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Female Hormone Replacement Therapy

Bio-Identical Hormone Therapy

What is menopause?

Menopause is the time in a woman's life when she stops having monthly periods. It is the natural result of the decline of follicles in the ovaries. Hormones like estrogen and progesterone start to change significantly. Menopause usually occurs between the ages of 45 and 55. The average age is 51. Menopause can last from months to years, with the average length is about four years. 



How do I know if I am going through menopause?

The first sign of menopause woman notices is their periods start to change. If you are going through menopause, you might:

●Have periods longer or shorter than usual (For example, every 5 to 6 weeks instead of every 4 weeks)

●Have bleeding that lasts for fewer days

●Skip one or more periods

●Have symptoms of menopause, such as hot flashes or depression (described below)

If your uterus has been removed, but you still have your ovaries, it might be tough to tell when you are going through menopause. Still, women who do not have a uterus can have menopause symptoms. If your ovaries were removed before the usual age of menopause, you had what doctors call "surgical menopause." That means that you went through it early because your ovaries were removed.



What are the common symptoms of menopause?

Women might go through menopause without symptoms. But most have one or more of these symptoms from mild to severe:

Hot flashes – Hot flashes feel like a wave of heat that starts in your chest and face and then moves through your body. Hot flashes usually start happening before you stop having periods. 


Night sweats – When hot flashes happen during sleep, they are called "night sweats." They can make it hard to get a good night's sleep.


Difficulty sleep – During the transition to menopause, some women have trouble falling or staying asleep. This can happen even if night sweats are not a problem.


Vaginal dryness – Menopause can cause the vagina and tissues near the vagina to become dry and thin. This usually starts a few years after menopause. It can be uncomfortable or make sex painful.


Mood change – During the transition to menopause, many women start having symptoms of depression or anxiety. That's especially true for women who have been depressed before. Depression symptoms include: Sadness, losing interest in daily activities, increase or decrease sleep time.


Having difficulty concentrating or remembering things – This might be caused by a lack of sleep that often happens at menopause, or by the a lack of estrogen. Some experts suspect that estrogen is important for good brain function.


However, do I need to see a provider?

If your periods start changing and you are 45 or older, you might not need to see a provider. But if your symptoms are bothering you significantly, seeking medical care would be indicated. 

You might need to see a provider if you:

  • Have your period more often than every 3 weeks
  • Have very heavy bleeding during your period
  • Have spotting between your periods
  • Have been through menopause (have gone 12 months without a period) and start bleeding again, even if it's just a spot of blood


Is there a test for menopause?

Some common serum tests like estrogen, progesterone, FSH, LH, and TSH might reflect the transition of menopause. However, they are more indicated if women who are too young to be in menopause or with other medical conditions. Discuss with Dr. Zi for an evaluation based on your need and concern. 


How are the symptoms of menopause treated?

Some treatments can help relieve symptoms.

Treatments for hot flashes include:

Hormones (estrogen) 

The hormone estrogen is the most effective treatment for menopause symptoms. Most women need to take estrogen with another hormone, called progesterone. Women who have had a hysterectomy (surgery to remove the uterus) can take estrogen by itself. Experts think these hormones are effective and safe for many women in their 40s and 50s with symptoms of menopause. If this is your preference, ask a provider if it is indicated for you. You should not take hormones if you have a history of breast cancer, a heart attack, a stroke, or a blood clot.


Anti-seizure medicine 


Treatments for vaginal dryness include:

Topical(vaginal) estrogen 

This is an option for women who have vaginal dryness without other symptoms of menopause. Vaginal estrogen is any form of estrogen that goes directly into the vagina. It comes in creams, tablets, or a flexible ring. Vaginal estrogen comes in small doses that don't increase the estrogen levels in other parts of the body very much.

Other medicines like Ospemifene and Prasterone


What are Bio-Identical Hormones?

"Bio-Identical" refers to a hormone with the same molecular/chemical structure as a hormone that is endogenously produced in the human body. 


What can I do to protect my bones?

You can:

●Take calcium and vitamin D dietary supplements. 

●Be physically active (Exercise helps keep bones maintain their strength). 

●Maybe you are indicated for bone density tests. 


(Information Source: UpToDate: Treatment of menopausal symptoms with hormone therapy)