Many perimenopause and postmenopausal women can feel like zombies, with their fire-burning cauldron bubbling and a burning desire to grab the nearest broom and head off into the darkness. Midlife doesn’t need to be ghoulish. You can end the madness.
When you go through perimenopause and menopause, estrogen, progesterone, and/or testosterone hormones begin to fluctuate. These fluctuations often result in less-than-thrilling physical symptoms, such as weight gain, sleepless nights, hot flashes, and night sweats. In addition to the physical effects of menopause, there is an emotional component. A decrease in estrogen can cause anxiety, depression, mood swings, weeping, bursts of anger, and loss of libido.
Drop that broom stick and treat yourself to this information:
Find a Menopause Specialist
I let out a blood-curdling scream when I learned that very few medical school graduates, residents in internal medicine, or obstetrics/gynecology receive training in the management of menopausal women!!!! One survey of residents in their final year of training in both specialties found that 30 to 50% said they are not prepared to manage a menopausal woman. In addition, 50-60% could not identify the optimal therapy for a 52-year-old menopausal woman with severe symptoms, nor could they recommend treatment for a healthy 39-year-old woman with POI (primary ovarian insufficiency).
It is essential to find a menopause specialist to be your menopause partner. If you don’t have one, here are some tips on how to find one: Tips on How to Find a Menopause Specialist.
I have created a Menopause Symptoms Chart to help you chart your symptoms. Take the filled-out chart in with you to your menopause specialist.
Hormone Therapy Options
There are many names and initials thrown around when discussing hormone replacement. The main three are HT (hormone therapy), HRT (hormone replacement therapy), and MHT (menopausal hormone therapy). Let’s use the term HT.
You may have heard the words natural, synthetic, and bioidentical tossed around in discussions of HT. The term “bioidentical” doesn’t have a precise medical definition. Most of us define bioidentical hormones as hormones identical in structure to that produced in the human body. Many doctors use this word to describe preparations containing either progesterone or one or more of three estrogens — estradiol, estrone, and estriol.
The hormones that the WHI 2002 (Women’s Health Initiative) studied were synthetic hormones that were not bioidentical. Instead, they researched conjugated equine estrogens synthesized from pregnant mares’ urine, either alone (as Premarin) or with the progestin medroxyprogesterone acetate (as Prempro).
If your HT has Medroxyprogesterone Acetate in it, you are taking a synthetic progestin. Bioidentical progesterone is also synthesized in a lab but made to be identical to what your body produces. Prometrium is an example of bioidentical progesterone.
You may hear the term Progestogens. Progestogens is a blanket term for both natural progesterone and synthetic progestins.
It’s important to understand that your body may react differently to all these different therapies. When you engage in bioidentical hormone therapy, your body may respond the same way it would if it produced the hormone itself because, chemically speaking, they are identical. When you take hormone therapy that is not bioidentical, your body may react differently.
Remember that all women are different (and fabulous). Each woman has unique challenges that require solutions crafted for their individual needs. There are many schools of thought on hormone therapy. It is up to you to educate yourself and, together with your menopause specialist, draw your conclusions about what is best for your body.
The Latest Hormone Statement from NAMS
We know there has been a decline in HT use since the initial publication of the Women’s Health Initiative (WHI) in 2002. Although the new data validates it’s safety in younger post-menopausal women, prescription rates have stayed low.
Here is The 2022 hormone therapy position statement of The North American Menopause Society:
“Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.
The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used.
Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.
For women aged younger than 60 years or who are within ten years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for the treatment of bothersome VMS and the prevention of bone loss.
For women who initiate hormone therapy more than ten years from menopause onset or who are aged older than 60 years, the benefit-risk ratio appears less favorable because of the greater absolute risks of coronary heart disease, stroke, venous thromboembolism, and dementia.
Longer durations of therapy should be for documented indications such as persistent VMS, with shared decision-making and periodic reevaluation.
For bothersome genitourinary syndrome of menopause, symptoms not relieved with over-the-counter therapies in women without indications for use of systemic hormone therapy, low-dose vaginal estrogen therapy, or other therapies (eg, vaginal dehydroepiandrosterone or oral ospemifene) are recommended.”
Depending on your medical history, your options may vary. A good starting point is to ask yourself, “On a scale of 1 to 10, how am I functioning?” You don’t have to settle! Once you are aware of your challenges, you can begin to find the right solutions. Treat yourself to wellness and happiness. You deserve it!
BTW don’t be tricked by Halloween treats – they are not a menopausal woman’s friend.
My Motto: Suffering in silence is OUT! Reaching out is IN!
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*EllenDolgen.com does not recommend, endorse, or make any representation about any tests, studies, practices, procedures, treatments, services, opinions, healthcare providers, physicians, or medical institutions that may be mentioned or referenced.
