Menopause
Question: What is Menopause?
Answer: Menopause is the point in a woman's life when menstruation stops
permanently, signifying the end of her ability to have children. Known as the
"change of life," menopause is the last stage of a gradual biological
process in which the ovaries reduce their production of female sex hormones--a
process which begins about 3 to 5 years before the final menstrual period. This
transitional phase is called the climacteric, or perimenopause. Menopause is
considered complete when a woman has been without periods for 1 year. On
average, this occurs at about age 50. But like the beginning of menstruation in
adolescence, timing varies from person to person. Cigarette smokers tend to
reach menopause earlier than nonsmokers.
Question: I'm a 48-year-old woman, and I'm going
through menopause. My doctor wants me to start taking hormone replacement, but
I'm worried about safety. What should I know?
Answer: Hormone replacement therapy (HRT) is
started at the time of menopause. It usually consists of estrogen and
progesterone. Women who are prescribed HRT should have annual checkups
including Pap smears, breast exams, and mammograms.
Estrogen comes in different
forms, such as oral pills, skin patches, and vaginal creams or gels. Estrogen
eases the symptoms of menopause, such as hot flashes, vaginal dryness, and
urinary irritation. It also protects you against heart disease and
osteoporosis, and it can lower your cholesterol. In some women, estrogen also
improves mood.
The most worrisome side effect
of taking estrogen without progesterone is an increased chance of endometrial
cancer, which affects the lining of the uterus. If you have had a hysterectomy
it is okay to take estrogen alone, but if you haven't, progesterone should be
added to your regimen. Progesterone is given in pill form. It should be used in
women who have a uterus and are receiving estrogen therapy to decrease the risk
of endometrial cancer. A doctor should evaluate any woman receiving HRT who has
abnormal vaginal bleeding.
Many women worry about the
relationship between estrogen therapy and breast cancer. The exact relationship
between these is not clear, but women who have a very strong personal or family
history of breast cancer might not be given estrogen therapy. This should be
discussed with your doctor.
Women with undiagnosed vaginal
bleeding, breast cancer, endometrial cancer, or an active blood clot in the leg
should not be given HRT. Other conditions may be made worse by HRT and should
be considered when deciding about therapy. These include endometriosis,
gallbladder disease, and menstrual migraine headaches.
The choice
concerning HRT is an individual one. Factors that include your personal risk of
heart disease, osteoporosis, breast cancer, and endometrial cancer should be
considered. For most women, the benefits of HRT outweigh the risks, but as
always, you should talk to your doctor to find out what is best for you.
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