Some of the most frequently asked questions in my practice revolve around hormone treatment. Menopause is defined as cessation of periods for more than 12 months in women over the age of 40. Menopause is not defined as "having hot flashes." Laboratory tests or hormonal levels are unnecessary in women with a uterus and not on birth control pills to diagnose menopause.
Once you are menopausal, the decision to use estrogen and/or progesterones is up to you based on your symptoms. If your symptoms are unbearable and inhibiting your enjoyment of life, I recommend the use of hormone replacement therapy.
Symptoms of menopause that are reduced or eliminated with hormone use are:
- Hot Flashes
- Vaginal Dryness
- Painful Sexual Intercourse
- Possibly Mood Changes
- Possibly Skin and Hair Changes
You should not use hormones in menopause if:
- You have had Breast Cancer
- You have had Uterine Cancer
- You have had Blood Clots
- You have had a Stroke
- You have significant Heart Disease
In my option, the risks of hormone replacement have been over-blown in the media. We all take risks everyday to improve our lifestyles. For example, we drive our cars every day although we have a 1 in 12 chance of being involved in an auto accident every year. By using hormone replacement , there is a 1 in 1000 risk of developing breast cancer at the age of 40 per year or a 1 in 250 chance of developing breast cancer at the age of 60 per year.
Most women would not give up the use of their car because of the great benefits they receive from being able to drive. The same is true for hormone replacement. If you feel dramatically better on hormone replacement, the small risks can be reasonable for the great benefits you receive.
If estrogens can improve your life and make the quality of life better for you, the benefits outweigh the risks. If, however, your menopausal symptoms are tolerable for you, then I would recommend not using these medications. The only way to know how you will feel on or off of hormones is to try one way or the other. If you are currently on hormones, you can come off by slowly weaning off of them.
Recommended weaning schedule:
- For one month take a half of a pill per day, then
- For one month take a half of a pill every other day, then
- For one month take a half of a pill every third day, then you can stop
I do recommend that you take the smallest amount of hormone for the shortest period of time to control your menopausal symptoms. Estrogen and progesterone does, in most studies, slightly increase your risk for breast cancer. Estrogen alone, in the most recent studies, did not show an increase in breast cancer risk. All estrogens do increase risk for blood clots and stroke.
If you have any further questions about your hormones, I would be happy to address them at your annual visit.