HORMONE REPLACEMENT THERAPY

Understanding Menopause

As you reach menopause, usually between the ages of 47 and 55, your reproductive years come to an end. Your productive years, however, are far from over. Yet many women are affected during this time by hormonal changes that cause unpleasant symptoms and may also put them at risk for major health problems in the future. Fortunately, advances in hormone replacement therapy (HRT) allow women to reduce these symptoms and health risks. Prescribed by your doctor, HRT can help restore a hormonal balance, which may enhance your health and enrich the quality of your life.

What is Menopause? End of reproductive capability � End of menstrual bleeding � End of menstrual periods � Change in body chemistry - ovaries stop making sex hormones: estrogen, progesterone, androgen � Time leading up to cessation of menstrual periods is called perimenopause � Surgical menopause (removal of uterus and/or ovaries) may cause the same symptoms as natural menopause, but in a more rapid and dramatic fashion

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MOST COMMON SYMPTOMS OF MENOPAUSE

Hot Flashes: The symptom menopausal women complain of most is hot flashes (or flushes). It seems that decreased estrogen, through its effect on the autonomic nervous system, causes capillaries in the skin - particularly in "blush areas" - to open suddenly. The resulting rush of blood brings on flushing, a wave of heat, and perspiring. This may occur from once a month to 20 times a day. Hot flashes can be embarrassing, but are never dangerous and last only a few minutes (research suggests no longer than 3!). Just try to make yourself comfortable. Dressing in layers, wearing lower necklines, and choosing cotton clothing will help heat escape.

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Night Sweats: Night sweats are simply hot flashes that happen at night. The heat and sweat get trapped under bedcovers, so you may wake up feeling clammy or cold. (As a note, the materials often used in sheets today aggravate this problem because synthetics are less absorbent than all-cotton fabrics.) The biggest problem with night sweats is the sleep you lose. Once you are awake, problems may chase around inside your head and simply not allow you to fall back to sleep. This fatigue, brought on by lack of sleep, is the main reason menopausal women get tired, irritable, and depressed.

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Palpitations: A low level of estrogen may trigger nerves in the heart muscle when you are tense or tired. If your doctor has ruled out heart disease, he or she may prescribe estrogen, a tranquilizer, or a sedative to control the frightening pounding sensation. If hot flashes, night sweats, and palpitations are disrupting your life, your doctor may recommend estrogen, which will effectively eliminate these problems. The smallest dose needed to relieve your symptoms should be used. When estrogen is combined with progesterone to stimulate a natural cycle, an increased risk of endometrial cancer seems to be avoided.

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Aches, Weakness, and Stiffness: With decreased estrogen, you may also notice a loss of muscle strength. Emotional tension and stress can cause muscle spasms in the back and neck. And a lack of exercise can leave you feeling stiff all over, and cause fluid to collect in the legs. Regular exercises and relaxation can do wonders for these symptoms.

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Weight Gain: A woman at menopause needs only about two-thirds of the calories she needed before. Her body simply doesn't burn up foods as quickly. Fat tends to be deposited on the shoulders, back, and abdomen. Water is retained more easily, too. And aging tends to make the waist thicker and the stomach rounder. But you can avoid gaining weight at menopause if you eat less and exercise more!

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Wrinkles: The reduced estrogen level decreases elasticity in the skin's connective tissue, paving the way for sags and lines in the skin. Wrinkles increase if you lose a lot of weight after menopause. And too much sun dries and wrinkles unprotected skin like "tanned" leather. Of course, some wrinkling simply comes with age.

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Gas and Constipation: When the estrogen level drops, the entire digestive tract may slow down, and you may be bothered by gas, indigestion, and constipation. All you can do is eat more sensibly - but do report persistent symptoms to your doctor.

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Memory Loss: Evidence suggests that less estrogen may cause that part of the brain in charge of recent memory to become sluggish. However, because of the many concerns that a woman has to deal with at this time of life, your attention may be easily distracted and more often than not, this is what accounts for most memory loss.

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Depression: Some women find they feel depressed at menopause. A lack of estrogen may make you vulnerable to the blues, but lack of support from family and friends can also be the cause. Extra attention, especially from someone close to you, can usually lift your spirits.

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Not all changes are obvious. Hidden changes include: Osteoporosis (bone loss) Increased risk of heart disease Increased risk of developing Alzheimer's disease

THREE HORMONES ARE INVOLVED: Estrogen controls reproductive function, helps maintain cardiovascular health and bone strength later in life Progesterone acts with estrogen to regulate your reproductive organs and menstrual cycle Androgen is vital to healthy reproductive functioning; it is also used by your body to make estrogen

WHAT CAN BE DONE? Eat a healthy diet: low in fat to protect against heart disease, and high in calcium to maintain strong bones Stop smoking Exercise regularly: Aerobic exercise to help your heart, and weight-bearing exercise to help strengthen bone Hormone replacement therapy: Androgens added for vasomotor symptoms unresolved by estrogens alone

Relief of symptoms in menopausal women receiving testosterone pellets (androgen replacement)

Symptom	No. Patients	Relief of Symptoms (%)
Fatigue	544	85
Loss of libido (sexual drive)	610	78
Nervousness &/or irritability	515	77
Headache	550	72
Depression	450	75
Hot flashes	718	86
Backache	165	72