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When a woman is born she has a finite number of eggs in her ovaries which during her reproductive years either gets released or ovulated or reabsorbed. The cysts, or follicles, which contain the eggs are a woman’s major source of estrogen. When they become depleted, the woman is considered menopausal and an estrogen deficiency occurs.

The average age of menopause in the United States is 51 with the range extending from the mid-40s to the late 50s. It is clinically defined as one year without a menstrual period. There are also biochemical markers such as estradiol and FSH which can further define menopause.

Hormone replacement therapy for menopause can be introduced as early as a patient has symptoms which negatively impact her quality of life. It is definitely not necessary to meet the clinical definition of menopause to start treatment.

To take maximal advantage of the medical benefits, such as cardiovascular protection, hormone replacement therapy should be started within one to two years after menopause.

Common Symptoms of Menopause

Not all women have symptoms of estrogen loss, and if they do experience symptoms they can be variable in type and intensity. Additionally, the symptoms can begin years prior to menopause; this is called the climacteric, going through the changes, or perimenopause.

Menopause symptoms can range from hot flashes, night sweats, significant sleep disturbance, vaginal dryness and painful intercourse, urinary frequency, depression, loss of libido, migraines, weight gain, hair thinning and loss, collagen loss resulting in fine lines and wrinkles, brain fog, cognitive changes and memory loss.

Increased Risks Post Menopause

Menopause means loss of estrogen, which subjects women to all the symptoms of estrogen loss as well as the increased risks of aging, including:

  • Heart Disease
  • Dementia
  • Diabetes
  • Cancer
  • Osteoporosis

The risks of natural hormone replacement, properly monitored, are negligible compared to the probability of disease which has been strongly supported by well-designed, meaningful studies in the medical community.

Since the depletion of one’s own source of estrogen causes the menopausal symptoms, replacement of bioidentical estrogen alleviates those symptoms. Estrogen can be replaced vaginally, to address vaginal atrophy causing painful intercourse and overactive bladder, or systemically by pills or topical agents which are effective for the alleviation of all symptoms. Each mode of delivery has its advantages and disadvantages.

After a Hysterectomy

If a woman has had a hysterectomy during the reproductive years and the ovaries have been retained there is no benefit to giving additional estrogen. Hormonally she should be functioning normal but without a menstrual period. If the ovaries have been removed, however, she is surgically menopausal. If the woman had the ovaries removed at a young age she is at great risk for severe estrogen loss symptoms, especially sleep disturbance and hot flashes. Her risk also extends to early onset cardiac disease and dementia, so estrogen replacement therapy is strongly recommended.

A common mistake after a hysterectomy in either pre or post-menopausal women is to omit progesterone therapy, believing that since there is no further risk for uterine cancer it is not needed. However, the breasts always need protection from constant estrogen replacement.