Menopause & Midlife Women’s Hormone Health

The average age of menopause in the United States is 52. Menopause is when your periods stop permanently, and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period.

After menopause, your ovaries make very low levels of the hormones called estrogen and progesterone, impacting symptoms experienced and women’s bone health, risk for diabetes and cardiovascular health. 

Source: https://womenshealth.gov/menopause/menopause-basics

Overall, when started within 10 years of menopause, for most women, menopause hormone therapy is considered safe and benefits outweigh risks.

It is important to have a personalized discussion about your individual risk with your menopause specialist provider when considering menopause hormone therapy.

There are certain women who are considered too high risk for systemic hormone therapy.

Women with a history of or at risk for blood clots, breast cancer, heart disease, or stroke should NOT take estrogen therapy. 

Women with a history of or at risk for blood clots, breast cancer, heart disease, or stroke should NOT take progesterone therapy.

These discussions require nuance and medical details and shared decision-making.

There is a small risk of heart attack, stroke, and blood clots in the veins of women who use menopausal hormone therapy (either combined estrogen and progesterone or estrogen alone, especially in pill form).

Estrogen treatment can also increase the risk of gallstones.

The combination of estrogen and progesterone (but not estrogen alone) can increase the risk of breast cancer, if used for more than 4 to 5 years. Using estrogen alone (for women without a uterus) does not appear to carry the same risk

In addition, the small risk of heart attack, stroke, and blood clots in the veins of women who use estrogen therapy is slightly increased when progesterone is added.

If you have a uterus and take estrogen with progestogen, there is no increased risk of cancer of the uterus.

Ways to reduce the risks:

1. Consider using the estradiol patch instead of taking pills. The patch has a lower risk of stroke and blood clots than estrogen pills.
2. Consider using micronized progesterone rather than synthetic progesterones. Breast cancer risk may be lower with micronized progesterone.

Sources:

https://mymenoplan.org/hormone-therapy/#risks-hormone

MenoNotes

Systemic and low-dose are the two main types of hormone therapy.

• Systemic therapy: When hormones are delivered throughout the body via pills, patches, sprays, gels, or a vaginal ring, this is known as systemic therapy. Systemic doses are absorbed into the bloodstream at high-enough levels to have significant effects in widespread areas, which is needed to treat symptoms of menopause such as hot flashes.

• Low-dose therapy: Also called vaginal estrogen therapy (ET) for GSM after menopause, this therapy is administered into the vagina and is effective for both moisturizing and rebuilding tissue. Very little goes into blood circulation, so the risks are far lower.

Benefits:

• Quality of life improvement: Lessening of hot flashes, night sweats, vaginal dryness and the poor sleep, irritability, and “brain fog” that go with them.
• Vaginal symptom relief — Including thinning tissue and dryness and the consequences, such as painful intercourse. (If you take low-dose oral or transdermal HT, you may need to add a vaginal estrogen to get relief.)
• Ease overactive bladder — You might see relief from your frequency issues and maybe even recurring urinary tract infections with vaginal estrogen.
• Protect your bones — Standard-dose HT helps prevent bone fractures later in life. If you are at high risk of broken bones or have early menopause, you may be able to take hormones earlier or longer. Discuss this with your healthcare professional.
• Lower your risk of cardiovascular disease — If you start HT within 10 years of menopause, you could lower your risk of cardiovascular disease.
• Reduce your diabetes risk — Scientific evidence shows women who use HT have a lower risk of developing type 2 diabetes.

Source: https://menopause.org/patient-education/menopause-topics/hormone-therapy

There is no “right” time to stop menopause hormone therapy. Many women try to stop therapy after 4 to 5 years because of concerns about a potential increased risk of breast cancer. Other women may lower doses or change to nonpill forms. Hot flashes may or may not return after you stop. The decision to stop or continue hormone therapy should be individualized based on personal risk, symptoms and overall health evaluation.

Bioidentical hormone therapy are processed hormones from plants that are similar to those made by the ovaries. 

Estrogen, micronized progesterone and testosterone are the most commonly used bioidentical hormones.

There are several FDA approved bioidentical hormones available to use that are generic and cost-effective. They do not necessarily require compounding or have to be costly. 

Compounded bioidentical hormones are advertised as being a safer, more effective, natural and individualized alternative to conventional hormone therapy. However, these claims remain unsupported. 

Using any type of hormone therapy, synthetic or bioidentical should be a decision made between you and your healthcare provider, after carefully weighing the risks and benefits.

Source: https://my.clevelandclinic.org/health/treatments/15660-bioidentical-hormones

Based on your evaluation, we will discuss the need for lab testing. Perimenopause symptoms occur even when hormone testing shows normal labs. This makes lab testing for hormones during the menopause transition less useful; however, there are situations in which it is informative and useful. Beyond hormone testing, it is important to assess labs to diagnose and treat other labs and conditions that also show up during this time in a woman’s life. Examples are high cholesterol, increase in insulin and blood sugar, inflammation markers and vitamin deficiencies. We perform lab testing and guide our patients with a medical and lifestyle plan to prevent and improve these issues. 

We work closely with our patients to assess weight gain and body changes. This includes Inbody body composition analysis, lab testing and assessment of medical conditions that can cause weight gain, as well as nutrition and lifestyle assessment. 

Menopause itself, along with aging and loss of muscle, can contribute to weight gain and and increase in mid-section visceral fat gain, which is specifically linked to high cholesterol, blood sugar and cardiovascular disease.

The mood changes and sleep disturbances that women experience further make maintaining health habits and weight difficult during this phase of life. 

We create a personalized plan for women to help with menopause weight gain with a focus on losing visceral fat, gaining muscle, optimize sleep, nutrition and stress management along with use of medication, when appropriate. 

Learn more about our weight management approach and medications we can use to help here: https://myradianthealth.com/fighting-menopause-weight-gain-in-frisco/

Absolutely! We are thrilled to offer the convenience of telemedicine to all patients who live within the state of Texas.