What Are the Symptoms of Menopause?

The absence of estrogen in the body affects women differently. Some women have no symptoms. Most women have one or more of several symptoms:

• Hot flashes
• Night sweats
• Vaginal dryness
• Mood swings
• Depression
• Decreased libido
• Skin dryness
• Arthritis-like symptoms
• Mental dysfunction, or “brain fog.”

The average age of menopause is 51-52. The average length of hot flashes is 4 years.

What is Perimenopause?

A woman is considered in “menopause” when she has gone one year without a period. Perimenopause is defined as the events preceding menopause. This time is characterized by irregular cycles. The ovaries become dysfunctional as the number of eggs diminishes.

Perimenopause is a time of irregular bleeding. Some women do not have a period for several months. When the period does not come, some women experience menopausal symptoms briefly until the period resumes.  Other women may have prolonged episodes of bleeding as hormones fluctuate.

Not knowing what the ovaries will do from one week to the next can create distress, especially if mood swings develop and emotions are out of control.

What Does Hormone Replacement Therapy Treat or Help With?

The primary goal of HRT is to alleviate the physical and emotional symptoms associated with perimenopause and menopause. The absence of estrogen affects every woman differently. While some women experience zero symptoms, most deal with a combination of disruptive issues. HRT can address all of these:

• Hot flashes go away
• Sleep tends to improve
• Vaginal dryness is not a problem 
• Mood swings go away
• Depression improves
• Libido improves
• Skin feels less dry
• Arthritis-like symptoms improve
• Brain fog improves

When you start therapy, you can expect hot flashes to vanish and your sleep quality to dramatically improve. By addressing these symptoms at their root cause, HRT does more than just mask your discomfort. It restores your body's hormonal balance so you can enjoy a much higher quality of life and even potentially increase your longevity.

How is Bio-Identical HRT Different from Standard Treatment?

You will often hear the term "bio-identical" when researching hormone therapy. This term specifically refers to the non-oral absorption of hormones, such as through a patch, gel, cream, or pellet. The FDA approves many bio-identical patches, creams, and gels, and standard insurance plans typically cover them.

However, compounded creams and pellets do not have FDA approval and usually lack insurance coverage. Some compounding pharmacies claim they provide "natural hormones," but this is misleading. They actually use the exact same manufactured hormones as the companies producing commercial HRT. Furthermore, some compounded products contain unnecessary weak estrogen metabolites like estrone or estriol.

We strongly caution patients about the unethical practices surrounding some pellet prescriptions. Some prescribers insert excessively high doses of testosterone into pellets, creating levels that act like anabolic steroids. While this provides an initial energy boost, it can lead to permanent unwanted side effects such as facial hair growth and a deepening voice. We strictly follow the American College of Obstetricians and Gynecologists' guidelines to ensure your safety.

Are There Other Options Besides Hormone Replacement Therapy?

Modern medical science led to the production of estrogen for human consumption and had an enormous impact on quality of life for many women. However, not all women have severe enough symptoms to require HRT. Breast cancer survivors are told to avoid HRT. Alternatives to HRT include:

• SSRI antidepressants: Many studies have shown some reduction in hot flashes, but not as effective as estrogen. One of them, called "Brisdelle," is FDA-approved.
• NK3 antagonists: This class of medicine works directly in the brain to halt hot flashes and is highly effective. The only current FDA-approved product is “Veozah”. It was not assessed for other symptoms such as depression and mood swings.
• Herbal remedies: Examples include black cohosh, dong quai, St. John’s wort, maca, valerian root, ginseng, evening-primrose oil, red clover, and licorice. According to the Menopause Clinic, London, “Most of the complementary medicines on the market have never been subjected to the rigorous scrutiny for safety and effectiveness that is required for conventional medicines.”
• Phyto-Estrogens: These are soy products that are controversial, with mixed results in placebo-controlled studies.
• Acupuncture: May help with hot flashes.
• Yoga: Yoga and other exercise programs have been recommended to reduce hot flashes.
• Other FDA-Approved Medications Used ”Off-Label”: Medications on the market for other reasons that have been shown to help hot flashes include gabapentin, clonidine, belladonna, and mirtazapine.

Many experts express concern about ingesting unknown compounds long-term. It is impossible to be sure an herbal compound worked, or that the menopausal symptoms would have gone away on their own. None of these alternatives is as effective at relieving menopausal symptoms as HRT.

Is Hormone Replacement Therapy Safe?

Safety remains a top priority when we evaluate any patient for hormone therapy. According to recent data published in The Cancer Journal, initiating HRT in women under 60 years of age, or near the onset of menopause, significantly reduces all-cause mortality and cardiovascular disease. In fact, HRT provides primary cardiovascular prevention benefits that other therapies fail to achieve.

We always discuss the potential risks openly with you. The magnitude and type of risks associated with HRT—including breast cancer, stroke, and venous thromboembolism—remain incredibly rare, occurring in fewer than 10 events per 10,000 women. These risks are comparable to those of many other common medications.

Studies show that taking estrogen alone carries a lower breast cancer risk than combining estrogen with progesterone. Additionally, using transdermal estrogen (like patches or creams) often presents a lower risk of cardiovascular issues compared to oral estrogen pills. We carefully weigh your personal and family medical history to ensure HRT is a safe, beneficial choice for you.

What Should I Expect Regarding Side Effects?

Like any medical treatment, hormone replacement therapy can cause some side effects, especially as your body adjusts to the new hormone levels. If you still have a uterus, breakthrough bleeding represents the most common side effect. Managing this bleeding can present a challenge, but we have numerous established protocols to address it effectively.

Women with a uterus must take progesterone alongside estrogen to protect the uterine lining. However, just as some women experience mood swings and depression from oral contraceptives, the combination of estrogen and progesterone can trigger similar mood changes in certain patients.

Some women also report experiencing migraines after starting therapy. If you encounter any of these side effects, you do not need to simply endure them. We closely monitor your progress and can adjust your dosages, change the delivery method, or switch the type of hormone you receive to minimize side effects and maximize your comfort.

How Do I Schedule My Hormone Replacement Therapy Appointment?

Taking control of your menopause symptoms should never feel like a hassle. We make it incredibly easy for new and returning patients to schedule a consultation with our experts. You can use our convenient online scheduling tool to find a time that fits perfectly into your busy life, or you can call our Denver office directly to speak with our friendly staff.

Our team will guide you through the initial paperwork and let you know exactly what medical records to bring to your first visit. We look forward to seeing you and helping you build a comprehensive plan for your health.