Riverview Physicians for Women

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439 Jennick Drive, Colonial Heights, Virginia 23834 View Location

Menopause And Beyond

Menopause is defined as occurring 12 months after your last menstrual period. It signifies the permanent end of menstruation and fertility. Menopause is not an illness although it can certainly make you feel sick! A fortunate 25% of women have little or no symptoms in menopause while some women have a terrible time. All women will suffer the effects of menopause to a greater or lesser degree because of the lack of estrogen.

Not that long ago women did not live long enough to be concerned with menopause. Now, however, women will live, on average, at least 41% of their lives in the menopause. It is important to remember that menopause is not an illness and does not signify "the end is near!" It is a time of transition and we encourage patients to celebrate their freedom from periods and fear of unintended pregnancy!!

All women should be tested for osteoporosis at menopause because within seven years of menopause, women can lose up to 20% of their bone density. Half of women over 50 will suffer an osteoporotic fracture. As always, it is important to eat right, exercise and take care of yourself.

As noted above, menopause is a normal part of a woman's life. It is caused by a lack of estrogen as a result of the natural cessation of ovarian function. It follows therefore, that the treatment of menopause is estrogen replacement. In women who do not have a uterus (have had a hysterectomy) only estrogen is given. However, women who have a uterus need to have progesterone as well as estrogen because estrogen by itself can increase the risk of cancer of the lining of the uterus. Women taking continuous hormone replacement with estrogen and progesterone have less risk of cancer of the lining of the uterus than comparable women their age, not taking hormone replacement therapy. If that is not confusing enough, there was a study done several years ago called the "Women's Health Initiative" (often referred to as the "WHI"), which found that estrogen replacement by itself did not increase a women's risk of breast cancer, but taking estrogen and a certain progesterone (medroxyprogesterone acetate) did show a "trend" towards a increase in breast cancer. We don't give much credence to this study for many reasons. Among them: the average age of study participants was 63 years old (in our opinion, no one would initiate hormone therapy at that age), the difference in the number of breast cancers between the combined hormone group and the control group was 8/10,000 (hardly a significant number) which is why the authors stated there was a "trend" towards a increase in breast cancer. In addition, animal studies have not shown an increase in breast cancer and have shown a decrease in atherosclerosis (plaque formation which narrows arteries). More recent studies suggest that hormone replacement study initiated close to the onset of menopause does lower the risk of heart attack and stroke. While there may be an increase in breast cancer risk, it is so slight as to be statistically insignificant. Please keep this in mind as you read things on the Internet and elsewhere. Hormone Replacement Therapy can, and often does, make a marked difference in the quality of a woman's life, which is why we recommend that our patients consider it at the onset of menopause. We work with our patients to individualize treatment, as no two women are the same.

Some women have questions about "Bioidentical" or "Compounded" hormones for hormonal replacement therapy and we agree with ACOG regarding this issue. Our position is that these hormones have the same risks as hormone therapies approved by the FDA and may have additional risks. Therefore, we do not prescribe or recommend them. Here is a reliable source of information regarding menopause, its effect on women's health and treatment options.