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Frequently Asked Questions About Menopause
How do I know if I’m menopausal?
Menopause is diagnosed retrospectively after 12 months without a period.
The period leading up to that time, called perimenopause, can begin up to
five years or more earlier. Although a woman may still have a menstrual
cycle during perimenopause, she may experience symptoms very similar to
those of menopause. A blood test or saliva test can measure hormone levels.
What are some of those symptoms?
Symptoms may include:
Hot flashes
Cold sweats
Weight gain
Rheumatic pains
Cold hands and feet
Breast pains
Headaches
Numbness and tingling
Skin crawls
Vaginal dryness
Pain with intercourse
Urinary difficulty including recurrent bladder infections
Feelings of suffocation
Heart pounding
Dizzy spells
Pressure or tightness in head or body
Fatigue
Irritability and nervousness
Depression
Forgetfulness
Sleeplessness
Inability to concentrate
Crying spells
Panic attacks
Loss of interest in typical activities
Tension
Needless worry
What can I do?
Many women have been treated with synthetic hormone replacement therapy (HRT). That
method recently came under fire, however: part of a large, clinical trial of synthetic
HRT in post-menopausal women conducted by the Women’s Health Initiative (WHI) was
stopped early when it showed an increased risk of breast cancer, blood clots, heart
disease, and strokes in women using Prempro™ (a combination of estrogen and progestin).
Alternatives include the use of biologically identical hormones and proper nutritional support.
What are biologically identical hormones?
Biologically identical hormones are derived from plants, such as the wild yam or
soybean plant. The wild yam is rich in precursor molecules that can be converted
into estrogens and other hormones whose molecular structure is the same as those
produced naturally in the human body.
Estrogen is actually not one hormone, but a group of three hormones: estrone
(E1), estradiol (E2), and estriol (E3) are natural human hormones. A high ratio
of estriol to the other estrogens has been associated with a lower risk of breast
cancer. Premarin®, a drug commonly used in estrogen replacement therapy, is derived
from pregnant mare urine. Because horse estrogen is foreign to the human body, people may
lack the enzymes and cofactors to metabolize it safely.
Progesterone may be needed to balance the effects of estrogen on the uterus as well as
the rest of the body and also may help build bone. Natural progesterone might be
safer than synthetic progestins (like Provera®), which may have a negative effect on the
cardiovascular system. Likewise, natural testosterone (typically thought of as a male
hormone but also produced in the ovaries) may be safer than synthetic methyltestosterone
for treating problems with libido.
What are the side effects of natural hormones compared to synthetic hormones?
The side effects (such as breast tenderness, bloating, facial hair, and acne) might be the same if
the hormones are not balanced properly. However, many women who take biologically identical hormones
report fewer side effects, if any at all.
How are biologically identical hormones administered?
A patient may need to try several different delivery systems to determine
which one works best. Non-oral routes of administration, such as transdermal
(through the skin), sublingual (under the tongue), and pellet implants, may
provide a more consistent and natural way to introduce medications into
the body.
Can anyone take hormones?
Relative contraindications to estrogen therapy include:
Family history of breast cancer (outside immediate family)
Benign breast disease
Past history of recurrent thromboembolisms (blood clots)
Moderate or severe endometriosis
Enlarging fibroids or fibroids that produce heavy bleeding
Absolute contraindications to estrogen therapy include:
Presence of non-eradicated endometrial cancer
History of breast cancer
Cancer history in first-degree relatives
Active thrombosis (blood clot)
Acute liver disease or chronic liver failure
Unexplained vaginal bleeding
Pregnancy
Contraindications to progesterone therapy include:
Allergy to progesterone, progesterone-like drugs, or inactive ingredients
Past or present blood clots
Liver disease
Known or suspected cancer of the breast or reproductive organs
Unusual bleeding from the vagina, not evaluated by a physician
Miscarriage with suspected tissue remaining in the uterus
Breastfeeding
If I am already on synthetic HRT, is it difficult to switch to biologically identical hormones?
In most cases, the transition is a smooth one.
How do I find a doctor who will prescribe biologically identical hormones?
Please CONTACT US at College Pharmacy.
Will my insurance pay for biologically identical hormones?
About 80-85 percent of insurance companies will cover this therapy. (Cigna is an exception.)
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