Menopause means the end of menstruation. This occurs after the supply of eggs in the ovaries runs out. Estrogen and progesterone are two hormones that are made by the body naturally. Their levels drop significantly with menopause. This stage of a woman’s life usually takes place between the ages of 45 and 55 and is most often a gradual process.
During menopause, periods become irregular and unpredictable before they stop completely. Many women will also experience hot flashes. These are marked by sudden reddening of skin accompanied by intense heat and sweating. Flashes may last a few seconds to a few minutes, and often interfere with sleep. As estrogen levels continue to decline during menopause, women can experience dryness of the vagina and thinning of the wall of the vagina. This can lead to sexual discomfort.
Decreased estrogen may also cause changes in the urinary structures. As a result, a woman may need to empty her bladder more often, and may lose some bladder control.
Some women may experience mood swings, irritability, fatigue and loss of sexual desire. These symptoms may be both physical and psychological as many changes are taking place during this period in life. The decrease of estrogen may, over time, have a negative affect on other parts of the body, including the bones, the heart and the brain.
Hormone replacement therapy is a way of providing a woman with synthetic hormones to replace those made naturally by her body before menopause.
Most studies show that HRT gives women a better quality of life during and after menopause. HRT is used to control hot flashes, mood swings, and vaginal dryness during menopause. It is also used to prevent long-term problems of menopause such as osteoporosis and heart disease.
Women who still have their uteruses are given estrogen and progesterone. Both are necessary because the lining of the uterus will grow without regulation if only exposed to estrogen. This can lead to uterine cancer. Progesterone is given to help prevent cancer of the uterus developing from the estrogen. Women who have had hysterectomies can take estrogen without progesterone.
Osteoporosis literally means porous bones. A severe loss of bone mass occurs over time. Bone loss starts in the 30s and speeds up once a woman reaches menopause. This makes the bones at greater risk for breaking. Bone fractures, especially of the hip and spine, are a major cause of disability and death in the elderly.
Studies consistently have shown helpful effects for HRT on preventing fractures. It is clear that estrogen slows the loss of bone mass. It prevents osteoporosis by acting with bone cells to slow bone breakdown. Risk of fractures is reduced by more than 50 per cent in women who start HRT early in menopause and continue for six to nine years. Even when HRT is given to women many years after menopause, it appears to have a helpful effect on bone.
Heart disease remains the number one killer in Canada. The risk of dying from heart disease is almost 10 times that of breast cancer.
It has been shown that estrogen has a positive effect on the lipid or fat profile in the body. It increases the 'good cholesterol' HDL, lowers the 'bad cholesterol' LDL, and lowers triglycerides. High cholesterol is a known risk for heart disease. Recent studies have also shown that estrogen can work on the blood vessel walls to help maintain smooth blood flow.
Whether HRT lowers the risk of heart disease is still somewhat controversial at this time. Many early studies have shown much lower rates of heart disease after menopause among women who are taking HRT, compared to women who are not. However, a recent study looked at the effects of HRT in women who already have heart disease. It suggested no overall benefit for these women. Previous studies had shown a benefit. One possible reason was that the type of progesterone used in the study may have weakened the helpful effects of the estrogen.
A large study has been done to look at these questions. It was expected to provide more answers about the many long-term effects of HRT. The results were made available in the 2005.
Some studies have suggested that estrogen reduces the risk for memory difficulty and dementia in elderly women. This area of research is very new and a lot of work is still needed to give us more information.
Many women are hesitant to take HRT because they fear breast cancer. About one in nine women will develop breast cancer, and one in 25 will die from the disease. Most of the women who have breast cancer are older than 50.
Taking HRT increases the risk of breast cancer only very slightly, by about two per cent. This risk is only associated with taking HRT for longer than 10 years. HRT is not recommended for women who have had breast cancer, and those who have a very strong family history of the disease. This means more than two immediate relatives (mother, sister).
Many forms of HRT are available and the individual choice can be tailored. Estrogen can be taken as a pill, a patch, vaginal cream or a gel. It is taken daily. Progesterone usually comes as a pill, and it can be taken every day or in the last 10 days of a month. If progesterone is taken for part of a month, women will often still have their periods each month.
Even though HRT has many benefits, not all women can take it. Women who have undiagnosed bleeding from the vagina, cancer of the breast or uterus, liver disease, or a history of blood clots cannot take HRT. Other medical conditions may need careful evaluation by a doctor before HRT is started. These include uncontrolled high blood pressure, migraine headaches, gallbladder disease, fibrocystic breasts, or diabetes. If a woman smokes, this must also be considered.
Whether to take HRT may be a difficult decision for you. Other lifestyle choices are also important to ensure this stage of your life is healthy and enjoyable. A thorough discussion about the pros and cons of HRT should take place between you and your doctor before you make a decision.