Hormone Replacement Therapy (HRT) helps to alleviate the symptoms of the menopause. Menopause occurs over several months as the menstrual period eventually stops. After one year of no menses, the diagnosis of menopause is made. The age is variable but it usually happens in the late 40’s or early 50’s. Menopause is a natural event and once a woman achieves the status of menopause, she never leaves it. Some women will need to go on hormone replacement therapy to treat symptoms or prevent osteoporosis.
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Written by Dr Kimberly Langdon, MD
Information last reviewed 06/21/19
Hormone replacement therapy or HRT is a treatment used to treat menopausal symptoms including preventing osteoporosis (a degradation of the bones associated with menopause). HRT is either a pill, patch or cream containing estrogen or a combination of both estrogen and progesterone. It is offered to women once they have stopped having periods, especially if they experience severe menopausal symptoms such as hot flashes or night sweats.
During menopause, the levels of estrogen and progesterone (both female sex hormones) fall as the ovaries stop releasing eggs each month. This alters the levels of hormones in your body and produces some of the uncomfortable symptoms associated with menopause, such as hot flashes and night sweats.
Perimenopause refers to the period of time leading up to the menopause and can last for a few years. Anyone who starts the perimenopause before 40 is likely to experience early menopause, probably before the age of 45. During perimenopause, periods do not just stop, but instead they become less frequent and can sometimes last for more than 7 days. Erratic spotting or even excessive blood loss can occur during the perimenopause.
The average age of menopause is 51, but it varies based on genetics, race and whether you smoke or not. It is worth keeping in mind that some conditions and treatment can cause early menopause. Autoimmune diseases, removal of the ovaries and some cancer therapies are a few examples of conditions and treatments that can lead to menopause.
In the majority of cases, menopause occurs naturally as the ovaries gradually stop hormone production. However various other conditions and treatments can cause menopause at any age after puberty. These include:
The average age of menopause is 51 but it varies based on heredity, race, and smoking status.
During menopause, the menstrual cycle may become more irregular. Often periods become less frequent until they stop altogether. But menopause also has several other symptoms that are related to the effect of estrogen on different systems of the body. Here we outline common symptoms of menopause and how they relate to these different bodily systems:
Estrogen plays a role in regulating body temperature. During menopause, these hormones are out of sync and diminished levels of estrogen can cause the following symptoms.
The Urogenital System
Estrogen is involved in the formation of collagen, which is an important substance for the lining of the bladder, urethra, vagina and vulva. A decrease in estrogen can lead to the thinning of the mucosal lining of these areas. In addition, this can cause the vagina to lose its elasticity, to become shorter and narrower. The normal secretions of the vagina and the blood supply to the vagina are also reduced. This leads to the following symptoms:
In addition, as estrogen levels decrease, the production of a substance called glycogen decreases. Glycogen is involved in maintaining the acidity of the vagina. The change in acidity can make the bladder and vagina more vulnerable to bacterial infections. Therefore, this causes an increased risk of the following:
Bone loss occurs as we age, but it can also be affected by gender, family history, diet, exercise and smoking status. During menopause, the low estrogen levels can accelerate bone loss, especially during the first 5 years of menopause. This can lead to the following conditions:
Women are naturally protected against heart disease, however, after menopause women begin to lose this protection and by the age of 65, their risk of having a heart attack is equal to men . This is because after menopause, cholesterol and triglycerides start to increase, deposition of fat changes, clotting factors and other factors that predispose heart disease start to rise. In addition, lower levels of estrogen can lead to overstimulation of the heart causing the following symptoms:
Hormones, especially estrogen, can have a big effect on mood and mental health. This can lead to the following symptoms:
Menopause is diagnosed after one year of having no periods. If the symptoms of menopause are having a negative impact upon your life, you may be suitable for hormone replacement therapy (HRT). To evaluate your suitability, the following tests will be done:
If menopausal symptoms are severe enough to have a negative impact on your life, you may be prescribed hormone replacement therapy (HRT) to treat your symptoms. This will not reverse the menopause, you will not regain your fertility. HRT can be started in postmenopausal women if they are at risk of a fracture or osteoporosis (bone weakening) before the age of 60 or within 10 years [4,5].
HRT contains estrogen or both estrogen and progesterone. Depending upon the variety, they may need to be taken daily or cyclically. HRT is available in a wide range of forms including:
The International Menopause Society guidelines state that HRT is the most effective treatment for menopause symptoms such as hot flashes. However if you do not wish to take HRT, some anti-depressant medications can be used instead. Examples of suitable antidepressants are: Paroxetine, Venlafaxine, Escitalopram, and Desvenlafaxine [4,5].
HRT is not suitable for patients with the following conditions:
Common side effects of HRT include:
It may become lighter, heavier, more spaced out, closer together, last or linger more than 7 days, turn darker brown or black.
They can stay the same, become lighter, heavier, or more irregular, either more frequent or more spaced out. They are related to the change in ovarian function that gradually wanes over time. This fluctuation means fewer cycles are ovulatory.
No periods, hot flashes, night sweats, mental fog, vaginal atrophy-or dryness, moodiness—probably due to feeling hot all the time, and sleep disturbances.
No more premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), sleep disturbances, memory lapses, decreased concentration, increase or decrease in libido.
Weight gain, depression, heart attacks, hair loss.
Yes, a blood test to check your levels of a hormone called FSH (follicle-stimulating hormone). FSH is responsible for telling your ovaries to release an egg and the levels of FSH are altered during menopause and perimenopause.
Exercise, yoga, hormone therapy either oral or vaginally, antidepressants, herbal supplements-soy and others, for osteoporosis, calcium and Vitamin D and other medications to build back and strengthen bones.
According to the International Menopause Society, the most effective form of HRT is any HRT which includes tibolone and the combination of estrogen and bazedoxifene (CE/BZA).
Abstinence is the practice of avoiding sex altogether, be it as a means of birth control or as a life choice. It is free, has no side effects, is generally harmless and is effective against preventing STDs and pregnancy, so long as it is practiced.
Iron deficiency anaemia is one possible cause of hair loss in men and women. There are several options available to effectively treat the condition including dietary changes, medication and clinical procedures to promote hair growth and prevent further hair loss.
Prediabetes means your blood sugar levels (glucose dissolved in your body) are more than normal but still less those of a diabetic. Glucose is vital for every human body and serves us with energy through a process named glycolysis. Several hormones constantly check the glucose dissolved in our body to stay in a balanced stage, which is called homeostasis. Those who have trouble keeping their blood sugar levels balanced suffer from diabetes.
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