The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman’s oestrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51. However, around 1 in 100 women experience the menopause before 40 years of age.
Symptoms: As menopause is due to the depletion of ovarian follicles/oocytes and severely reduced functioning of the ovaries, it is associated with lower levels of reproductive hormones, especially estrogen. Low estrogen can result in vasomotor instability (such as hot flushes and night sweats), psychological changes (such as mood swings, depression, and difficulty concentrating), insomnia, genital tract atrophy (such as vaginal dryness, painful intercourse, and urinary incontinence), skin changes (such as thinning and decreased elasticity). Lower androgen levels (male hormones) can contribute to the loss of sex drive. Any abnormal vaginal bleeding should be reported immediately to your doctor, since this may represent a precancerous or cancerous condition of the uterus or endometrial lining.
Premature ovarian failure: Premature ovarian failure is defined as the occurrence of menopause before the age of 40. This condition occurs in about 1% of all women. The cause of premature ovarian failure is not fully understood, but it may be related to autoimmune diseases or inherited (genetic) factors.
Estrogen and progesterone therapy
Hormone therapy (HT), or menopausal hormone therapy (MHT), consists of estrogens or a combination of estrogens and progesterone (progestin). This was formerly referred to as hormone replacement therapy(HRT). Hormone therapy controls the symptoms of menopause related to declining estrogen levels (such as hot flashes and vaginal dryness), and HT is still the most effective way to treat these symptoms. But long-term studies (the NIH-sponsored Women’s Health Initiative, or WHI) of women receiving combined hormone therapy with both estrogen and progesterone were halted when it was discovered that these women had an increased risk for heart attack, stroke, and breast cancer when compared with women who did not receive HT. These risks were most pronounced in women over 60 taking hormone therapy. Later studies of women taking estrogen therapy alone showed that estrogen was associated with an increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone, however, is associated with an increased risk of developing endometrial cancer (cancer of the lining of the uterus) in postmenopausal women who have not had their uterus surgically removed.
Hormone therapy is available in oral (pill), transdermal form (for example, patch and spray such as Vivelle, Climara, Estraderm, Esclim, Alora). Transdermal hormone products are already in their active form without the need for “first pass” metabolism in the liver to be converted to an active form. Since transdermal hormone products do not have effects on the liver, this route of administration has become the preferred form for most women.
There has been interest in recent years in the use of so-called “bioidentical” hormone therapy for perimenopausal women. The hormones are created in a laboratory by altering compounds derived from naturally occurring plant products. Some of these so-called bioidentical hormone preparations are made at compounding pharmacies that make the preparations on a case-by-case basis for each patient. That does not regulate individual FDA compound preparations because compounded products are not standardized. Bioidentical hormone therapy products are typically applied as a cream or gels. Studies to establish the long-term safety and effectiveness of these products have not been carried out, and expert panels currently do not recommend the use of custom-compounded hormone therapies.
In summary, the decision about hormone therapy is a very individual decision in which the patient and doctor must take into account the inherent risks and benefits of the treatment along with each woman’s own medical history. It is currently recommended that if hormone therapy is used, it should be used at the smallest effective dose for the shortest possible time. It is currently recommended that hormone therapy be used if the balance of risks and benefits is favorable for the individual woman.