PERIMENOPAUSE, MENOPAUSE, POST MENOPAUSE & HOW HORMONES HELP

PERIMENOPAUSE

Perimenopause is a transition phase in all women’s lives, caused by fluctuating hormone levels and results in a wide range of physical and emotional symptoms. The most common symptoms include changes in the menstrual cycle, hot flashes, sleep disturbances, and mood changes, just to name a few. Perimenopause usually starts in the 40’s but some women start experiencing symptoms in their late 30’s. Every woman’s body is different.

• Changes in the menstrual cycle: heavier cycles, lighter cycles, spaced out cycles.
• Vasomotor symptoms: hot flashes, night sweats, heart palpitations, skipped beats, and racing heart.
• Brain symptoms: anxiety, depression, decreased motivation, fatigue, worse or new onset of ADD, new onset migraines, brain fog. (Many women are started on antidepressants this phase of life.)
• Urinary Issues: Increased urinary urgency or frequency, and a higher susceptibility to urinary tract infections (UTIs) and bladder leakage (incontinence).
• Physical Aches: Joint pain, muscle aches, and general body stiffness are common.
• Weight Gain: A slowed metabolism can lead to weight gain, particularly around the abdomen.
• Development of insulin resistance.
• Skin, hair and teeth: Changes in skin, dryness, thinness, even onset of adult acne. Hair loss, facial hair growth. Changes in gums and teeth.
• Bone and muscle changes: joint stiffness, aches and pains, frozen shoulder.

With all these symptoms, it is understandable why so many women feel like they are not heard and misdiagnosed. An important point to remember: hormones fluctuate during the cycle. Lab testing during certain times may or may not be helpful.

MENOPAUSE

Menopause comes from two Greek words month (mẻn) and pause (pausis). It is defined as one year after your last menstrual cycle. So one day in a woman’s life. The average age is 50 year +/- 2 years. That does not mean it can’t happen sooner or later. Additionally, some women choose to use IUD’s and take oral contraceptive pills continuously or have had uterus ablations or partial hysterectomies. Which can muddy the water as far true menopause date. If this is the case, then checking labs for follicle stimulating hormone is needed.

POST-MENOPAUSE

One year since your last cycle (366 days) is considered post-menopause. That magic day, now you are post-menopausal. You can have continuation of some or all the symptoms of perimenopause, now without bleeding. Without Menopausal hormone therapy (MHT) or Progesterone, Estradiol and Testosterone (PET) therapy, other symptoms can develop. Genitourinary Syndrome of Menopause (GMS), once called the senile vagina, vaginal atrophy and vulvovaginal atrophy. GMS is triad of symptoms of genital, sexual and urinary systems, due to lack of estrogen. The most common symptoms are vaginal dryness, dyspareunia (painful sex), and urinary urgency/frequency, stress incontinence and increase in urinary tract infections. Symptoms are chronic and progressive and can impact quality of life. These symptoms can be treated with local estrogen (vaginal
estrogen).

OSTEOPOROSIS

Osteoporosis is a condition that weakens bones, making them more prone to fractures. It is often called the “silent disease” because it typically does not cause symptoms until a fracture occurs. The scary thing is 1 in 3 post-menopausal women with osteoporosis will experience a fracture. Mortality risk is significantly increased after an osteoporotic fracture, particularly in the first year. The 1-year mortality rate for hip
fractures can reach around 20%, and the risk is higher in the months immediately following the fracture. Estrogen prevents and treats osteoporosis by restoring the balance between bone breakdown and bone formation that is disrupted after menopause. It suppresses bone-resorbing cells called osteoclasts and promotes bone-building cells called osteoblasts, thereby maintaining bone density and strength. By inhibiting osteoclasts and boosting osteoblasts, estrogen reduces the net loss of bone tissue and can help decrease the risk of fractures, particularly in women experiencing menopause. 

THE BIG QUESTION IS: Does estrogen cause breast cancer? The answer is NO.

Estrogen therapy alone has not been shown to cause breast cancer, with some studies even indicating it may lower the risk. However, a few studies have shown, combined estrogen-progestin therapy is linked to an increased breast cancer risk. The risk from combined therapy is thought to be driven by progestins, not estrogen itself. Additionally, there is a type of breast cancer that is called Hormone receptor-positive cancer. Estrogen can promote the growth of breast cancer cells if they already exist. Remember 1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. Early detection is key, monthly self-breast exams and yearly mammograms. Important to note is that even women that have had breast cancer can use vaginal estrogen for GMS, as it is not systemically absorbed.

Menopausal hormone therapy (MHT) or Progesterone, Estradiol and Testosterone (PET) improve your quality of life. Unfortunately, in 2002 a study called the Women’s Health Initiative was published. Most of the information that was published was false. Now in hindsight two decades of women have missed out on MHT/PET and are suffering because of it. No need to suffer, ladies!

WE HAVE THE EXPERTISE TO HELP YOU NAVIGATE LAB TESTING AND SAFE HORMONE OPTIONS

Now that more women are learning about the safety and effectiveness of menopausal hormone therapy (MHT), it’s important to be cautious as many companies are eager to profit from this growing awareness. For example, hormone pellet therapy is not FDA-approved for women and not recognized as standard care for menopause. Safety concerns include pellet extrusion, infection, and hormone levels that exceed physiologic ranges. Additionally, some promote expensive lab tests such as salivary hormone panels or the DUTCH (Dried Urine Test for Comprehensive Hormones), which are not covered by insurance and not considered standard of care. The gold standard for hormone evaluation remains blood testing, which is typically covered by insurance. At Direct Family Healthcare, we can help you choose the safest hormone replacement options and our blood labs are available at reasonable cash prices.

References:
Levy, B., & Simon, J. A. (2019). A contemporary view of menopausal hormone therapy. Menopause, 26(10), 1161–1172. https://doi.org/10.1097/GME.0000000000001393
Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975–4011.
https://doi.org/10.1210/jc.2015-2236
Portman, D. J., & Gass, M. L. S.; Vulvovaginal Atrophy Terminology Consensus Conference Panel. (2014). Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause, 21(10), 1063–1068.
https://doi.org/10.1097/GME.0000000000000329
Chlebowski, R. T., Anderson, G. L., Aragaki, A. K., Manson, J. E., Stefanick, M. L., Pan, K., Barrington, W., Kuller, L. H., Simon, M. S., Lane, D., Johnson, K. C., Rohan, T. E., Gass, M. L. S., Cauley, J. A., Paskett, E. D., Sattari, M., & Prentice, R. L. (2020). Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women’s Health Initiative randomized clinical trials. JAMA, 324(4),
369–380. https://doi.org/10.1001/jama.2020.9482