FAQS – Menopause

How long does menopause last?

Menopause symptoms (hot flashes, insomnia, irregular periods) may last for years before menopause actually occurs. This is referred to as peri-menopause. Following complete loss of estrogen production in the ovaries, true menopause is present. As the mind-body becomes adjusted to the low level of estrogen, many of the symptoms of menopause may gradually resolve. The effects of loss of estrogen, however, continue throughout a woman’s life. The greatest risk is for bone loss (Osteoporosis). This condition has devastating effects, and does not cause symptoms in the early stages. As Dr. Gurley expresses this problem, “With menopause, the symptoms are frequently short-term, while the risks are long-term”. The identification of women at risk for the diseases more common after menopause will allow early preventive treatment to be offered.

How do I know if an oral or skin patch form of estrogen is better for me?

Many people prefer the convenience of a once-a-day oral dosing schedule, especially if also using an oral form of progesterone. Estrogen given through the skin, such as a patch, cream, or gel is reported to have a lower risk of causing blood clots in the legs. Skin sensitivity may prevent the use of the patch in some people. Factors favoring the use of a patch include an elevated triglyceride level, cigarette use, history of a deep vein blood clot, or poor absorption of oral medicines. Certain side effects, such as nausea or migraine headaches, may be better controlled with the patch form of estrogen. A new patch contains both estrogen and a progesterone-type medicaton for women who have not had a hysterectomy.

Do I need both estrogen and progesterone?

Estrogen alone may be used in most women who have had a hysterectomy. Progesterone or a progestin (a medication with properties of progesterone) is needed if the uterus is present to reduce the risk of increased thickening of the lining of the uterus, which could lead to pre-cancer or cancer.

I don’t understand why my doctor has mentioned the use of an androgen or testosterone. Is testosterone natural for a woman?

Testosterone is produced in a woman’s ovaries, both before and after menopause. Women who have had a hysterectomy have a greater loss of androgen than women who go through natural menopause. In both instances, the decrease in androgen may lead to a decreased sense of well-being or reduced sexual desire. If either of these symptoms is a problem, adding a very low dose of testosterone may be helpful. It is suggested that the doses of estrogen and progesterone be adjusted and well tolerated before adding androgen, in order to avoid confusion about the cause of any side-effects.

I feel well while using estrogen, but progesterone medications cause me to be irritable and depressed. I have tried many brands of oral progesterone. What can I do? I have not had a hysterectomy, so I need the progesterone along with my estrogen.

Progesterone is available in an oral prescription form. If this is not satisfactory, an injectable form of progesterone can be used every two to three months. The injection is likely to cause a much shorter duration of side-effects, perhaps only 2-3 days. Finally, in a woman who hasn’t had a hysterectomy, estrogen alone may be considered only if close monitoring of the growth of cells inside the uterus is possible with regular ultrasound exams and bioposies.

I felt terrible when I started taking estrogen. I have had a hysterectomy. My mom has osteoporosis. I want to use estrogen, but I am afraid to start it again. Every type my doctor has tried causes me to feel bloated and have breast tenderness. What do you suggest?

First, ask your doctor about a fluid pill of the potassium-sparing type. Fluid pills (Diuretics) frequently help both bloating and breast tenderness. If the breast tenderness continues, adding a low dose androgen hormone may help. When you re-start estrogen, avoid a standard dose. Instead, a very low dose can be used and gradually increased over several months as your symptoms allow. A very low dose can be delivered by several methods, including cutting a low-dose pill into several pieces, having a compounding pharmacist prepare a custom pill, or cutting a low-dose patch into 4 sections.

I am bothered by hot flashes and vaginal dryness. I just don’t want to use estrogen or any other hormones. What are my options?

An oral medication, clonidine, is known to help hot flashes. Although estrogen is the most effective treatment to prevent bone loss, monitoring and treatment using other medications is possible. Effexor and gabapentin are two other prescription medicines that may be used to treat hot flashes. Vaginal dryness may be helped by an over-the-counter preparation called Replens. Prescription vaginal rings, tablets, or cream containing very small amounts of estrogen are also available. These are called “local estrogen therapy”.  New types of lasers can be used to treat vaginal irregulalities. Dr. Gurley offers the FemiLift laser treatment.

My friend, who has had a hysterectomy, uses a progesterone cream purchased over-the-counter. I would like to use this cream, in place of my oral progesterone, along with the estrogen I use (I have not had a hysterectomy). Is this a good idea?

Over-the-counter progesterone creams contain very little, if any, biologically active progesterone. It is preferable to use a prescription strength of progesterone. A recent study showed no greater effect of over-the-counter progesterone cream than placebo.