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A Time of Change

For most women, the years between 45 and 55 are full of change. This is the time of menopause. Periods stop. The ability to bear children ends. But these years may also offer new opportunities. You have a chance to apply all that life's taught you. Even so, coping with your own body may be a challenge now. You may have hot flashes and mood swings. Plus, your risk of bone loss (osteoporosis) increases. For many women, hormone replacement therapy (HRT) helps. It reduces symptoms of menopause and helps restore a sense of well-being.

Find Out About HRT

Before and after menopause, you may have lower levels of certain female hormones (chemical messengers). This change in hormone levels can affect how you feel. But HRT can relieve some of your symptoms. Some types of treatment may also help reduce your risk of bone loss. Talk with your health care provider about taking hormones. You may also want to talk with women who are using HRT. Learn all you can. That way, you can make an informed choice.

Hormones Control Your Cycle

A woman's menstrual cycle (monthly period) is controlled by changing levels of certain hormones. These hormones travel through the blood. Two hormones, estrogen and progesterone, play a big role in the menstrual cycle. They are produced in the ovaries (where eggs are stored).

The Menstrual Cycle

Hormones help prepare the uterus for pregnancy. At the start of the cycle, the two ovaries produce estrogen. This makes one ovary release an egg, and signals the production of progesterone. The egg travels through the fallopian tube. Then it enters the uterus. If the egg is fertilized, a woman becomes pregnant. If this doesn't happen, the egg is shed along with the uterine lining. This bleeding is called menstruation.

Symptoms you may have:

Day 1 to 7:

  • Menstrual bleeding (period)

  • Cramping

  • Headache

Day 8 to 14:

  • Increased and thickened vaginal mucus

  • Higher energy

Day 15 to 28:

  • Bloating

  • Tiredness

  • Irritability

  • Cramping

  • Breast tenderness

What Happens During Menopause

Menopause is not a sudden change. During the months or years before menopause (perimenopause), the ovaries begin to run out of eggs. Less estrogen and progesterone are produced. This may bring on symptoms such as hot flashes. Twelve months after your last period, you've reached menopause. From that point on, you are in postmenopause.

Perimenopause

In the years leading up to menopause, the ovaries produce less estrogen. Fewer eggs are released. Periods become less regular.

Symptoms you may have:

  • Heavier or lighter periods

  • Longer or shorter time between periods

  • Hot flashes

  • Breast tenderness

  • Bloating

  • Mood swings

Postmenopause

After menopause, very little estrogen is produced. As a result, the uterine lining does not thicken. Periods have ended.

Symptoms you may have:

  • No periods

  • Vaginal dryness

  • Hot flashes

  • Mood swings

  • Night sweats

  • Insomnia

Surgical Menopause

Menopause can occur after a hysterectomy (removal of the uterus) if the ovaries are also removed. Estrogen and progesterone levels decrease quickly. This may cause sudden and severe symptoms.

The Effects of Low Estrogen

When your estrogen level falls, changes occur throughout your body. You may be at greater risk for osteoporosis and heart disease. You may also notice some of the symptoms of menopause. These include night sweats and headaches. Your diet, family health history, lifestyle, and other factors affect your risks and symptoms.

Osteoporosis

Estrogen helps maintain strong bones by preventing calcium loss. Too little calcium can increase the risk of fractures in the spine, hips, and leg and arm bones. Thin or petite women are at greater risk. So are those who drink a lot of alcohol, smoke, or are not active. A family history of osteoporosis may also increase risk.

Heart Disease

Before menopause, women's natural estrogen seems to protect them against heart disease. It may do this by raising the level of HDL (good) cholesterol in the blood. After menopause, when women no longer produce much estrogen, their risk for heart disease rises sharply. About 10 years after menopause, a woman's risk equals a man's.

Symptoms of Low Estrogen

Flashes, flushes, and night sweats are the most common symptoms of low estrogen. At times, blood rushes to your skin's surface. This can give you a feeling of warmth (hot flash). Your face may look red (flushed). If you have hot flashes while sleeping, you may perspire a lot. These hot flashes are called night sweats.Mood swings are another effect of low estrogen. You may feel sad, anxious, or frustrated. Shifting hormone levels and night sweats may disrupt your sleep. This can cause fatigue, which may make mood swings worse.Thinning tissues may cause discomfort. Skin may appear more wrinkled. Thinning in the urinary tract may lead to bladder infections. You may also have an urgent need to urinate. Or, you may lose bladder control (incontinence). Thinning of the vagina may cause dryness and painful sex.

How HRT Helps

HRT replaces some hormones your body no longer produces. Because of this, it reduces some symptoms of menopause that are linked to low hormone levels. HRT may also help control certain health risks in some women. Estrogen and progestin (a form of progesterone) are used most often. HRT can also include other hormones.

You may not need HRT—not all women do. Talk to your health care provider to see if HRT is a good choice for you.

What HRT Can't Do

HRT cannot prevent aging, wrinkles, or gray hair. HRT also cannot prevent pregnancy. (You need to use birth control for at least one year after your last period.) And HRT may not prevent all the risks and symptoms associated with menopause.

Deciding About HRT

Your health care provider will review your health needs. Then he or she will suggest steps you can take to control any symptoms or health risks. HRT may be one part of your overall program.

Health History

Your health care provider will ask about any symptoms that you may have. You will also discuss any family history of health problems. This includes any breast or uterine cancer. In some cases, HRT may not be right for you.

Physical Exam

You will have a complete physical exam. A pelvic exam,Pap test, and breast exam will be done. These check for certain kinds of cancer.

Medical Tests

Test results can help your health care provider decide whether HRT is right for you.

  • Blood tests can measure hormone levels. This shows if you are nearing or if you have passed menopause.

  • Blood cholesterol tests help assess your risk of heart disease.

  • Other tests may help show if you have osteoporosis.

  • A breast x-ray (mammogram) may be done to check for breast cancer.

  • Thyroid function tests may show problems with the thyroid hormone. Symptoms of thyroid problems can be similar to those of menopause.

Making the Choice

Deciding about HRT is a personal choice. So, take some time to weigh the pros and cons. Discuss them with your health care provider.

Benefits of HRT

  • Slows bone loss

  • Decreases hot flashes and sweating

  • Less vaginal dryness

  • Fewer bladder problems

  • Fewer mood swings

Risks

  • Taking estrogen alone increases the risk of uterine cancer if you have a uterus. Taking progestin along with estrogen helps reduce this risk.

  • Long-term use of estrogen may increase your risk for breast cancer. Some newer estrogen-like treatments may not carry this risk. Studies are still being done.

Your Personalized Program

Your health care provider will look at your symptoms and health risks. Then he or she will try to find the best balance of hormones for you. You can work as a team to fine-tune your program as needed. If you smoke, you may be asked to quit before you begin taking estrogen.

HRT May Not Be for Everyone

For some women, HRT may not be a safe option. Tell your health care provider if you are pregnant. Also, be sure to mention if you have or have had any of the following:

  • Breast or uterine cancer

  • Blood-clotting problems

  • Phlebitis (inflammation of a vein)

  • Liver disease

  • Migraine headaches

  • Abnormal vaginal bleeding

  • Gallbladder disease

  • High blood pressure

  • Seizure disorders

  • High cholesterol

  • Heart attack or confirmed heart disease

How to Take HRT

Have you decided on HRT? If so, your next choice concerns how you will take the hormones. This depends on your symptoms, and the type of hormones you'll be taking. It also depends on which days of the month you'll take them. All methods are prescribed by a health care provider.

By Mouth

Pills are the most common way to take HRT. Your health care provider tells you when to take them.

Through the Skin

Skin patches, creams, and gels all release hormones into the bloodstream. Patches are placed on your abdomen or hip. They are changed once or twice a week. Hormones can also be given by injection every few months.

Into the Vagina

Vaginal cream or gel can be placed into your vagina. You do this one or more times a week. Or a ring can be placed in your vagina. The ring releases estrogen slowly over time.

When to Take HRT

Which hormones you take and when you take them is called your HRT program, or regimen. Your program is tailored for you, based on certain factors. These factors include whether you have a uterus and what your risk of cancer is. Whether or not you have reached menopause is also a factor. You may take more than one type of hormone. And you may use more than one delivery method. For instance, you may use pills and a vaginal cream.

Common HRT Programs

Cyclic Estrogen and Progestin

You take estrogen all month and progestin about half the month. This method is based on a normal menstrual cycle. You will have some of the same symptoms, such as bleeding. This program helps reduce your risk of uterine cancer.

Combined Continuous

You take a lower dose of progestin. Both estrogen and progestin are taken each day of the month. You're less likely to have the symptoms of a menstrual cycle. And you still reduce your risk of uterine cancer. But symptoms may be present during the entire cycle.

Combined Continuous with a Break

You take five to seven days off both estrogen and progestin each month. This method also helps reduce the risk of uterine cancer. You may have less irregular bleeding with this program.

Unopposed Estrogen

Estrogen is prescribed by itself. This is most likely if you have had a hysterectomy. You may use this option if you still have a uterus. But you will need yearly tests to check for uterine cancer.

Combined Estrogen and Androgens

Estrogen is combined with hormones called androgens. This option may be prescribed if your symptoms are not controlled by estrogen alone.

Making HRT Work for You

HRT can be changed to meet your needs. If the first program doesn't work for you, tell your health care provider. He or she can adjust the dosage. Or, the way you take HRT can be changed. Be sure to mention any other treatments you are using besides HRT. This includes vitamins or herbs.

How Well Is Your Program Working?

After you've been on HRT for a while, your health care provider will want to follow up with you. You can help by reading the list below. Make a list of any symptoms you still have. Bring the list to your next visit.

  • Hot flashes and night sweats

  • Bloating

  • Vaginal dryness during sex

  • Cramps

  • Mood changes

  • Increased vaginal secretions

  • More tiredness than usual

  • Regular bleeding (like a normal menstrual cycle)

  • Breast tenderness

  • Irregular bleeding

  • Other symptoms (list below):

Follow-up Visits

If you're on HRT, have routine follow-up visits with a health care provider. These visits help track how well your HRT program is working. You can also be checked for any problems that might require you to stop HRT.

Your Exam

Tell your health care provider about any symptoms you're having. This includes problems such as monthly bleeding. You may also have a breast or pelvic exam, a Pap test, and a rectal exam. These help detect cancer.

Special Tests

A mammogram (breast x-ray) may be done every year. One may also be done to follow up on findings from a breast exam. If signs of a problem are found, other tests may be needed. You may also have to stop HRT.

Fine-Tuning Your Program

Your HRT program may be changed from time to time. Changes are based on your symptoms, exam, and any test results. These changes may help control bleeding problems or relieve symptoms better.

Alternative Treatments

Many treatments claim to relieve symptoms of menopause. You may hear about the benefits of soy, wild yam, herbs and vitamins, and special exercise routines. You may want to try one of these. But talk with your health care provider first. Find out the pros and cons of using these types of treatment in place of HRT. You may choose to combine them with HRT. If you do, your HRT program might need to be adjusted. Alternative treatments may affect HRT and make it too strong or not strong enough.

When to Call Your Health Care Provider:

Call your health care provider if you have any of the following:

  • Unexpected, long-lasting, or heavy bleeding

  • A breast lump or breast tenderness that doesn't go away

  • An unexpected vaginal discharge

  • Severe headaches

  • Aching or cramping muscles in your back or legs

  • Sudden pain in your legs or chest

  • Shortness of breath

Other Steps to Health

HRT works best when you are doing all you can to stay healthy. Eat a balanced diet, get frequent exercise, and don't smoke. Following these guidelines is the best way to stay healthy and feel better.

Eat a Well-Balanced Diet

Stay healthy by eating a well-balanced diet. Include plenty of fresh fruits and vegetables. Here are some other tips for keeping your bones and heart strong:

  • To help prevent osteoporosis, get a total of 1,500 mg of calcium daily. Eat foods high in calcium. This includes low-fat or nonfat milk, yogurt, and cheese. Dark green vegetables and beans are good too. Taking a calcium supplement along with a balanced diet can also help.

  • To lower your risk of heart disease, reduce the amount of fat you eat. Choose lean cuts of meat. Take the skin off chicken. Also, cook with less fat. Steam, microwave, broil, or bake foods.

Stop Smoking

Smoking increases your risk for heart disease, osteoporosis, and breast cancer. HRT may lower these risks. However, combining HRT and smoking may cause other problems. If you smoke, stop. These tips may help:

  • Talk to your health care provider about stop-smoking aids and programs.

  • Get your family and friends to help you quit.

  • Join a stop-smoking support group.

  • Find ways to delay smoking. The urge to smoke should pass within minutes.

  • Set a quit date. Then do it.

Be Active

Staying active helps keep you fit. It's good for your bones and all your muscles, including your heart. Try to be active for at least 30 minutes daily.

  • Find ways to keep moving. Garden. Take the stairs. If you can, ride a bike instead of using a car.

  • Work out with weights and do other weight-bearing activities to help strengthen bones. Try walking, running, or dancing.

  • Check with your health care provider before starting an exercise program.

Don't Forget About Birth Control

Even if you're nearing menopause, you could still become pregnant. Prevent unplanned pregnancy. Be sure to use birth control for at least one year after your last period.

Online Medical Reviewer: Louise Akin, RN, BSN
Online Medical Reviewer: Daphne Pierce-Smith, RN, MSN, FNP, CCRC
Date Last Reviewed: 12/2/2003
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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