Some of the symptoms which women may experience during menopause include:

1. Irregular menses or cessation of menses.
2. "Hot flashes"
3. Vaginal dryness
4. Painful intercourse
5. Emotional changes such as moodiness, irritability
   sleeplessness, and depression
6. Memory loss
7. Hair loss
8. Weight gain due to decreased metabolism

Menopause marks the time in a woman's life when ovarian function is declining and as a result, the amount of estrogen in the body decreases as well.  Estrogen depletion is associated with many unpleasant symptoms such as hot flashes, moodiness, irritability, depression, and skin dryness.

Hormone replacement therapy can relieve many of these symptoms.  Typical estrogen replacement therapy consists of estrogen and progesterone either given together on a daily basis, known as continuous therapy, or given during different times of the month, known as sequential therapy.  It is important to remember that if you have a uterus, you must take progesterone with estrogen in order to prevent uterine cancer.  If you have had a hysterectomy, your gynecologist may give you estrogen alone.

 The benefits of estrogen replacement therapy are threefold:

1.  To help prevent or decrease complications associated with osteoporosis.

2.  To prevent heart disease.

3.  To prevent Alzheimer's disease.

If you have had a history of breast cancer, endometrial cancer, blood clots in your legs or lungs, or liver disease, you should inform your doctor prior to beginning therapy as estrogen replacement therapy may not be appropriate for you.

 If you are in a phase of your life known as the perimenopause, a time in which menses are becoming irregular but have not stopped completely, hot flashes have begun, weight is harder to lose, and irritability and depression are common, you will most likely be placed on sequential hormonal therapy.  You will take one tablet of estrogen every day of the month and progesterone on days 16 through 25 of the month.  This regimen tends to mimic your natural menstrual cycle so that you will only bleed once per month.  You can anticipate bleeding like your menses after you complete taking the progesterone pills.  This is a normal response to hormone replacement therapy and it may take six months to a year for this bleeding to decrease.  If bleeding persists for longer than six months, your doctor may perform a biopsy of your uterus in the office to sample the uterine lining.

On the other hand, daily continuous estrogen replacement therapy may be started.  You will be taking a single pill containing both estrogen and progesterone known as  Prempro or  a combination of an estrogen tablet and progesterone tablet on a daily basis. 

Forty to sixty percent of  women beginning this regimen will experience breakthrough bleeding during the first 6 months of treatment.  This is expected.  The percentage of women who bleed after one year is less than 20%.  If you continue to bleed after six months of therapy, your uterine lining will be assessed with an ultrasound and /or an office sampling of the inside of your uterus. 

Typical side effects of hormone replacement therapy include breast tenderness, bloating, depression and vaginal bleeding.  If these symptoms persist, you may need a revision in your hormonal therapy.  I often will halve the dose of estrogen in women complaining of severe breast tenderness.

 The most publicized risk of estrogen replacement over the past two years has been its association with breast cancer.  What you need to know is that there is a minimal  increase in the risk of breast cancer after 10 years of estrogen use.  Estrogen has been shown to stimulate many types of breast cancer.  In a woman who is genetically predisposed to breast cancer, estrogen replacement therapy may hasten the process.

Dr. Tara  Solomon

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