Women may experience menopause between the ages of 40 and 58 with an average age of 51 years old. Some women experience perimenopausal symptoms in their 40s (4-8 years before the actual onset of menopause) and this can be very distressing if left untreated. The most common symptoms include hot flashes and night sweats (also known as vasomotor symptoms). Vasomotor symptoms can interrupt sleep and lead to fatigue and brain fog during the day. The hot flashes/night sweats resolve after about 7 years, but around 15% of women will have hot flashes that never subside. Also, 1 in 2 women will experience genitourinary syndrome of menopause (GSM); unlike hot flashes which usually subside over time, the chronic and progressive genital, sexual, and urinary symptoms will only get worse without treatment.
The life expectancy for American women is about 82 years which means they are menopausal one-third of their life. We can help you choose a treatment option (hormonal or non-hormonal) that works best for you.
Hormone therapy (HRT) is the gold standard for relief of hot flashes and night sweats. HRT can also prevent bone loss and reduce fractures in postmenopausal women who are at risk of osteoporosis or fractures. HRT is a safe and effective option for the treatment of menopause symptoms when initiated in healthy women younger than 60 years of age or within 10 years of menopause onset. Also, data has shown a cardioprotective effect when HRT is initiated earlier in menopause. However, women who initiate HRT at age 60 or older have a higher risk of coronary heart disease, venous thromboembolism (blood clot), and stroke.
Treatment
Symptomatic women with a uterus taking HRT must take estradiol (or estrogen) with progesterone (or progestogen) or bazedoxifene. This is very important because taking estradiol (or estrogen) alone can cause hyperplasia (an overgrowth of cells in the uterine lining) which can lead to endometrial cancer. Therefore, progesterone (or progestogen) prevents this by keeping the uterine lining thin.
Bioidenital HRT
This includes FDA approved options such as estradiol (oral pill), Evamist (estradiol transdermal spray), Femring (estradiol ring), and Prometrium (oral progesterone). Bijuva is the newest treatment option (approved October 2018) and it is unique because it is the first bioidentical, combined estradiol/progesterone oral pill and requires only one co-pay. Bijuva is plant derived, vegan, and unlike Prometrium, it does not contain peanut allergens.
Synthetic HRT
This includes Prempro, Activella, Femhrt, Clima Pro, Combipatch, and Provera (medroxyprogesterone).
Non-Hormonal Options
Some women cannot take HRT due to a personal history of breast cancer, blood clots, a clotting disorder, or intolerance to these medications. Other evidence-based treatment options include:
- Paxil (paroxetine)
- Effexor (venlafaxine)
- Neurontin (gabapentin)
- Catapress (clonidine)
- Detrol (oxybutinin)
Facts About Estrogen
- Oral/transdermal estrogen replacement therapy can be helpful in treating hot flashes, sleep disturbances, night sweats, irritability, and depression during menopause.
- Oral/transdermal estrogen replacement (also known as unopposed estrogen) causes the lining of the uterus (endometrial lining) to become thick and this can lead to endometrial cancer. Therefore, it is important to take progesterone replacement as directed to prevent abnormal thickening of the uterus (endometrial hyperplasia).
- It appears that concerns about HRT causing breast cancer have been overstated. The associated breast cancer risk has not been consistent across studies. The Women’s Health Initiative (2003) found that oral estrogen alone actually reduced the risk of invasive breast cancer. The risk for breast cancer was not increased in women who used HRT for 5 years or less. There were 8 breast cancers per 10,000 women per year in the WHI participants who took conjugated estrogen 0.625 mg/medroxyprogesterone 2.5 mg. In addition, an analysis estimated that the number of excess breast cancer cases among women who started HRT at age 50 and used it for 5, 10, or 15 years was 2, 6, and 12 cases, respectively, per 1000 women.
- Women with a family history of breast cancer often consider themselves to be at an increased risk for breast cancer if they use HRT. According to the Iowa Women’s Health Study, using HRT with a family history of breast cancer did not increase the patient’s risk for breast cancer; the risk did not significantly differ when compared to patients who did not use HRT.
Frequently Asked Questions
Question: I do not have a uterus and I was prescribed progesterone. Should I be concerned?
Answer: Possibly. Progesterone and progestogen are FDA approved to protect the uterus from unopposed estrogen. It may help with sleep, but it could possibly increase the risk of breast cancer. In the WHI study, women who took Prempro (conjugated estrogen and medroxyprogesterone) had an increased breast cancer risk. Interestingly, women who took Premarin (conjugated estrogen) actually had a decreased risk for breast cancer.
Question: What is progestogen?
Answer: Progestogen is a generic term for progesterone or progestin replacement therapy.
- Prometrium is a progesterone that is considered a bioidential hormone because it is derived from plants. Prometrium has a similar chemical structure as the progesterone produced by your ovaries.
- Provera and medroxyprogesterone are examples of a progestin. Progestins are considered synthetic types of hormone replacement.