Q-There are difficulties enough when a woman enters menopause, and the confusion of taking medications just adds to the problems. Although I have tried to understand it all, I could use some of your advice. Could you please discuss menopause?
A-There is no reason for menopause to mark a change in your lifestyle.
Menopause is defined as the cessation of menstrual periods for one year. It can occur naturally or surgically, when the ovaries are removed. Either way, the result is decreased production of the hormones estrogen and progesterone.
One consequence of reduced estrogen is osteoporosis, a loss of bone density that may lead to spine and hip fracture, a major health problem today. In fact, 1.3 million fractures, mostly spine, hip and wrist, occur each year in the U.S.
Another consequence of decreased estrogen in menopause are hot flashes and night sweats that may significantly affect the quality of sleep. These are the vasomotor symptoms that affect about 85 percent of women and are due to an abnormal signal from the heat regulation center of the body.
The natural reduction in estrogen may also result in changes in vaginal tissue (senile vaginitis). Inadequate lubrication causes dry, painful intercourse. There is also an increased susceptibility to lower urinary tract infections.
How can estrogen replacement therapy offset these problems?
First, clear evidence shows that age-related bone loss can be forestalled, perhaps indefinitely, with even low doses of estrogen
replacement. The addition of calcium is also recommended.
To be most effective, though, therapy needs to be started as soon as possible after the onset of menopause. Estrogen therapy for osteoporosis must be lifelong; once stopped, bone loss begins and progresses rapidly.
Medium to high doses of estrogen will prevent hot flashes. Those and night sweats tend to diminish with time, so your physician may taper the dosage in accordance with the extent of symptoms.
Estrogen therapy will also reverse the atrophy affecting the genito-urinary tract during menopause. It restores cervical and vaginal secretions and thickens the vaginal tissue to its premenopausal state.
Because estrogens are absorbed through the skin, an estrogen cream will work as well for those symptoms as oral estrogens.
Your physician can determine the amount of estrogen you are still producing and decide on the amount you need.
A progesterone supplement may also be given to women with an intact uterus.
We now have enough experience to feel confident that the benefits of hormone replacement therapy outweigh the risks. The only women who should not be treated are those with breast or endometrial cancer, chronic liver disease, or a history of thromboembolism.
The menopausal period of life can be a anxious time for a woman, but with good counseling from your physician and a real understanding of this natural life process, you can pass through it with a minimum of discomfort or fear, and without breaking stride in the normal pattern of your lifestyle.
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Dr. Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Bruckheim c/o the Chicago Tribune, P.O. Box 119, Orlando, Fla. 32802-0119.