USF-COM
Department
of Family Medicine
Patient Education Information on...
Index of
Patient Education Topics
What
is menopause ?
Menopause is the
ending of a woman’s menstruation. It is caused by decreasing production
of estrogen by the ovaries and typically occurs between the ages of 45
and 55.
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What
are the symptoms of menopause ?
The loss of estrogen
may lead to hot flushes and night sweats, which can cause sleep disruption,
fatigue, and irritability. Additionally, the lining of the vagina
can become dry and thin, causing painful intercourse and more frequent
urination. These symptoms can last from months to years.
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What
are the health risks of menopause ?
The loss of estrogen
following menopause is responsible for a dramatic decrease in bone mass,
which can lead to a condition called osteoporosis. Research has also
indicated that menopause may increase the risk of heart attack, colon cancer,
depression, memory loss, vision loss, and high cholesterol.
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Why
is osteoporosis a danger ?
One out of four women over the age of 50 is affected by osteoporosis, a
brittle bone disease that can result in loss of height or potentially crippling
fractures. Women at highest risk for this disease include those
who are Asian or Caucasian, are thin and small-framed, have an early
menopause, are physically inactive, smoke, drink excessive amounts of alcohol
or caffeine, have a diet low in calcium, or have a family history of osteoporosis.
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Can
replacing estrogen reduce these risks ?
In addition to alleviating the unpleasant symptoms of menopause such as
the hot flushes, vaginal dryness, and mood alterations, research has shown
that estrogen reduces the risk of potentially serious medical complications.
Studies have shown that women on estrogen therapy retain more bone mass
and have 60% fewer fractures than women who have never taken estrogen.
Research also indicates that estrogen lowers total and LDL(“bad”) cholesterol
and reduces the overall risk of cardiovascular mortality.
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What
are the dangers of taking estrogen ?
The amount of estrogen taken after menopause is much lower than the level
of estrogen present during the reproductive years. However, women
on estrogen may experience continued vaginal bleeding, breast tenderness,
headache, and abdominal pain. They may also be at risk for more serious
complications including blood clots, uterine cancer, and breast cancer.
The potential risk of these serious complications has not yet been accurately
determined, however it is recommended that women with a history of breast
or uterine cancer, blood clots, or who could become pregnant not be given
estrogen replacement.
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Is
Hormone Replacement Therapy better than estrogen alone ?
Taken alone, estrogen can cause an overgrowth of the uterine lining, a
condition called endometrial hyperplasia. This may in some cases lead to
uterine cancer. Hormone Replacement Therapy(HRT) involves taking
progestin along with estrogen on a daily or cyclic basis. The added
progestin significantly reduces the risk of endometrial hyperplasia and
uterine cancer. Women who have had a hysterectomy do not need the
added progestin.
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What
types of HRT are available ?
There are two types, cyclic and continuous combined. Cyclic HRT involves
taking estrogen every day of the month, with progestin taken 2 weeks per
month. With this regimen, women may experience regular monthly bleeding
for 3-5 days. Continuous combined HRT involves taking estrogen and
progestin every day of the month. Women on this regimen may experience
irregular bleeding or spotting which stops after about one year.
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What
about Evista ?
Evista is a new type of
drug called a Selective Estrogen Receptor Modulator. Like estrogen,
it helps to prevent osteoporosis and cardiovascular death. However,
research has so far indicated that it does not stimulate the breast, uterus,
or vascular system. It therefore does not treat hot flashes, and
may be less likely to increase the risk of breast or uterine cancer.
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Is
HRT for me ?
This is question
that you must discuss with your physician after reviewing this information.
Consider the risks, benefits, and alternatives of HRT and make the decision
that is right for you.
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