Top Ten Menopause Issues Explained by MenopauseRx

1. What is the Perimenopause and how is it diagnosed?
   Women usually begin to experience the physical and emotional changes that indicate the beginning of menopause between the ages of 40 and 60...this is often referred to as the 'perimenopause'.

   - Hotflashes - Night Sweats - Disrupted Sleep - Mood Changes - Fatigue - Decreased Sex Drive - Vaginal Dryness - Increased Weight Gain

   - Unwanted Facial Hair - Skin Changes - Irritability - Anxiety - Depression - Headaches - Irregular Bleeding

   Learn more about these and other symptoms by visiting the MenopauseRx Health Center.
   
   These normal changes occur because estrogen, progesterone and testosterone levels naturally fluctuate and then gradually decline during the transition from perimenopause to post-menopause.
   
   The perimenopausal transition is a confusing time for women. Perimenopause is a distinct transition between the reproductive years and cessation of menses. The World Health Organization defines the onset of the perimenopause as the beginning of menstrual cycle changes. Early perimenopause changes include the first break in regular cycling of menses. Late perimenopause is classified after missing 3 to 11 months of menses, while menopause is reached after 12 months of no menstrual flow. Women usually notice the onset of perimenopause symptoms during their 40's and irregularities usually persist for approximately 5 years. The constantly changing hormone levels of the perimenopause can precipitate significant hot flashes and night sweats. The 'peaks and valleys' of estrogen production during the hormonal 'roller coaster' invariably contribute to these symptoms.
   
   The diagnosis of the perimenopause is based upon a careful menstrual cycle history and symptom review. Maintaining a 'menstrual calendar' for 4-6 months will detect a pattern of changing cycle lengths and flow patterns. Evaluating for other conditions that are common during the perimenopause and may mimic symptoms of the perimenopause is also important. Therefore, thyroid and diabetes testing is prudent. Due to the rapid fluctuations of estrogen in the perimenopause, the measurement of gynecologic hormones can be difficult to interpret and may lead to inappropriate treatment. A commonly used test (FSH; follicle stimulating hormone) for the diagnosis of menopause can be especially misleading in the perimenopause. The most prudent use of FSH testing and estrogen levels during the perimenopause has not been determined and should always be used in the context of a person's menstrual history and symptoms. The transition to menopause can be diagnosed after no menses for a 12-month period of time and signifies cessation of ovarian function. Often associated with symptoms, this diagnosis does not routinely require laboratory testing.
   
   For more information, please click here.

2. What are the tests for Perimenopause and Menopause?
   
   - Follicle Stimulating Hormone Blood Test
   - Thyroid Stimulating Hormone Blood Test
   - Estrogen Blood Test
   - Progesterone Blood Test
   - Testosterone Blood Test
   
   Talk to your doctor…. and visit www.MenopauseRx.com to evaluate your symptoms with our MRX Survival Kit symptom checklist. Menopause is the medical term for the end of a woman’s menstrual cycles. It is a natural part of a woman’s life and occurs when the ovaries stop making hormones. This causes estrogen levels to drop and leads to the end of menstrual cycles. Menopause can also occur when the ovaries are surgically removed.
   
   See the MenopauseRx Menopause Assessment Center to help learn more about your specific symptoms and how they relate to the menopause and perimenopause transition.

3. What about Saliva Test?
   Saliva tests are unreliable. The concentration of hormones in saliva can vary widely depending upon diet, the time of day the test was performed, and the laboratory testing procedure.
   
   Most saliva tests require strict temperature conditions for processing, including the use of sub-zero conditions for storage and transport. Therefore, the use of home kits that are mailed to a processing center will invariably undergo degradation, which will make the results inaccurate. In addition, the use of salivary hormone levels are very controversial, as there are no known ‘normal’ ranges for patients and their health care providers to guide the dosage of hormone therapy.

4. What is Bio-Identical?
   The term bio-identical is not a medical term. When something is labeled and marketed as a bio-identical, it is structurally identical to the naturally occurring substance in your body. Most bio-identicals come from soy (estrogen) or yams (progesterone). Once the hormones are extracted from the plant source, they are processed for use by a women’s body, and are available by prescription in pills, patches or a gel, as well as compounded formulations.

5. What is the difference between compounding hormones and Food and Drug Administration (FDA) approved hormones?
   While there are no studies that show the bio-identical hormones are safer than synthetic hormones, many women prefer the types of hormones normally found in the body. These include bio-identical hormones such as estradiol and micronized progesterone. There are bio-identical prescription FDA approved products that are similar to what the body made naturally prior to mid-life changes. Today some pharmacies offer to custom-compound bio-identical hormone therapies for a woman’s individual menopause symptoms. These custom-compounded therapies are not FDA approved. They are not regulated, and have no long-term studies; they are not covered by insurance and may have quality control issues. It is important to realize that estradiol and micronized progesterone are available by prescription in many FDA – approved products that insurances do cover!

6. Is there a difference in how I take hormones?
   Yes, many options exist for women contemplating hormone therapy. The delivery of hormones into the body can occur via an oral tablet/capsule or through the skin (topical or transdermal).
   
   Topical
   Patches, lotions, gels, sprays and vaginal rings are available that contain bio-identical estradiol and help relieve menopausal symptoms with less hormone compared to pills. For instance, patches use fewer hormones because estrogen taken via a patch is absorbed through the skin directly into the blood stream to be delivered to the body. The skin efficiently delivers the hormone it absorbs since the hormone does not have to first go through the GI tract and liver. This difference can lead to lower dosages of estrogen for the same relief of symptoms among patch users. Another major difference between the patch and the pill that also results from the way the hormone is delivered to the body is the consistency of estrogen delivered. The patch releases estrogen evenly over time, maintaining a steady level of estrogen throughout the day. This results in around-the-clock symptom relief, even when changing to a new patch.
   
   For more information, please visit: http://www.menopauserx.com/health_center/med_HRTERT.htm
   
   Oral
   Pills require "extra" hormone because the GI tract and liver must absorb hormones taken via a pill first (called the "first pass liver effect") where it is metabolized before entering the blood stream. As the liver metabolizes the estrogen it is converted into a less active form of estrogen before reaching the blood stream to be delivered to target organs. The pill provides a sudden increase in hormones and then a drop-off in hormones everyday it's taken; as a result, some women get erratic symptom relief. If you take oral hormone therapy and still don't feel well, ask your doctor about changing over to a topical therapy. 
   
   Clotting Factors
   Research has found that estrogen applied to the skin may have a lower risk of blood clots and strokes than pills.
   
   Lipid Factors
   Cholesterol and lipid changes that occur during menopause and the natural loss of estrogen can place women at greater risk for heart disease. Many experts believe the main issue is beginning estrogen therapy early in menopause (when you are most likely to need hormone therapy) if you going to use hormone therapy at all.

7. What type of Hormone Therapy is needed?
   When discussing hormone therapy, the most common hormones mentioned are estrogen, progesterone and androgens.
   
   Estrogen alone is utilized by a woman who has had a hysterectomy (removal of the uterus). These women do not need a progesterone hormone, and can take estrogen alone.
   
   Estrogen and Progesterone
   In addition to estrogen, women who still have a uterus should use another hormone (a progesterone hormone in combination with estrogen) because estrogen therapy alone causes the lining of the uterus to grow. The progesterone hormone protects the uterus from the risk of endometrial cancer.
   
   Progesterone:
   Progesterone is another female hormone that helps shed the uterine lining and prevents the development of abnormal thickening and cancerous changes.  It is important to know the difference between progesterone and progestins.   Progestins are synthetic (man-made) hormones.  Although different from natural progesterone, progestins are made to react in a similar way in your body.
   
   In the last decade, researchers found a way to produce absorbable progesterone made from plants. These scientists used micronization , a process that allows the body to easily absorb natural progesterone when it is taken orally.
   
   You may have heard about topical progesterone cream or gel preparations that are available either over-the-counter or with a prescription. According to The North American Menopause Society such products may not work well enough to protect the uterine lining from unopposed estrogen, and could lead to abnormal uterine thickening and precancerous changes.
   
   Click here to read more: http://www.menopauserx.com/health_center/med_progest1.htm
   
   There are many progestin products available, including micronized progesterone made exclusively from yam plant sources.  Micronized progesterone is bio-identical to the progesterone produced by the ovary before menopause and has been shown to be well tolerated when used as part of an HT regimen. A recent study revealed 80% of study subjects reported excellent satisfaction with micronized progesterone. Over 65% thought the micronized progesterone containing HT was better than other HT regimens they had taken. Specifically, study participants reported significant improvements in anxiety, depression, and fluid retention and hot flash symptoms when taking micronized progesterone compared to another synthetic progestin.
   
   Androgens
   Although estrogens are the primary female sex hormone, androgens are important for the female body. Overall, there are four primary androgens produced by women, including testosterone, androstenedione, DHEA, and DHEA-sulfate. These androgens are typically produced by the ovary and adrenal glands. Menopause may be associated with a 50% decrease in androgen production. Androgens affect the body by maintaining muscle mass, stimulating sexual desire, stimulating bone growth, and controlling oil gland activity in the skin. Androgens can also lead to a more efficient use of estrogen. By improving the amount of estrogen that can be available for use by the body, androgens can improve symptom relief from HT. Research has shown that lower testosterone levels in some menopausal women may lower sex drive and lead to bone loss. By supplementing testosterone, many women notice improvement in their libido and theoretically improved bone density. Physicians often recommend a combination of estrogen and testosterone in women experiencing diminished libido after menopause.

8. How do I find the ‘right’ health care provider for Menopause?
   It is important to find a health care provider who is compassionate, educated about resent research on hormone replacement issues and a good listener. It may take some shopping around to find such a provider. It is important that you do your own research. Make an appointment and be prepared to review all of your symptoms, as well as your health and family history.
   
   Gynecologist vs. Family Doctors
   Gynecologist specialize in caring for women at every stage of life. If you are contemplating hormone replacement therapy it is important to discuss all the risks and benefits with a gynecologist.

9. What about Breast Cancer and HT?
   Women’s Health Initiative review
   As the data has been further analyzed, limitations have become apparent and many questions are being raised about how to interpret the results. For instance, the average age of WHI participants was 63 years of age and 18 years from their menopause. This does not necessarily provide information for women and physicians seeking information who are younger in age and closer to the menopause transition. In fact, women with moderate or severe menopausal symptoms were discouraged from participating in the study. Only 12% of WHI participants reported moderate or severe symptoms. These quality of life altering symptoms are the primary reason many women use HT. Therefore, it is important for women to be aware of the limitations of this study as they contemplate the use of HT. It is certainly appropriate to talk to your doctor about the WHI results and the implications they may have for you as an individual.
   
   Estrogen Therapy vs. Estrogen and Progesterone Therapy combined
   In the combined estrogen and progesterone arm of the study, the WHI investigator's reported 7 more cases of heart disease events (like heart attacks), 8 more cases of stroke, 8 more cases of breast cancer and 18 more cases of blood clots per 10,000 women per year in hormone therapy users compared to non-users. Positive outcomes from the combined arm of the WHI include a 24% reduction in total fractures and 34% reduction in hip fractures.  This would result in 5 fewer hip fractures per 10,000 women.  The risk of colon cancer was reduced by 37% in the group, which resulted in 6 fewer cases per 10,000 women. The benefit appeared after 3 years of use and became more significant over time. The Estrogen-only arm of the WHI study was stopped in March 2004 after a follow-up of 6.8 years revealed no effect on the risk of heart disease and a slight increase in risk of stroke. 10,739 postmenopausal women were enrolled between the ages of 50 and 79 who had undergone a hysterectomy. Twelve more cases of stroke per 10,000 women were observed during this trial. Six fewer hip fractures per 10,000 women were seen in the women taking estrogen. Importantly, there was no increase in risk of breast cancer in this arm of the WHI trial.

10. What about other alternatives for Menopause?
    Several natural complementary and alternative medicine remedies, including herbal products that offer relief from troubling symptoms and may be used in place of, or in combination with traditional therapies.
    
    Black Cohosh
    Black cohosh is an herb sold as a dietary supplement in the United States that is used for hot flashes, night sweats and mild mood disturbances seen during the menopause. The mechanism of action is not completely understood. However, it does not appear to act on target tissues such as the uterine lining, thereby no increase in bleeding should be seen with its use.
    
    To read more about Black Cohosh, please visit: http://www.menopauserx.com/health_center/com_BlackCohosh.htm
    
    Soy
    Several studies have shown that women who consume large amounts of soy-based phytoestrogens have fewer menopausal complaints.