What happens during menopause?
What are kind of symptoms should I expect with menopause?
Are there any alternative therapies I can look into using as a substitute for HRT?
What happens during menopause?
Menopause refers to the ending of menstrual cycles or periods and can begin as early as forty or as late as fifty-five or sixty. We cannot know that we have reached menopause until we have gone an entire year (12 months) without a period. Confusion about menopause can occur because more of the discomforts and difficulties such as menstrual irregularities, severe PMS, and sometimes even hot flashes occur during the years leading up to menopause, the perimenopausal years. By the time we have experienced a year without periods, often the worst of these problems has subsided.
Some of us have a more difficult time and may need support of one kind or another, but that does not mean that every woman should take medication to prevent distress. It may take about four years, on average, before our menstrual periods stop completely. There is nothing abnormal or diseased about the changes that come with menopause and it does not necessarily require medical attention or treatment.
The states of the menopausal transition :
Perimenopause : This is the time during our later reproductive years (35-50) when out ovaries become less responsive, when our periods become irregular and other changes may begin to occur. Early changes of perimenopause are triggered by alterations in the hormonal feedback system that control the menstrual cycle. Early in perimenopause, the hormonal feedback system is working, but our cycle may be a bit shorter or longer than when we were younger. Later during perimenopause, we experience anovulatory cycles (no eggs being released) some months, while other months the orderly events of the menstrual cycle occur as before. Some women's periods stop suddenly but we only know in retrospect. These irregular periods have a number of consequences. We are less fertile than we were before, and we may experience changes in our cycle length and amount of flow. Many women begin to have hot flashes in perimenopause.
Menopause : This means the end of menstruation, defined after the fact, once 12 months have gone by without a period. Menopause can happen in three ways: periods can remain regular and then stop suddenly; they can change in a regular pattern (e.g. cycle gets longer or shorter) and eventually stop; or they can be completely unpredictable until they stop. The third pattern is the most common.
Post-menopause : This is the years after the end of menstruation during which the body completes its adaptation to its new hormonal state. After our last period, our ovaries produce much less estrogen. Our body has other sources of hormones once the role of the ovaries diminishes. The amount of estrogen in the blood after menopause varies from woman to woman and depends on a number of factors. Heavier women have more estrogen since body fat is one of the sites where the hormone is produced.
Later On : At a certain point we stop orienting ourselves around menopause. Our hormone levels stabilize and we consider ourselves as having completed that stage in our lives. Although our bodies continue to change, these are not menopausal changes, but the general effects of aging that touch all of us, women and men alike.
The Canadian Women's Health Network has gathered a number of resources on menopause and hormone replacement therapy. You can access the listing at the following web address:
What are kind of symptoms should I expect with menopause?
Every woman's period will stop at menopause. Some women may not have any other symptoms. But, as you near menopause, you may have:
- Changes in your period – the time between periods and the flow from month to month may be different.
- Abnormal bleeding or “spotting" – common as you near menopause. But if your periods have stopped for 12 months in a row and you still have “spotting,” you should report this symptom to your doctor to rule out serious causes, such as cancer.
- Hot flashes (“hot flushes”) – getting warm in the face, neck and chest.
- Night sweats and sleeping problems – these may lead to feeling tired, stressed, or tense.
- Vaginal changes – the vagina may become dry and thin, and sex and vaginal exams may be painful. You also might get more vaginal infections.
- Mood changes – such as mood swings, depression, and irritability.
- Urinary problems – such as leaking, burning or pain when urinating, or leaking when sneezing, coughing, or laughing.
- Problems with concentration or memory.
- Less interest in sex and changes in sexual response.
- Weight gain or increase in body fat around your waist.
- Hair thinning or loss.
We don't know exactly what causes hot flashes. It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger the hot flashes.
Mood changes can be caused by a lot of factors. Some researchers believe that the decrease in estrogen triggers changes in your brain causing depression. Others think that if you're depressed, irritable, and anxious, it's influenced by other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue-not hormonal changes. Or, it could be a combination of hormone changes and symptoms. Other things that could cause depression and/or anxiety include:
- having depression during your lifetime
- feeling negative about menopause and getting older
- increased stress
- having severe menopause symptoms
- smoking
- not being physically active
- not being happy in your relationship or not being in a relationship
- not having a job
- not having enough money
- low self-esteem (how you feel about yourself)
- not having the social support you need
- regretful that you can't have children anymore
The occasional "missed" period can be worrisome to women who might fear they might be pregnant. In spite of scanty periods, you can still be fertile, so keep using contraceptives until a year without periods has passed. Some women report more severe premenstrual discomforts (PMS), such as swollen tender breasts, water retention, tension, or anxiety, when periods become irregular. Whether one has had such discomforts for years or begin to have them in the perimenopausal years, one can look forward to relief as periods stop and hormone cycles level out. This may take several years. Hot flashes can begin when menstrual cycles are still regular or when they are becoming irregular, typically continuing for less than a year after the final menstrual period.
The Canadian Women's Health Network has gathered a number of resources on menopause and hormone replacement therapy. You can access the listing at the following web address:
What are the pros and cons of hormone replacement therapy? I have heard some stories in the media and am debating whether or not to take my doctor's advice to be on it.
Hormone therapy (HT) is also known as hormone replacement therapy or HRT. It is a hormone treatment prescribed by a doctor. Some women take HT to offset the lower levels of estrogen and progesterone that happen naturally at the beginning of menopause.
HT is either:
- estrogen taken alone, sometimes called estrogen therapy (ET) or estrogen replacement therapy (ERT);
- progesterone (natural or synthetic);or
- combination estrogen plus progesterone.
HT may be taken as:
- a pill;
- a patch;
- a cream or gel;
- an implant;
- an injection; or
- a vaginal ring
For an excellent overview of hormone therapy to help you decide whether you want to be on HT, we recommend The Pros and Cons of Hormone Replacement Therapy: Making an Informed Decision, written by the Women's Health Clinic. You can find this resource online at: http://www.cwhn.ca/resources/hrt/index.html
Hormone therapy has been debated in the news since July 2002, when the Women's Health Initiative (WHI) findings were released. Based on the first 3 years of this Estrogen Plus Progestin Study (16,608 postmenopausal women), researchers found that estrogen and estrogen plus progestin were associated with an increased risk of heart attacks, blood clots and strokes compared to placebo. The trial was stopped on July 9, 2002 due to increased risks of invasive breast cancer, coronary heart disease, stroke and pulmonary embolism in women taking active medication over placebo. The WHI study did not address the use of estrogen alone, whether it is administered orally (pills), by patch or by cream.
We do know that hormone therapy (estrogen only or estrogen with progesterone) is very effective in relieving menopausal discomforts such as hot flashes, night sweats and vaginal dryness. For symptom relief, HT is generally prescribed for 1-5 years. The absolute risk associated with short-term HT is low.
The Canadian Women's Health Network has gathered a number of resources on hormone replacement therapy. You can access the listing at the following web address:
I have been on HRT for ten years and have been thinking about ending this treatment. What is the best way to stop and what kind of symptoms should I expect?
Gradual reduction of HRT over many months is recommended for those who have taken HRT for an extended period of time and wish to stop. Stopping HRT suddenly will not cause serious harm, but troublesome symptoms of menopause, such as hot flashes, may reappear. Slowly decreasing the dose of hormones over four to six months (or more if menopausal symptoms are still a problem at this time) is a wiser approach and more closely approximates what the body does naturally when it is going through menopause. Decreasing the dose of hormones by one half every month is a reasonable way to wean yourself from HRT. If you find your symptoms are a problem at any time, then don't decrease your dose so quickly.
If you are on pills, you can ask your doctor for a lower dose pill to use in this process. Once you are on the lowest dose pill you can start taking a pill every other day, and then every third day, etc. until four to six months have passed.
Check out these sites for more information:
http://www.cwhn.ca/resources/faq/quitHT.html
http://www.cwhn.ca/resources/afi/stop-ht.html
Are there any alternative therapies I can look into using as a substitute for HRT?
Many women are turning to alternative or complementary approaches to hormone replacement therapy. Even before the Women's Health Initiative called off its study in 2002, many women were interested in more natural alternatives to HRT - hoping they would be safer, while offering the same benefits. Unfortunately, there are no panaceas - natural, or otherwise - for menopausal symptoms. Though they are derived from natural sources, natural hormones should be viewed with as much caution as conventional HRT. Hormones have powerful effects in the body and just because they are natural doesn't mean they are safe. We recommend that you begin looking into alternatives to HRT by discussing it with your physician or alternative health care provider.
Complementary and alternative therapies are based on the idea that all illnesses impact on your emotional and physical well-being. For any treatment to be truly effective, it must address all the ways you are affected by illness. Most complementary medical therapies are holistic: they treat the whole person rather than a specific ailment or body part. They also focus on prevention of disease compared to mainstream medical systems that focus on treatment of disease. Complementary and alternative therapies are those not normally offered by the general medical system. They include a wide range of therapies such as herbal medicine, homeopathy, acupuncture, chiropractic, osteopathy and naturopathy.
Many complementary therapies can be helpful; others may have potentially harmful side effects or interactions. Consumers may not have enough information about the quality of products or about how effective they are. Before taking anything, whether it's herbs or medications, learn about the possible risks and side effects and find out whether there are any reasons you should not take them. Seek out knowledgeable practitioners and sources of information. Tell all your health care providers about everything you are taking. This will help avoid any harmful interactions and encourage providers to work more as a team in relation to your health care needs.
Making an informed choice about Natural Health Products (NHPs) means doing some research. There is far less reliable information on NHPs than on pharmaceuticals at this point. Many NHPs, including those recommended by doctors, naturopathic doctors and doctors of Traditional Chinese Medicine, are used based on anecdotal evidence and traditional use rather than on clinical trials.
Before a woman takes an NHP to treat menopausal symptoms, she should attempt to find out if:
- There are studies showing the product is effective for its recommended purpose.
- The risks of taking the product are known
- There are contraindications – risks for specific health conditions, or conflicts with certain pharmaceutical drugs – for taking the product that apply.
It may not be easy to come up with answers, as the limited number of studies available disagree about the safety and effectiveness of a range of NHPs currently being promoted as HRT alternatives. This situation will likely improve over the next few years, as research studies are underway looking at dietary changes and several of the most promising herbal medicines typically used to relieve symptoms such as hot flashes, memory, concentration, sexual function, and irregular bleeding. These herbs include:
- Black Cohosh (Latin name: Cimicifuga racemosa - or more currently, Actaea racemosa)
- Chaste Tree (Vitex agnus-castus)
- Red Clover (Trifolium praetense)
- Ginkgo (Ginkgo biloba)
Using Herbs Safely:
- Ideally you will consult with a naturopathic physician or a certified herbalist before using herbs to treat yourself.
- Identify plants you intend to use by their botanical name because this is specific to only one plant, while common names overlap and vary. (i.e.”sage” refers to at least five plants in at least two different families.)
- Use only one herb at a time and learn as much as you can about it.
- Buy herbs that have been standardized. This means that every tablet you take has the same amount of the active ingredient. Look for a D.I.N. (Drug Information Number) or G.P. (General Public) number, which shows that Health Canada has reviewed and approved the product's information, labelling and instructions for use.
- Tell all your health care providers about any herbs that you are taking, especially if you are also taking any prescription medication.
- Understand that not every herb is right for every person in every situation.
- Respect the medicinal quality of plants; many are strong enough to act as stimulants, sedatives and mind-altering drugs these are often only useful and safe in small doses. Learn the differences between nourishing and tonifying herbs versus stimulating, sedating and toxic herbs.
You may also wish to consult with a dietitian to go over nutritional aspects that can help you with your menopausal symptoms. To locate a dietitian in your area, contact the Dietitians of Canada at (416) 596-0857, or search their web site to find a nutrition professional at http://www.dietitians.ca/find/index.html.
Use the following tips when considering complementary therapy:
- Seek a licensed therapist. If there are no national boards for certification in your area seek a therapist who is a member of a local association. This shows commitment to the profession.
- Get your herbs from a licensed practitioner or a certified herbalist. If you cannot find a local supplier there are a number of reputable companies who do mail order. Do your research to ensure you are getting quality products.
- You should see some results within 3-6 months of starting your treatment. It may take a bit longer for more complicated conditions. You should not have to wait years to see positive results. Ask your therapist ahead of time what results to expect.
The Canadian Women's Health Network has gathered a number of resources on hormone replacement therapy and alternative & complementary medicines. You can access the listings at the following web addresses:
Alternative & complementary medicines