Your Menopause Questions Answered
What is the best way to relieve my typical symptoms of hot flashes and vaginal dryness, and if it's estrogen, what dosage form is the best?
Prescription estrogen therapy (ET)-as an oral tablet, skin patch, gel, mousse, spray, or lotion-remains the most effective treatment for hot flashes. When this type of "systemic" (circulated through the body) ET is chosen, women with a uterus must also use another prescription hormone, progestogen, to protect the uterus. This combined estrogen-progestogen therapy is called EPT. If hot flash relief from hormone therapy is the goal, systemic ET or EPT is best.
ET in all dosage forms (oral tablets, skin products, and vaginal products) is also the most effective treatment for moderate to severe vaginal dryness. Vaginal forms of ET provide estrogen "locally" (not circulated through the body); in this case, progestogen may not be required. If vaginal symptoms are the only reason to consider hormone therapy, local vaginal ET is the most appropriate choice. Choices include vaginal creams (Estrace Vaginal Cream, Premarin Vaginal Cream), a vaginal ring (Estring), and a vaginal tablet (Vagifem). The newer vaginal ring (Femring) has both local and systemic effects.
Is hormone therapy for life?
In the past, most women who started hormone therapy for relief of symptoms such as hot flashes and vaginal dryness stayed on hormone therapy for life. Although the time of symptoms may have passed, women liked the fact that using estrogen reduced their risk of fractures from osteoporosis. Newer research has resulted in a different practice for most women. Hormone therapy, even at the lowest dose, should always be used for the shortest duration possible consistent with treatment goals.
A woman should eventually attempt to reduce or stop hormone therapy when appropriate for her, and always in consultation with her healthcare provider. If bothersome symptoms persist, hormone therapy can be resumed or other strategies can be tried. For the majority of women, a point will be reached when symptoms are gone for good, and hormone therapy can be stopped.
Importantly, however, hormone therapy is an effective option for some women to use long-term to keep bones strong. Some women may decide to continue long-term hormone therapy for other potential or perceived benefits. The decision should be revisited regularly to reassess the risk/benefit ratio for each individual in light of her health and research advances.
I have a very similar body type to my sister, so why do we receive very different dosages of hormone therapy?
Each woman experiences their menopausal transition in a unique way, and therapy needs can vary. Several factors to consider include the kind of therapy as well as the dose. These decisions will be based on finding a treatment that works while minimizing any associated risks.
One way to lower potential risk with any type of drug treatment, including hormone therapy, is to use the lowest effective dose. Some clinicians start with a standard dose and adjust up or down as needed for symptom relief. Other clinicians start very low and go up when required. Today's hormone therapies are available in very low doses to help with this approach. Research has shown that "lower than standard" doses of estrogen are almost as effective for symptom relief as standard doses.
It is important to remember that one milligram of one type of estrogen doesn't always equal one milligram of another in its effects on the body. More oral estrogen is required, because much of it is lost as it passes through the gastrointestinal system and is broken down in the liver before it reaches the blood stream. Transdermal estrogen goes through the skin and right into the bloodstream. The best thing is to listen to your body and have your clinician monitor you and continuously reassess your options.
Case Study
A Lifestyle Change
Although Louisiana native Deborah Keegan, 53, started to experience some pretty intense hot flashes that left her feeling confused and a little embarrassed, she decided to heed her doctor's first suggestion of lifestyle changes to see if it lessened the severity and frequency of her menopause symptoms.
"I was a pretty good candidate for what they call 'lifestyle changes,' as I had not been very good about taking care of myself after I turned 50," recalls Keegan. "The hot flashes were driving me crazy, and causing me so much distress I started almost hibernating out of fear of being overcome out in public." She found that her weight and lack of exercise contributed to her uncomfortable symptoms.
"I signed up with a personal trainer, who I meet with four times a week-she keeps me motivated, and I've now lost the weight and feel 100 percent better," Keegan explains. "The hot flashes haven't gone away completely, but they're bearable. I wasn't totally convinced that I needed to go on hormone therapy, as my sister had done, and it really benefited me to change my life first before taking hormones."
Keegan learned that adjustments to her lifestyle didn't have to be major. "Just going for a brisk, 30-minute walk most days, and assuring my diet has plenty of healthy foods is an excellent start to controlling the hot flashes that had been holding me back."
Remember: Every woman experiences menopause differently. Always discuss your options with a clinician.
|
