What are the symptoms of menopause?

The absence of estrogen in the body may variably affect a woman. Some women have no symptoms. Other women have one or more of several symptoms:

• Hot flushes
• Vaginal dryness
• Urinary incontinence
• Mood swings
• Depression
• Decreased libido
• Skin dryness
• Arthritis-like symptoms
• Cognitive dysfunction (memory issues)

Why use hormone replacement therapy?

Studies have shown that estrogen replacement can delay the effects of aging. It has been shown to help in the following areas:

• Central Nervous System (CNS)
• Estrogen is most effective for hot flashes and other CNS symptoms
• May also help dementia and Alzheimer’s
• Progesterones can help in decreasing hot flashes as well, but are less effective, therefore requiring higher doses and potentially more side effects
• Osteoporosis
  Estrogen has shown to be effective in decreasing bone breakdown.
  Estrogen supplements should be coupled with increasing dietary calcium and supplements, and possibly medications called bisphosphonates.
• Genital thinness and dryness
  Estrogen can decrease these irritative symptoms and decrease the risk of urinary tract infection.
• Cardiovascular
  One mechanism by which estrogens protect the heart is by lowering LDL and increasing HDL (the “good” cholesterol) This was shown in the PEPI trial

What about cancer?

• Endometrial hyperplasia and endometrial cancer
  Long-term use of unopposed estrogen has been associated with endometrial hyperplasia (abnormal overgrowth of the endometrium) and endometrial cancer. Progesterone treatment coupled with estrogens, however, is protective. Women with a uterus should receive a form of progesterone replacement therapy.

• Breast Cancer
  There is an increased incidence of breast cancer in women with long-term exposure to estrogen from internal sources (women with early menses, late menopause, and obesity). Some studies have suggested that estrogen from hormone replacement therapy may increase the risk of breast cancer, but other studies have not shown any association. Most studies show that estrogen neither causes nor protects against breast cancer.

  Estrogen may be a weak breast cancer promoter in a group of undefined women, if on estrogen for more then 10 years. All women, regardless of whether or not they are taking estrogen, should examine their breasts monthly, and have regular physicals, including a mammogram every 1-2 years after 40 and yearly after 50. Progesterones have also been reported to possibly stimulate breast cancer growth, studies are inconclusive For women with a previous personal history of breast cancer, estrogen replacement therapy should be considered cautiously, and with the input from an oncologist.

What other side effects are there?

• Blood Clots
  Two to four-fold increase in risk of blood clots. Keep in mind risk is very low to begin with. The increased risk must be weighed against the benefits.
• Endometriosis
  For women with a history of endometriosis, hormone replacement therapy is not contraindicated. Higher doses of estrogen may cause recurrence of endometriosis for women with an intact uterus
• Hypertension
  No significant increase in blood pressure.
• Weight gain
  No significant increase in weight
• Bleeding
  Most common side effect of hormone replacement therapy, sometimes caused by polyps or fibroids, and should be evaluated with ultrasound and hysteroscopy.

Return To Top

Who should not have hormone replacement therapy?

Women who meet the following criteria should not have HRT:

• Unexplained vaginal bleeding
• Severe active liver disease or chronically impaired liver function
• Recent leg blood clot or clot in the lung
• History of advanced uterine cancer

How do I take hormone replacement therapy?

If you have a uterus:

• Continuous combined – Estrogen and progesterone everyday
• Continuous sequential – Estrogen everyday, and progesterone for part of the cycle
• Cyclic combined – Estrogen and progesterone everyday, then a break from both
• Cyclic sequential – Estrogen every day, then a break, and progesterone for part of the cycle, then a break

If no uterus:

Estrogen only and continuously, no need for progesterone

Consider transdermal estrogen if:

• High triglycerides
• Gallbladder disease
• Migraine headaches
• GI upset
• Compliance problems

What about natural estrogens?

Phytoestrogens, also known as isoflavones are very weak estrogen agonists, and work best when there is little circulating estradiol to compete with for receptor sites.

• Diet:
  Phytoestrogens are contained in soy food products, flax seed and some legumes. Asian diets have about 10 times the amount of phytoestrogens as the average American diet, and it has been suggested that because of this Asian women have fewer hot flashes, hip fractures, and hormone dependent cancers than American women.

In all areas of postmenopausal health, more blinded randomized controlled trials are needed to look at the actual benefit.

Return To Top