Every day in the US, 3,500 women will enter menopause. With 82.5 years being the current female life-span, possibly half a woman’s life will be lived in the post-menopausal years.
Menopause can be a difficult transition in a woman’s life. It occurs on average in women between 48 – 52 years old. (However peri-menopause – the period of time leading up to menopause – can be of a 15 year duration.) By definition, menopause is the cessation of menses for twelve consecutive months. It is the result of the loss of ovarian function and subsequent decline in estrogen and progesterone production. The wild swings of these hormones and their decline can cause a myriad of physical and emotional problems. Ninety percent of women will have symptoms (almost disabling for some) and the decreased quality-of-life will affect them as well as their families.
In the 19th century, the climacteric (menopause) was considered a disease. Women with symptoms were thought to become “thoroughly unhinged by the change of life”. Little was understood about this change and nothing could be done to treat the symptoms. Now, in the 21st century, we have a detailed understanding of menopause and the role of estrogen, progesterone and testosterone in the body.
SYMPTOMS OF MENOPAUSE
- Mood Swings / Irritability / Depression
- Decreased Libido
- Slowed Memory Retrieval / Brain Fog
- Vaginal Dryness / Dyspareunia (painful intercourse)
- Skin Thinning
- Stress Incontinence
- Scalp Hair Loss / Growth of Facial Hair
- Weight Gain
- Hot Flashes / Night Sweats
The Hot Flash is the most common symptom of menopause and is attributed to the swings in estrogen and a withdrawal from estrogen and progesterone. It is described as a sudden, intense feeling of feverish heat and sweating, can occur daily (and even hourly!) and most often affect the face, neck and chest. When occurring at night, these sleep-interrupting hot flashes are termed night sweats.
DIAGNOSIS OF MENOPAUSE
With the cessation of monthly menstrual cycles, traditional confirmation of menopause is made through a blood test that checks FSH (Follicle Stimulating Hormone)levels. A diagnosis of menopause is made when FSH is highly elevated. While an elevated FSH correlates with anovulation (shut-down of ovarian function), it does not reflect the amount of estrogen or progesterone present. (Progesterone levels are virtually never measured.) Estrogen can be produced from a variety of sources within the body other than the ovary or it can be ingested from external sources as phytoestrogens or xenoestrogens. Progesterone is only produced after ovulation occurs so, when ovulation stops, so does the production of progesterone. Clearly, measuring more than an FSH level is necessary and this is why we use salivary testing: It verifies the decrease of estrogen and progesterone and allows measurement of these hormone levels during hormone replacement.
TREATMENT OF MENOPAUSE
Regular exercise, healthy nutrition, dietary supplements and stress management all help with the symptoms and signs of menopause, but often replacement of the missing hormones themselves is required. Unlike the synthetic hormones of yesteryear (Premarin, Prempro or Provera), we now use Bio-Identical hormone replacement (BHRT). These hormones are the exact replica of the bodies naturally occurring hormones. BHRT is safe, effective and aids greatly in prevention of menopausal-related health problems. Modes of hormone delivery include compounded creams, gels, pellets or transdermal patches (estrogen should never be given orally). Hormone levels are monitored through saliva testing and adjusted as needed. However, it is important to note, we are treating the patient’s symptoms; treatment is not based solely on lab values.
Although menopause is a natural occurrence, replacing estrogen, progesterone and testosterone as they wane does much to alleviate the physical and psychological symptoms of menopause. The goal of BHRT is to help menopausal women thrive and to decrease the health-complicating risks that occur with aging and hormone loss. Increased sense of well-being adds quality to the second half of a woman’s life.