The period of time when a woman passes from the reproductive stage of life to menopause is called the transitional years. This time period is associated with waning ovarian function. Because of this, 90% of women will experience some irregularity in menstruation. This can begin anywhere from age 39 to 51 and last from 2 to 8 years. However, for most, this will begin between the age of 45 to 47 and last 4 to 5 years. The mean age for menopause is 51. Menopause is the cessation of menstruation and occurs secondary to the loss of ovarian activity. This means a woman is no longer making estrogen. This is a physiological occurrence, but because half of the women alive today will live into their 80's, it is important to consider the consequences of being without estrogen.
Symptoms and Related Problems
Symptoms of perimenopause/menopause can include cycle irregularity, hot flashes, night sweats, vaginal dryness, interrupted sleep patterns, mood swings and concentration problems.
Cardiovascular disease is the major cause of death in postmenopausal women. It accounts for ten times the number of deaths caused by breast cancer. Osteoporosis affects 25 million Americans and causes 1.5 million fractures per year. Hip fractures affect 25% of women by age 80 with mortality up to 20% within on year of the fracture. Good health habits include aerobic exercises three times per week for 30 minutes, low fat diet, no smoking and moderation in alcohol use.
The most important benefits of estrogen replacement therapy are the relief of hot flashes, night sweats, vaginal atrophy with dryness and painful intercourse, and prevention of osteoporosis. Other benefits of estrogen replacement include reduction in colon cancer and hip fractures, improvement of sleep patterns, improved psychological function, improvement in verbal memory recall, and a possible decrease in Alzheimer's disease.
Hot flashes may also be relieved by avoiding hot flash triggers, dressing in layers, using a fan or sleeping in a cool room. Reducing stress with exercise, paced respirations and massage therapy may also be helpful.
Estrogen Replacement Therapy
Many patients have concerns about estrogen replacement therapy. The two most commonly expressed are bleeding and cancer. Risks of hormone replacement therapy include a slight increase in blood clots, strokes, heart attacks and possibly breast cancer.
Prior to the mid 1970's estrogen was given alone and was found to be associated with an increased risk of uterine cancer. The spontaneous rate of uterine cancer in postmenopausal women is 1 in 1000 per year. Estrogen alone increases this about seven-fold. However, by taking a progestin for 10 to 12 days a cycle, one can prevent this increased risk and may actually reduce it to below the spontaneous rate. Women without a uterus do not need to take progestin. The use of this progestin may introduce some side effects such as a withdrawal menses, premenstrual breast tenderness, fluid retention, and mood changes. Several different progestin schedules are available to try and meet one's specific needs.
One of every 8 American women who live to be older than 85 will develop breast cancer. The five-year survival rate for localized breast cancer is 93 percent. Screening mammography reduces the mortality from breast cancer in asymptomatic women by 24 percent between the ages of 40-, and by 30 percent in women over age 50. It is important for you to do monthly self-breast exams and screening mammography yearly.
More than 60 studies have been conducted in the last 20 years on the effect of estrogen and estrogen-progestin on breast cancer. Eighty percent have not shown an adverse effect, and 2 - 10 percent have even shown a decreased incidence. However, 10 - 13 percent of these studies have shown an increased incidence. These are the studies that usually hit the front page of your newspaper and TV. The rate of increase appears to be about 0.08% per year after 5 years of use. This information is confusing and conflicting, but overall is reassuring. The morality rate of women diagnosed with breast cancer while taking hormones is NOT higher than those women not taking hormones.
Most women will live at least one-third of their life in the postmenopausal years. It is therefore important for you to stay informed and make decisions about your health that meet your specific needs. You should discuss any of these issues with your physician.
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