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Facts about post-menopausal hormone therapy
As you age, significant internal changes take place that affect your production of the two female hormones, estrogen and progesterone. The hormones, which are important in regulating the menstrual cycle and having a successful pregnancy, are produced by the ovaries, two small, oval-shaped organs.
During the years just before menopause, known as perimenopause, your ovaries begin to shrink. Levels of estrogen and progesterone fluctuate as your ovaries try to keep up production of the hormones. You can have irregular menstrual cycles, along with unpredictable episodes of heavy bleeding during a period. Perimenopause usually lasts several years.
Eventually, your periods stop. Menopause marks the time of your last menstrual period. It is not considered the last until you have been period-free for 1 year without being ill, pregnant, breast-feeding, or using certain medicines, all of which also can cause menstrual cycles to cease. There should be no bleeding, even spotting, during that year. Natural menopause usually happens sometime between the ages of 45 and 54.
You also can undergo menopause as the result of surgery. A surgical procedure, called hysterectomy, removes the uterus and sometimes the ovaries and fallopian tubes as well. You go through menopause if both of your ovaries are removed. Otherwise, the surgery does not affect menopause, which still occurs naturally.
Whether you go through menopause naturally or surgically, symptoms can result as your body tries to adjust to the drop in estrogen levels. These symptoms vary greatly. One woman may breeze through menopause with few symptoms, while another has difficulty. Symptoms may last for several months or years, or persist. The most common symptoms are hot flashes or flushes, sweats, and sleep disturbances. (A hot flash is a feeling of heat in your face and upper body, which may cause the skin to appear flushed or red as blood vessels expand. Hot flashes that occur with severe sweating during sleep are called night sweats.) But the drop in estrogen also can contribute to other symptoms, such as changes in the vaginal and urinary tracts, which can cause painful intercourse, urinary infections, and the need to urinate more often.
To relieve the symptoms of menopause, doctors may prescribe postmenopausal hormone therapy. This can involve the use of either estrogen alone or with another hormone called progesterone, or progestin in its synthetic form. The two hormones normally help to regulate a woman's menstrual cycle. Progestin is added to estrogen to prevent the overgrowth (or hyperplasia) of cells in the lining of the uterus. This overgrowth can lead to uterine cancer. If you have not had a hysterectomy, you will receive estrogen plus progestin therapy; if you have had a hysterectomy, you will receive estrogen-only therapy. Hormones may be taken daily (continuous use) or on only certain days of the month (cyclic use).
They also can be taken in several ways, including orally, through a patch on the skin, as a cream or gel, or with an intrauterine device (IUD) or vaginal ring. How the therapy is taken can depend on its purpose. For instance, a vaginal estrogen ring or cream can ease vaginal dryness, urinary leakage, or vaginal or urinary infections, but does not relieve hot flashes.
Hormone therapy may cause side effects, such as bleeding, bloating, breast tenderness or enlargement, headaches, mood changes, and nausea. Further, side effects vary by how the hormone is taken. For instance, a patch may cause irritation at the site where it is applied.
There also are non-hormonal approaches to easing the symptoms of menopause.
Alternatives to hormone therapy to help prevent postmenopausal conditions and relieve menopausal symptoms:
You may want to consider alternatives to hormone therapy to ease menopausal symptoms. Talk with your doctor or other health care provider about the best treatment for you for each symptom.
Lifestyle changes: These include dressing and eating to avoid being too warm, sleeping in a cool room, and reducing stress. Avoid spicy foods and caffeine. Try deep breathing and stress reduction techniques, including meditation and other relaxation methods.
Antidepressants: These have been proved moderately effective in clinical trials.
Mood swings:
x Lifestyle behaviors, including getting enough sleep and being physically active
x Relaxation exercises
a Antidepressant or anti-anxiety drugs
x Insomnia
x Over-the-counter sleep aids
x Milk products, such as a glass of milk or cup of yogurt. Choose low- orfat-free varieties
x Do physical activity in the morning or early afternoon exercising later in the day may increase wakefulness
x Hot shower or bath immediately before going to bed
Postmenopausal use
Menopause may cause other changes that produce no symptoms yet affect your health. For instance, a woman's risk of developing heart disease begins to rise around menopause. After menopause, women's rate of bone loss increases. The increased rate can lead to osteoporosis, which may in turn increase the risk of bone fractures, usually after age 70.
Through the years, studies were finding evidence that estrogen might help with some of these postmenopausal health risks especially heart disease and osteoporosis.
Similarly, menopause is atime of increased bone loss. Bone is living tissue. Old bone is continuously being broken down and new bone formed in its place. With menopause, bone loss is greater and, if not enough new bone is made, the result can be weakened bones and osteoporosis, which increases the risk of breaks. One of every two women over age 50 will have an osteoporosis-related fracture during herlife.