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When does menopause start and do all menopausal women need hormone replacement therapy (HRT)?

Menopause can start at any time from age 35 or later however the average age it occurs is 52. It may appear early due to removal of the ovaries by surgery, or after radiation or chemotherapy for the treatment of certain cancers. There are cases of early menopause with no apparent reason. The symptoms of menopause are most commonly hot flashes, night sweats, vaginal dryness, painful intercourse, urinary tract infections, frequent urination, mood swings, irritability, insomnia, depression or anxiety, bloating, heart racing, sore breasts, hair loss, memory lapses, migraine headaches, and low sex drive. Not every woman experiences these symptoms and the intensity of these symptoms varies from woman to woman. Bioidentical hormone therapy is an excellent remedy to these symptoms.

How long will I be on the treatment with the bioidentical hormones?

Menopausal symptoms can last months, years or even decades, but on average it lasts about 5 years. Every woman is different and once the treatment with bioidentical hormones begins, it can continue anywhere from one year to as long as indefinitely. The length of treatment is dependent on the response to the bioidentical hormones and the decision to remain on the treatment will rely on the discussion between the doctor and the patient.

What will I expect to feel once I start the HRT?

Most women feel the benefits of the hormones immediately after starting the therapy and the symptoms of hot flashes and night sweats improve within a few days. However some take a few weeks to feel the relief of the menopausal symptoms. A minority of women may feel worse in the first week to two weeks of starting therapy and they may experience an increase in the night sweats and hot flashes before they improve. If your symptoms worsen and not improve within three weeks, the dosages of the hormones need to be adjusted.

Some symptoms that may arise are: breast tenderness, vaginal bleeding (like a menstrual bleed), feeling bloated and headaches.  These are usually transient and will dissipate within a few weeks

Will I have an increased risk of breast cancer if I use bioidentical hormones?

There are multiple studies that revealed that there is no increased risk of breast cancer with the use of appropriate hormones. The following are some of the studies that describe this:

WHI (US) and WHILA (Sweden) showed no increase in breast cancer in the estrogen–only arm. Only the Prem-pro (premarin and provera) arm showed a 40% increase.

Swiss HRT study (23000 women) using mostly estradiol and estriol – showed actual decrease in breast cancer (Schairer et. Al. Epidemiology 1997)

Finnish study (approximately 100,000 women) using oral or transdermal estradiol showed no increase in risk for use of 5 years. For up to 10 years, 2-3 extra breast cancer per 1000 women, particularly those using more than 1.9 mg/day (Lyytinen H. et al, Obstet Gynecol. 2006)

A large French study (Fournier) of 54,548 women who received Hormone Replacement Therapy (HRT) that consisted of Estradiol and Provera showed a 40% increase in breast cancer; the women who received Estradiol and natural progesterone showed 10% decrease in breast cancer [2005].

Fournier follow up on 80,000 women: Women who received Estradiol alone demonstrated a 29% increase in breast cancer, Estradiol and synthetic Progestin showed 69% increase in breast cancer, and those who received Estradiol and natural progesterone showed No increase in breast cancer.

 What can be done for vaginal dryness?

Vaginal dryness and painful intercourse is very common in menopause and it is caused by the lack of estrogen resulting in thinning of the vaginal wall. This can be remedied by applying estriol cream into the vagina, and/or testosterone cream.

Will I gain weight on HRT?

It is important to obtain a good balance of hormones in order to prevent weight gain on the HRT. Estrogen can cause fluid retention and progesterone acts as a diuretic. So if your estrogen and progesterone are well balanced, weight gain should not occur.

Are my hormone levels monitored during the treatment and how often will I see the doctor?

The hormone levels are monitored every 3-4 months with blood work until they are stable. After that, you will be monitored every six months. You will see the doctor to review your progress at each interval.  A mammogram and a pelvic us are required once a year, and sometimes you will be asked to have a pap smear. If you have a family doctor who performs your yearly physicals, we ask that you ask your doctor to send us copies of any pertinent tests that have been performed, such as the mammogram and pap smear.