Early Menopause - Women's Health
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Who should not take hormone therapy (HRT) for menopause? What are the common side effects?
HRT should not be used by women who:
• Think they are pregnant
• Have problems with vaginal bleeding
• Have had certain kinds of cancers (such as breast and uterine cancer)
• Have had a stroke or heart attack
• Have had blood clots
• Have liver disease
• Have heart disease
HRT can also cause these side effects:
• Vaginal bleeding
• Bloating
• Breast tenderness or swelling
• Headaches
• Mood changes
• Nausea
Be sure to see your doctor if you have any of these side effects while using HRT.
Do I need to undergo any tests before starting HRT?
HRT is not appropriate for all women. If you decide to take HRT you should have a number of initial tests which may include:
• Breast examination
• Internal pelvic examination
• Blood pressure
• Test of thyroid function
• Measurement of weight and height in order to determine body mass index (BMI)
While you are taking HRT your blood pressure should be checked every six months and you should continue having regular cervical smears and breast screening.
Will HRT make me gain weight?
This is one of those questions that so many women ask. It's especially worrisome because it's very common to put on weight when you're first experiencing early menopause.
As your estrogen levels drop, your body tries to keep as much estrogen as possible circulating. Since estrogen is both stored and produced in fat cells, your body may try to increase its fat content. To make matters worse, you also often tend to put weight on in your middle -- winding up with a disappearing waistline and tummy bulge.
The good news? HRT may actually help. This is what a number of studies have found -- women on HRT tended to gain less weight than those who weren't on it. In fact, when you raise your estrogen levels via HRT, you may actually notice a weight loss. You're getting the estrogen your body expected to have, so it doesn't need that extra fat any more. Plus your weight redistributes back to its normal pattern -- so your waistline reappears and your tummy may flatten a bit.
But some women do say they notice weight gain while on HRT. One culprit may be synthetic hormones, particularly the progestin "medroxyprogesterone acetate" or MPA (most common brand: Provera). This is because some women suffer side effects from this, including bloating and water retention. Natural progesterone doesn't seem to have this side effect. And other women have found that lower dosages of estrogen and progesterone helps keep bloating down. Finally, others report good luck with patches instead of pills.
My doctor put me on birth control pills. Is there a difference between bcps and HRT?
This is another of those areas about early menopause that gets very confusing....
Birth control pills are often prescribed to women in perimenopause -- that time when they're getting symptoms, but still are getting periods to regularize the periods and decrease bleeding. Bcps are synthetic hormones and have different dosage as compared to regular HRT.
I’m on HRT and I feel miserable. Now what?
Don’t give up! First, it sometimes takes a few weeks to notice a marked difference -- so it may make sense to wait a little while to see if the HRT helps you. Second, often switching forms of HRT -- from a synthetic to a natural, or from a pill to patch -- can make a difference. Our bodies are all different, so different forms of HRT may work better for you than others. Talk to your doctor, explain that you’re not satisfied and that you're interested in trying something new
Are there "natural" treatments available for my menopausal problems?
Yes. They include a wide range of therapies such as herbal medicine, homeopathy, acupuncture, chiropractic, osteopathy and naturopathy.
Various vitamins and mineral products also claim success in treating menopausal symptoms.
Before you use such therapies to treat menopausal symptoms, you should attempt to find out if:
• There are studies showing the product is effective for its recommended purpose.
• The risks of taking the product are known
• There are contraindications – risks for specific health conditions, or conflicts with certain pharmaceutical drugs – for taking the product that apply.
Some women try herbal or other plant-based products to help relieve hot flushes. Some of the most common ones are:
• Soy.
Soy contains phytoestrogens (estrogen-like substances from a plant). But, there is no proof that soy — or other sources of phytoestrogens — really do make hot flashes better. And the risks of taking soy — mainly soy pills and powders — are not known. The best sources of soy are foods such as tofu, tempeh, soymilk, and soy nuts.
Other sources of phytoestrogens. These herbs include:
• Black Cohosh (Latin name: Cimicifuga racemosa - or more currently, Actaea racemosa)
• Chaste Tree (Vitex agnus-castus)
• Red Clover (Trifolium praetense)
• Ginkgo (Ginkgo biloba)
• Dong Quai
• Wild Yam
• Valerian Root
Products that come from plants may sound like they are safe, but there is no proof that they really are. There also is no proof that they are helpful at easing symptoms of menopause. Make sure to discuss these types of products with your doctor before taking them. You also should tell your doctor about other medicines you are taking, since some plant products can be harmful when combined with other drugs.
Will exercise/physical activity help me in any way?
An active lifestyle can lower your risk of early death from a variety of causes and help you maintain a healthy weight. It also might improve your mood and help you to sleep better. For older adults, activity can improve mental function.
Are there alternative ways of preventing osteoporosis?
To reduce your chances of getting osteoporosis (a condition in which the bones become thin and fragile and break easily), it is best to start preventative measures early in life. But there are also self-help measures which women can take during or after the early menopause to maintain bone strength.
• Take regular weight-bearing exercise
• Maintain weight
• Eat a balanced calcium-rich diet
Milk and dairy products have high calcium levels. Other calcium containing foods include tinned fish with bones (but the bones need to be eaten) almonds, tofu, also fruit and green leafy vegetables.
• Bone Robbers
Avoid excess alcohol, caffeine and smoking all of which reduce calcium. Too much animal protein (meat and cheese) can affect calcium absorption and too much salt can increase the amount of calcium lost as can phosphoric acid (a preservative used in many canned fizzy drinks).
• DXA Scan (Dual Energy X-Ray Absorptiometry)
Women who have a high risk of developing osteoporosis e.g. past fractures after a minor fall, an early menopause before the age of 45, long-term steroid treatment or have a mother who has had osteoporosis, need to discuss whether it is worth having this type of scan which can help to show the likelihood of future fractures.
• Treating osteoporosis
HRT is no longer the treatment of first choice for osteoporosis because of safety concerns. Drugs such as calcitonin, bisphosphonates and raloxifene (Evista) a Selective Estrogen Receptor Modulator (SERMs) can be used as first choice treatments for post-menopausal women. Forsteo (teriparatide) is also now available for post-menopausal women who have severe osteoporosis of the spine. But it is important to note that the National Institute for Clinical Excellence (NICE), the NHS medical watchdog, is reviewing the use of these drugs, which may be restricted.
Useful links for further information -
Is HRT Right For You? by Dr Anne MacGregor (Sheldon Press, 2003). Written by a doctor with a special interest in women’s hormones, this is a comprehensive and balanced guide to the risks and benefits of HRT, with lots of information on the various HRT products.
The New Natural Alternatives to HRT by Dr Marilyn Glenville (Kyle Cathie) written by a psychologist and nutritionist, this takes a critical look at HRT and offers much information on alternative approaches.
For details of the guidance from The Medicines and Healthcare Products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM), see: www.mhra.gov.uk
The National Osteoporosis Society
Camerton
Bath BA2 OPJ
helpline: 0845 450 0230
www.nos.org.uk
Women’s Health enquiry line: 0845 125 5254 or the NHS information line: 0800 665544
The Pros and Cons of Hormone Replacement Therapy: Making an Informed Decision, written by the Women's Health Clinic.
You can find this resource online at:
http://www.cwhn.ca/resources/hrt/index.html
www.nhs.uk/conditions/Hormone-replacement-therapy
www.earlymenopause.com
www.earlymenopauseuk.co.uk
www.daisynetwork.org.uk
www.earlymenopause.org
If you have any queries regarding the topics raised within this article please do not hesistate to contact the Women's Health Clinic via the email form at the bottom of the page or by calling our London clinic on 020 8947 9877.
