The Cons: Reasons To Lean Against Hrt After Surgical Menopause
- Your menopausal symptoms aren’t bothering you, or other treatments work fine. Some women don’t have very severe symptoms after surgical menopause and don’t want or need treatment. Even if you do have acute symptoms, HRT is not the only way to control them. Other drugs or lifestyle changes can help. Talk to your doctor.
- You’re 50 or older. Many women who go into surgical menopause at 50 or older — the natural time of menopause – decide not to get HRT. That’s because their supply of estrogen would naturally drop during menopause anyway. There is some evidence that the older you are when you start HRT, the higher the cardiovascular risks – at least initially.
- You have liver disease. Estrogen pills can put a lot of stress on the liver. So if you have liver disease, your doctor may not want you to take oral HRT. Other ways of getting estrogen – like patches and gels – bypass the liver and are safer options.
- You’re concerned about the side effects. HRT can also cause symptoms of its own. Many resemble the symptoms of premenstrual syndrome — swollen and painful breasts, headaches, and nausea.
- You’re at a higher risk of health problems like:
o Strokes. Hormone therapy can increase the risk of stroke, although your odds are still very low.
o Blood clots. Oral estrogen, at least, may also raise the risk of blood clots. Estrogen patches and creams may pose a lower risk, but that’s still unclear.
Recommended Timelines For Menopausal Hormone Therapy
To start, lets look at some general guidelines and recommendations. One of the most common recommendations is to use HRT at the lowest dose and for the least amount of time needed to help relieve menopause symptoms. This means its individualized to you, your symptoms, and treatment goals.
According to the North American Menopause Society , benefits for hormone replacement therapy for menopause generally outweigh the risks for most women. If youve dealt with menopause symptoms, you might know what were talking about. Hot flashes, sleep disturbances, and more can take a toll on your health and quality of life.
In the past, recommendations were to use hormones for less than five years and stop completely before you turn 60. In fact, most women do successfully stop hormone replacement therapy within five years. However, NAMS and most healthcare professionals have updated their guidelines to be more personalized. Now, older women can stay on hormones after 60 if needed for symptom relief.
While most women notice their symptoms go away a few months or years after menopause, others have persistent symptoms that can interfere with their lives. For instance, hot flashes can last ten to twenty years after menopause. In these cases, stopping hormones could lead to dealing with symptoms that affect your wellbeing, so you might choose to use hormones for longer or find other treatments to help.
Can Perimenopause Cause Weight Gain
The hormonal changes of menopause might make you more likely to gain weight around your abdomen than around your hips and thighs. Instead, the weight gain is usually related to aging, as well as lifestyle and genetic factors. For example, muscle mass typically diminishes with age, while fat increases.
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What Are The Risks Of Hrt
The health risks of HRT include:
- Increased risk of endometrial cancer For women who have had a hysterectomy , this is not a problem
- Increased risk of breast cancer with long-term use
- Increased risk of cardiovascular disease
- Increase in inflammatory markers
- Increased risk of blood clots and stroke, especially during the first year of use in susceptible women
All women taking hormone replacement therapy should have regular gynecological exams . The American Cancer Society also recommends that women over age 50 should:
Not An Elixir Of Youth
Hormone therapy is not a magic bullet or an elixir of youth, and it shouldnt be used willy-nilly, Manson says.
But women who are suffering with menopause symptoms should not be denied hormone therapy, she says, unless they are at increased risk of cardiovascular disease, breast cancer or other estrogen-sensitive cancers.
The pendulum has swung widely from the perception that hormone therapy is good for all women to the perception that its all bad for all women, to now a more appropriate place in between where hormone therapy is perceived to be good for some but not all women, Manson says. Were recommending that hormone therapy be used for the duration that its needed to address symptoms at the lowest effective dose and with ongoing reassessment of the balance of risks and benefits.
The time to start therapy is as soon as the symptoms start. Intervening earlier, rather than later, actually seems to carry less risk, Santoro says.
Once symptoms start, they are unlikely to get better soon. On average, the menopause transition lasts about four years, Santoro says. Some women have symptoms that persist even longer, however. Although there are exceptions, most women wont go through menopause before 45, Santoro says.
If youre 45 or older and starting to have hot flashes, night sweats or mood or sleep changes, it could be your hormones and it might be time to start some active management, she says.
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What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
What Is Bioidentical Hormone Therapy
Companies that make bioidentical hormone therapy use the term bioidentical to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been done to evaluate how safe or effective these products are.
Talk to your doctor or nurse before trying any bioidentical hormone therapy.
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What Are The Risks Of Taking Hormone Therapy
While hormone therapy helps many women get through menopause, the treatment is not risk-free. Known health risks include:
- An increased risk of endometrial cancer .
- Increased risk of blood clots and stroke.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimers disease and dementia.
- Increased risk of breast cancer with long-term use.
Signs Of Hormone Imbalance During Menopause
Hormonal imbalance, one of the classic signs of menopause, is a natural side effect of the bodys change. However, with BHRT, women can help re-balance their hormone levels, taking back control and reducing the impact this time often has on their lives. Menopause is divided into 4 main stages, and each stage often includes a different version of hormonal imbalance.
This first stage, which makes up a good part of a womans life, is the time when she experiences regular reproductive functions. For the majority of women, this time includes a typical menstrual cycle and the ability to become pregnant. Premenopause lasts from a womans first menstrual cycle to her last menstrual cycleoften 30 years or more. During a womans teens and early 20s, hormone levels are at their highest, and she may experience the classic mood swings associated with this time. By the mid-20s to early 30s, the hormone levels plateau and may even begin to decrease.
This is the final stage of a womans reproductive years when the bodys levels of estrogen and progesterone drop sharply and the ovaries stop producing eggs. Monthly menstrual cycles end and the body can no longer become pregnant naturally. Women will often experience continued symptoms of menopause during this time. However, they typically decrease over the next year.
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Contraception Pregnancy And Hrt
Oestrogen used in HRT is different from oestrogen used in the contraceptive pill, and is not as powerful.
This means itâs possible to become pregnant if you are taking HRT to control menopausal symptoms. In some cases, a woman can be fertile for up to 2 years after her last period if she is under 50, or for a year if she is over 50.
If you donât want to get pregnant, you can use a non-hormonal method of contraception, such as a condom or diaphragm.
An alternative is the IUS , which is also licensed for heavy periods and as the progestogen part of HRT. You will need to add oestrogen as either a tablet, gel or patch.
At What Age Should A Woman Stop Taking Hormone Replacement
If youre a woman over the age of 30, you may not immediately recognize the symptoms of hormone deficiency in your life, which can include fatigue, decreased libido, weight gain, and more concerns often mistaken for a side effect of aging. Bio-identical hormone replacement therapy through the revolutionary pellet method is proven to help restore balance to hormone levels and decrease the symptoms of life stages such as menopause. For many women, BHRT is safe and effective for years of improved health. This hormone replacement treatment is proudly offered by Pellecome through our provider network,
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Benefits Of Taking Estrogen After Menopause
- Post author Scientific review: Dr Heben’s Team
In this article, I will explain the benefits of taking estrogen after menopause. Menopause happens in middle-aged women . Menopause is a condition where menstrual cycle stops, or the end of reproductive period. This is a natural condition, and all women will experience this. But the menopause symptoms give anxiety in women, since the stopping of menstrual cycle means the stopping of reproductive hormone production, such as estrogen and progesteron.
Estrogen is a steroid hormone, produced by theca follicle cells in ovaries. Estrogen functions are: promotes secondary sexual signs in women, promotes proliferation of endometrium cells, influences electrolytes balance, and improves protein anabolism with growth hormones, as in growth of reproductive organs such as the womb and vagina.
When a woman reach pre-menopause period, her estrogen production is much decreased. The symptoms are:
- irregular menstruation
- reduced bone density, which will lead to osteoporosis and bone fractures
- increased risk of atherosclerosis and cardiovascular disease
1. Prevents Dryness in Vagina
Vaginal dryness is caused by lack of estrogen. This makes difficulties and pain during sexual intercourse, which can lead to physical and psychological trauma . Taking estrogen after menopause can maintain vaginal lubrication and elasticity.
2. Increases Libido
3. Prevents Pre-menopause Syndrome
6. Prevents Atherosclerosis
What Should Women Do If They Have Menopausal Symptoms But Are Concerned About Taking Mht
Women who are seeking relief from hot flashes and vaginal dryness should talk with their health care provider about whether to take MHT, the possible risks of using MHT, and what alternatives may be appropriate for them. FDA currently advises women to use MHT for the shortest time and at the lowest dose possible to control menopausal symptoms. The FDA provides additional information about the risks and benefits of MHT use for menopausal symptoms on its Menopause & Hormones: Common Questions fact sheet.
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Putting The Risks And Benefits Of Hrt In Perspective
If youâre just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits. Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?
But look at the details. The risks of HRT â while real â are quite small for an individual person. For example, the 2002 Womenâs Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. Thatâs an increase of just 12 people out of 10,000.
On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of their day-to-day life.
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What Is Known About Hormone Therapy And The Risk Of Breast Cancer
Taking combined hormone therapy can increase your risk of developing breast cancer. Here are some important findings:
- Taking combination hormone therapy showed a rare increase of absolute risk of less than one additional case of breast cancer per 1000 person years of use.
- There was a nonsignificant reduction in breast cancer seen in women with hysterectomies on estrogen only therapy.
- If youve been diagnosed with breast cancer you should not take systemic hormone therapy.
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Diagnosis & Tests For Hormone Replacement Therapy
If you are age 45 and above, your doctor may not test you for signs and symptoms of menopause. Once symptoms occur, your doctor may examine you, take a personal and medical history, and work out lifestyle factors that improve your symptoms.
If you are under age 45, your doctor may perform blood tests to determine your hormone levels. They may also perform ultrasounds and physical exams to find the cause of your hormone deficiency.
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Who Shouldn’t Take Hormone Therapy
Hormone therapy is not usually recommended if you:
- Have or had breast cancer or endometrial cancer.
- Have abnormal vaginal bleeding.
Less common side effects of hormone therapy include:
- Fluid retention.
- Skin discoloration .
- Increased breast density making mammogram interpretation more difficult.
- Skin irritation under estrogen patch.
How Does Menopause Affect Hormone Levels
Menopause is not just about one moment when women do not have a period anymore. During this natural occurrence, there are three main stages. The first one is called perimenopause which lasts approximately 3-5 years. The symptoms of it, are irregular menstruation bleeding, hot flashes, night sweats, insomnia, and psycho-emotional disorders such as irritability, aggression, and even panic. Here the hormone levels start fluctuating.
The second stage is called menopause. It means there are no more periods, and a lady cannot give birth to children. Also, this stage is diagnosed only with a doctor after she was 12 months straight without menstrual bleeding. Here thelevels are decreased. And, the symptoms are the same, however, a woman can also experience memory problems, and decreased libido.
Finally, the last stage is the postmenopause. And, it lasts for the rest of your life. Nevertheless, all the stages are critical for ladies. Because hormonelevels during menopause are not stable, and they do not provoke symptoms only but may affect the development of a disease. For instance, nodes and polyps can occur in the uterus, benign fibroids in malignancies, and also, hormone levels in menopause may bring some discomfort in your intimate zone, such as vaginism.
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What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.