between a woman’s risk of developing breast cancer and the length of time that she receives HRT. Some women take HRT for only a few years, until the worst of their menopausal symptoms have passed, while others take it for a decade or more. Some researchers believe that there is little or no increased risk of breast cancer associated with short-term use (3 years or less) of either HRT with estrogen alone or estrogen combined with progestin, while long-term use (more than10 years) is linked to an increased risk.

The two most recent studies suggest that, with short-term use of HRT, the benefits seem to outweigh the risks, but for long-term use, the benefits must be carefully weighed against the risks.

What kind of research is underway to answer some of these confusing questions?

The Institute of Medicine will be reviewing the medical research on the use of HRT to prevent heart disease, osteoporosis and other problems associated with the aging process, and should release its findings in early 2002. The National Institutes of Health’s (NIH) Women’s Health Initiative, the largest clinical trial in the U.S., is exploring the association between HRT and the development of breast and colon cancer, heart disease and osteoporosis. Results from this study, available in 2005, should provide us with valuable information on the use of HRT. In the meantime, you should discuss these issues with your health care provider.

Why is menopausal hormone replacement therapy used in spite of the cancer risk?

The known benefits of HRT can improve the quality of life for many women, by reducing uncomfortable hot flashes, night sweats, and vaginal dryness. There also is evidence that HRT helps prevent and treats osteoporosis, and preliminary evidence that it can help prevent other problems associated with age, including Alzheimer’s disease, colon cancer and deterioration of eyesight. The addition of progestin to the treatment has dramatically reduced the risk of endometrial cancer. Until the questions about the risk of breast cancer are more fully answered, many women and their health care providers believe the benefits outweigh the risks. However, women considered to be at high risk for breast cancer, or who have other concerns about the risks, might want to use alternative methods to alleviate menopausal symptoms. Family history of breast cancer, early age of the first menstrual period (menarche), late age of child bearing, high fat diet, obesity, increased breast density on mammograms, and certain benign breast lesions increase the underlying risk of developing a breast cancer. These factors need to be considered when deciding to take HRT. A woman also might consider any family history of osteoporosis or heart disease when making a decision about HRT.

Are there other drug therapies known to treat conditions related to menopause?

A class of drugs called SSRIs (such as Prozac and Zoloft) is very effective in treating menopause-related symptoms of depression or mood changes. Vitamin E and Clonidine, a drug typically used for high blood pressure, can alleviate hot flashes. To prevent osteoporosis, bisphosphonates, alendronate, raloxifene and calcitonin are used in women who are at high risk for bone loss. Lastly, a class of cholesterol-lowering drugs called HMG-CoA-reductase inhibitors (statins) are proven to be effective for reducing risk of heart disease and are being explored to prevent osteoporosis. No alternatives to estrogen exist for prevention of Alzheimer’s disease, colon cancer, and macular degeneration – diseases for which preliminary evidence suggests HRT is beneficial.

Who should not use HRT?

HRT is often not recommended for women who have any of the following conditions:

  • Vaginal bleeding of an unknown cause;
  • Suspected breast cancer or history of breast cancer;
  • History of endometrial cancer or cancer of the uterus;
  • Chronic disease of the liver; or
  • History of venous thrombosis (blood clots in the veins or legs, or in the lung). This includes women who have had thrombosis or blood clots during pregnancy or when taking birth control pills. Although the risk of blood clots in women is very low, HRT increases the risk.

This information was adapted from “Age Page: Hormone Replacement Therapy: Is it for you?” prepared by the National Institute on Aging, from the NCI’s “Menopausal Hormone Replacement Therapy, Cancer Facts,” from the Centers for Disease Control and Prevention’s (CDC) booklet, “To Be or Not to Be – On Hormone Replacement Therapy,” and from ACOG’s Practice Bulletin, “Use of Botanicals for Management of Menopausal Symptoms.”

Adapted from the Office on Women’s Health in the Department of Health and Human Services.

Publication Date: August 2001