The extremes of a woman’s fertility, puberty, and menopause are remarkably similar. Both involve hormonal imbalances, unpredictable ovulation leading to unpredictable menstrual cycles. Despite the bad press given to one particular hormone replacement pill, Prempro, all hormone replacement therapy (HRT) has taken a big hit. HRT has its place in perimenopause, which is the 5-10 years leading up to the cessation of your menses.
The benefits are numerous, including increased feelings of well-being, prevention of osteoporosis, decreased risk of pelvic relaxation leading to hernias in the vagina, prolapse of the uterus and vagina, reduced pain with sex, and reduced risk of urinary incontinence.
The major drawback that attracted the attention of the media was increased breast cancer and coronary artery disease risk. The problem is the media leaves out important details, like your risk of breast cancer increases from 1/10,000 to 8/10,000 patients or that the breast cancer associated with HRT is caught the earliest, leading to the most favorable outcomes. The secondary benefit is that if you take HRT your doctor will not refill your prescription without a doctor’s visit, making women a captive audience, therefore required to get all the preventative treatments available to prevent ovarian, breast, uterine, colon, and bladder cancer. Your yearly visit is an opportunity to check for blood disorders, elevated cholesterol, undiagnosed hypertension, or thyroid disease.
In 2002, when the hormone scare occurred, it was not OB/GYN doctors rushing to stop hormone treatments. It was primary care providers, reading mainstream media information rather than the medical literature. We have a number of low dose options for HRT that are considered safe.
For those where HRT is just not an option, there are quite a few medications that improve your activities of daily living. Menopause is not the same for everyone. Some women have some inconvenient hot flashes while others can have debilitating depression, anxiety, and mood swings that are misdiagnosed as psychiatric issues treated with anti-depressants, anti-anxiety, and even antipsychotic medications.
Seek out your OBGYN doctor for guidance. The average age of menopause is considered to be 51 years old; however, it can vary as much as ten years in either direction.