CWC - Menopause Article

MENOPAUSE

By: Bradley G. Goldberg, M.D.

Menopause is the point in a woman’s life when there is permanent cessation of menstrual periods. This is a natural event that occurs following the loss of ovarian activity. The average age of menopause in this country is approximately 51 years old, although women who smoke usually begin several years earlier.

The perimenopause is the time period immediately before and after the menopause. This is a time that marks the transition from the reproductive years to the postmenopausal years. The effects of the perimenopause are related to waning ovarian function and include: disturbances in menstrual pattern, vasomotor instability (or "hot flushes"), mood swings, and other physical symptoms.

Unfortunately, over the years, the menopause has been associated with negative symbolism, when in fact this should be viewed as a point in a woman’s life where she has decades of productivity and healthful living ahead of her. For many women hormone replacement therapy is the cornerstone of this transition.

Hormone replacement therapy (or "HRT") means the replacement of the female hormone estrogen in physiologic doses. Modern therapy involves daily oral estrogen tablets or weekly estrogen patches applied to the skin, with the addition of the hormone progesterone for women who still have their womb. Older therapies include estrogen injections, and sub-dermal pellets. HRT can alleviate most of the annoying effects of the menopause, such as hot flushes and mood swings. HRT also may provide some health benefits, although the recent Women's Health Initiative (WHI) study has demonstrated that it should be used with caution.

In addition to providing relief from hot flushes, other health benefits include a significant reduction in the occurrence of osteoporosis (brittle bones), and a 29% reduction in the risk of death from colon cancer. However, as I mentioned above, risks do exist. The WHI study (see my article "Warning on Hormone Replacement") demonstrated higher risks of breast cancer, stroke and heart disease, although these events were mostly seen after 5 years of treatment.

Another benefit of HRT was mentioned in a study by the National Institute on Aging, published in 2000 in the journal Neurology found that women who used estrogen reduced their risk of Alzheimer’s disease by 54%. Alzheimer’s disease affects twice as many women as men. Although the authors felt that further studies are needed on this issue, this is nonetheless important news.

In summary, the decision to take or not to take replacement hormones remains a very personal and complicated one. A woman should discuss this with her physician before reaching any conclusions. Although not for everyone, hormones may provide relief of some of the annoying symptoms of menopause, but all should be aware that potential risks exist. For those not willing to take the risks there are alternatives. These alternatives may not provide the same level of relief, buy do not carry the risk either.