Menopause & Hormone Therapy

Menopause is the next big change in a women’s life after passing through the adolescence and reproductive stages. During this last and important change, learning how to handle the changes will allow you to have a better quality of life, physically and mentally, and to feel more comfortable during daily activities.

What is Menopause?

For most women, menopause starts between 45 – 55 years old. When a woman's body enters this stage the ovaries decline and stop functioning, thus no ovulation occurs. A woman’s period will ultimately stop, with no female hormones produced, leading to physical and mental changes.

The missing hormones causing this change are estrogen and progesterone. 

Symptoms of Menopause

  • Shorter duration and lighter menstrual bleeding.
  • Hot flashes - especially on the upper part of the body, hot flashes usually manifest in ways such as: fatigue, palpitation, night sweating. Some experience shivering without known cause
  • Skin: Thinning of skin, scratches easily, itchy skin, and skin rash.
  • Hair: Dry hair,thinning of hair, hair loss, hair does not look shiny anymore.
  • Muscle, joint or bone pain.
  • Mood swings: Easily becomes stressed and frustrated without reason, easily upset, unable to control mood, forgetful, dizzy, depressed.
  • Difficulty sleeping.
  • Vaginal dryness, pain during intercourse.
  • Frequent urination, incontinence.
  • Thinning of bones, fracturing easily.

Self Care During Menopausal Period

  • Food: Menopausal women should eat a balanced diet, and eat high calcium foods such as yoghurt, beans, tofu, black sesame, fish, green leaf vegetables, etc. Calcium helps strengthen bones in order to prevent osteoporosis. Try to control cholesterol by avoiding food with high fat content and eat foods that are easy to digest.
  • Regular exercise: This includes walking, jogging, dancing, aerobics, etc.
  • Mood control: Positive thinking, try to be lively.
  • Regular check up (at least once a year): Blood pressure, cholesterol, pap smear, mammography, bone mineral density, and hormone levels.

Consult Your Doctor About Hormone Replacement

In case a menopausal woman has many of the above symptoms or conditions (especially osteoporosis) and needs hormone replacement, a doctor will make the decision about what hormones are necessary for the patient.

Hormone Replacement Therapy (HRT)

Hormone replacement refers to the use of bio-identical hormones that are chemically identical to those produced in a woman’s body. Replacement of estrogen is always done in combination with progesterone, and both have the same effect as natural ones.

Results of Hormone Replacement

  • Reduce depression, fatigue, shiver, difficulty sleeping.
  • Improve skin moisture, reduce skin inflammation, thicker and shinier hair.
  • Improve concentration and memory.
  • Increase bone density when taken together with calcium and proper exercise.
The results of hormone replacement are different from one woman to another, based on several different health factors. 

Hormone replacement can be done in the following ways: 

  • Hormone replacement after hysterectomy
Supplement with estrogen alone. This hormone helps reduce menopause symptoms, and is available in tablet, gel and patch forms.
  • Hormone replacement for women with their uterus
Use a combination of estrogen and progesterone in order to prevent endometrial hyperplasia and endometrial cancer. This regimen can be divided into:
    • Cyclic regimen: Supplemental estrogen for 21 days, with the last 12 days adding progesterone. There are 7 days that hormones are not used, and the woman consistently has a period during these 7 days. This HRT program is recommended for women in transition years or the early stages of menopause.
    • Continuous combined regimen: Estrogen is supplemented daily in combination with progesterone in the same amount.  Woman who use this type of HRT will have no period. This regimen of hormone replacement is recommended for women who have been in menopause for more than 1 year.
  • Other hormone replacement (not estrogen or progesterone)
 These hormore replacements may also prevent and cure menopause symptoms in some women.  You should consult with your doctor to determine what hormones may work best for you.

Common Hormones for Replacement

  • Estrogen:
Estrogen is a hormone for controlling the reproductive system, playing a role in the maturation of a girl, menstruation, and conception. It also affects other parts of the body such as bones, blood vessels, heart, and brain. The majority of estrogen is made in the ovaries. A smaller additional quantity of estrogen is produced by peripheral tissues such as fat.
Ovaries start to produce estrogen when a girl reaches her puberty. In reproductive ages, a woman has highest level of estrogen. Ovaries produce less estrogen when a woman reaches 40 years old and stop producing estrogen when she reaches menopause. The average age of Thai woman to reach menopause is 45 – 51 years, often slightly earlier than Western women.
If both ovaries have been removed before menopause, types of changes in the body are the same as a standard menopause, but likely to be more serious because of the abruptness of the estrogen deficiency.
There are many types of estrogen in hormone replacement. The most popular one is bio-identical hormone. Hormone replacement is available in tablet, gel, patch, or vaginal ring forms. A doctor will make the decision which form is most suitable for each patient. 
  • Progesterone:
Menopausal women need progesterone hormone mainly to prevent endometrial hyperplasia and endometrial cancer. Progesterone blocks DNA systhesis, cell division, and reduces estrogen
receptors. There are many types of natural progesterone. To prevent endometrial hyperplasia in women who receive estrogen replacement, the dose and duration of progesterone supplementation are important, and given only when necessary.

Side effects of hormone replacement

  • Vaginal bleeding frequently occurs, and causes some women to stop using the HRT program. This mostly occurs during the first 3 – 6 months, and after consistent use of the HRT, vaginal bleeding will disappear.
  • Breast pain appears only in the early days of receiving hormone replacement. The woman will feel less pain as time goes on, and the pain will eventually disappear.
  • Migraine headaches.
  • Weight gain: Most menopausal women easily gain weight. Hormone replacement by itself does not make a woman gain more weight. It is the woman’s daily life, especially the imbalance of eating, exercise, and slower metabolism, which causes most weight gain.
Hormone replacement is given in quantities as low as the normal physiologic level, thus side effects are not frequent or long lasting.

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