Menopause (cont.)
Are hormone levels or other blood tests helpful in detecting menopause?
Because hormone levels may fluctuate greatly in an
individual woman, even from one day to the next, hormone levels are not a
reliable method for diagnosing menopause. Even if levels are low one day, they
may be high the next day in the same woman. There is no single blood test that
reliably predicts when a woman is going through the menopausal
transition. Therefore, there is currently no proven role for blood testing
regarding menopause except for tests to exclude medical causes of erratic
menstrual periods other than menopause. The only way to diagnose menopause is to
observe the lack of menstrual periods for 12 months in a woman in the expected age
range.
What are the treatment options for menopause?
Menopause itself is a normal part of life and not a disease that requires
treatment. However, treatment of associated symptoms is possible if these become
substantial or severe.
Hormone therapy
Estrogen and progesterone therapy
Hormone
therapy (HT) , also referred to as hormone
replacement therapy (HRT) or postmenopausal hormone therapy (PHT), consists of
estrogens or a combination of estrogens and progesterone (progestin). Hormone
therapy has been used to control the symptoms of menopause related to declining
estrogen levels such as hot flashes and vaginal dryness, and HT is still the
most effective way to treat these symptoms. But long-term studies (the
NIH-sponsored Women's Health Initiative, or WHI) of women receiving combined
hormone therapy with both estrogen and progesterone were halted when it was
discovered that these women had an increased risk for heart attack, stroke, and
breast cancer when compared with women who did not receive HT. Later studies of
women taking estrogen therapy alone showed that estrogen was associated with an
increased risk for stroke, but not for heart attack or breast cancer. Estrogen therapy alone,
however, is associated with an increased risk of developing endometrial cancer
(cancer of the lining of the uterus) in postmenopausal women who have not had
their uterus surgically removed.
The decision about hormone therapy, therefore, is a very individual decision
in which the patient and doctor must take into account the inherent risks and
benefits of the treatment along with each woman's own medical history. It is
currently recommended that if hormone therapy is used, it should be used at the
smallest effective dose for the
shortest possible time. The WHI study findings do not support the use of HT for
the prevention of chronic disease.
Oral contraceptive pills
Oral contraceptive pills
are another form of hormone therapy often prescribed for women in perimenopause to treat irregular vaginal bleeding.
Prior to treatment, a doctor must exclude other causes of erratic vaginal
bleeding. Women in the menopausal transition tend to have considerable
breakthrough bleeding when given estrogen therapy. Therefore, oral
contraceptives are often given to women in the menopause transition to regulate
menstrual periods, relieve hot flashes, as well as to provide contraception.
The list of contraindications for oral contraceptives in women going through the
menopause transition is the same as that for premenopausal women.
Local (vaginal) hormone treatments
There are also local (meaning applied directly to the vagina) hormonal
treatments for the symptoms of vaginal estrogen deficiency. Local treatments
include the vaginal estrogen ring, vaginal estrogen cream, or vaginal estrogen tablets. Local and oral
estrogen treatments are sometimes combined for this purpose.
Next: Bioidentical hormone therapy »
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