Menopause
& Hormone Replacement Therapy

Susan J. Momont, MD, FACOG
Obstetrics/Gynecology
Obstetrical & Gynecological Care, Eau Claire

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause. Menopause marks the end of the reproductive years that began in puberty.

The average age at which most women go through menopause is 51. Most women are able to enjoy a healthy lifestyle for the years following menopause. Hormone replacement therapy may be able to optimize health and lifestyle during the years leading up to and following menopause.

The decline in levels of hormones during the menopausal transition is associated with many symptoms. These symptoms can be categorized into early, intermediate and late symptoms resulting from estrogen deficiency.

The early effects of estrogen deficiency include hot flashes, night sweats, insomnia, menstrual irregularity, unusual hair growth and various psychological symptoms. The psychological symptoms can include irritability, anxiety and other mood problems.

The intermediate symptoms resulting from estrogen deficiency occur in approximately the mid-50s and include vaginal and urinary changes. The vaginal lining may become thin and dry resulting in pain during sexual activity.

These vaginal changes can also result in increased vaginal infections, burning, itching and irritation.

Urinary tract changes include urinary frequency, urgency and increased risk of bladder infection, as well as urinary incontinence. Other effects of estrogen deficiency that are more noticeable in the mid to late 50s progressing into the 60s are a decrease in skin thickness which results in increased wrinkling , increase in tooth loss and dry eye syndrome.

Later effects of estrogen deficiency include osteoporosis (thin brittle bones) and associated fractures, cardiovascular disease and Alzheimer’s disease.

Hormone replacement therapy (estrogen alone or combinations of estrogen and progesterone or estrogen and testosterone) has been shown to alleviate many of the previously mentioned effects of estrogen deficiency that can occur from perimenopause to advanced age.

There is evidence that hormonal therapy alleviates hot flashes, night sweats and improves sleep quality. There is also evidence that estrogen replacement therapy increases skin thickness and thus diminishes wrinkling. The impact of estrogen therapy on tooth loss has been evaluated and there was a reduction in tooth loss in women who were taking estrogen replacement therapy.

Osteoporosis that results from low estrogen levels results in fractures and loss of height. Estrogen therapy helps protect against bone loss. There is increasing evidence suggesting that estrogen therapy may improve cognitive function and reduces the risk of dementia. Another possible health benefit is prevention or relief of dry eye syndrome.

Like most treatments, hormonal therapy is not free of risk. In considering and selecting the most appropriate treatment, you and your doctor should discuss your individual symptoms and goals. In general, hormonal therapy is of benefit to most perimenopausal and menopausal women. These benefits must be weighed against potential increased risk of breast cancer and cardiovascular problems. Many women are willing to assume some risk, in order to improve their quality of life. There are many available options regarding dosage and route of administration of hormonal therapy to minimize these safety concerns.

Hormone Replacement Therapy

Most women, who choose to take hormone replacement therapy (HRT) have a uterus and therefore take estrogen and a progestin. HRT can be administered in many ways. The woman and her doctor will discuss the type of HRT that’s right for her. There are many choices including oral, vaginal (cream, pill or ring) or transdermal (through the skin).

Continuous Cyclic Therapy

Estrogen is taken every day in 4 week cycles. The progestin is added only during the first 2 weeks. During the time when the estrogen is taken alone, you may have some bleeding.

Continuous-Combined Therapy

Estrogen and progestin are taken every day. It is common to have irregular bleeding the first few moths, but within 1 year most women stop bleeding.

Cyclic Therapy

Estrogen is taken throughout the cycle and progestin is added for certain days in the month. The exact times may vary. During the time when estrogen is taken alone, you have some bleeding.

When taking hormone therapy or other medications, you should follow your doctor’s advice and get regular check ups.

For more information or to schedule an appointment with
Dr. Susan Momont » 715.834.9998 Obstetrical & Gynecological Care