Menopause – Symptoms, Hormone Replacement, Alternative Treatment

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For  women in menopause, a partner or a comprehensive husband is very important. It is much easier for her when your husband is willing to listen to her, to learn and to help her in this period with many changes.

The ovarian hormone secretion begins to decline after the age of 40 years. Menstruation becomes irregular and finally stops. The estrogen plays an important role in many processes such as regulating body temperature, bone formation and the balance of the vaginal mucous membranes. The decrease of the level of estrogen is responsible for most symptoms of menopause.


Article contents



How to help women during menopause?

Situations in which menopause should be taken into account

Long term substitution versus short term substitution

Medical implications of menopause


Side effects



- Hot flashes, due to the decrease in estrogen that regulates temperature

- Sleep interruptions, generally due to occurrence of hot flashes at night, interrupting the deep sleep

- Changes in mood, due to insomnia; other causes may be due to changes in family (the age at which children move from home, partners are busy with their jobs, decisions regarding the maintenance or change of the job, etc.. )

- Vaginal dryness due to the decreased estrogen levels, causing thinning of the vaginal walls; dyspareunia (painful intercourse) can occur and increased vaginal infections

- Loss of sexual desire, frequently reported to women of all ages; the motive is not known; fatigue, couple problems and alcohol consumption certainly contribute to the appearance of this symptom

- Memory problems, often related; the reason is unknown.


Other effects

The risk for osteoporosis – estrogen plays an important role in preventing osteoporosis; in time, the loss of bone density causes bone fractures, most commonly in the vertebrae, hip and radiocarpal joint (wrist).
Other changes – loss of elasticity of tissues, muscles, ligaments, changing the appearance of breasts, all these are very difficult to accept for a woman.

How to help women during menopause?

Women should be supported by their partners. A step forward is to understand the physiological cause of the changes a woman goes through during this period. Other ways to help them include:

- Encourage discussions about the emerging disorders. Open communication is key to good relationships

- Discussion about choosing a contraceptive method: even after several months of amenorrhea, women have 50% chances to ovulate. For safety, they must use a contraceptive method for one year since amenorrhea. There are health reasons for which that pregnancy should be avoided. The risk of fetal abnormalities increases along with age

- Understanding why sex is uncomfortable, even painful. Men and women reach orgasm later than before. A prolonged intercourse may be needed. Lubricants can be useful. Vegetable oils can be very helpful – one of them is olive oil which is expensive and it is useful. The oils should be used with condoms because it reduces their efficiency. Face creams or vaseline should be avoided because they cause vaginal irritation

- Supporting a healthy lifestyle. A balanced diet, less coffee, decreased consumption of salt, are all part of this regime. The exercises and the adequate rest are important in avoiding stress

- Some women need help in the decision to initiate hormone replacement or not. Understanding the benefits and risks are important for both women and men

- Love and communication are very important to pass more easily through this difficult transition period of women.

Foods to eat and avoid during menopause

Situations in which menopause should be taken into account

During physiological menopause, after the moment when menstruation becomes irregular and then stops, the ovaries produce increasingly less estrogen (female hormone). This change occurs over a period of 5-7 years, usually between the ages of 45 and 55.

During surgical menopause (removal of ovaries), hormone secretion is suddenly interrupted. In both cases, the result is given by estrogen deficiency. Some women have no symptoms, while others have a wide variety of symptoms. The most common symptoms are hot flashes, mood disorders, insomnia, vaginal dryness and urinary infections. These symptoms, the risks and benefits of hormone replacement therapy and alternative treatments will be discussed next.

Long term substitution versus short term substitution

Many women decide to use hormone replacement therapy (HRT) in order to control symptoms, but not for a period of less than five years. There is no study demonstrating that substitution in the short term (less than five years) increases the risk of breast cancer, a type of cancer commonly encountered. Instead, there are no long-term benefits either. For example, in order to prevent osteoporosis a substitution of more than five years is required.

Estrogen replacement increases the risk of venous thrombosis and pulmonary thrombosis. This risk is independent of the substitution period. However, this risk is relatively small in healthy women. Estrogen therapy is not recommended to women with diseases that would favor venous thrombosis. The risk for biliary diseases slowly increases in substituted women. Neither this risk is dependent on the substitution period.

Medical implications of menopause

Osteoporosis – Osteoporosis can cause fractures, due to the decrease of bone density and strength. Many studies show that the decrease of bone density is faster after menopause, when estrogen levels decrease. This decrease can be slowed by estrogen administration. The most common are hip fractures. 85% of hip fractures occur in women and 10-20% of the patients die from complications. Other effects of osteoporosis are height decrease, deviation of the spine and back pain due to vertebral fractures.

There are 2 types of drugs as an alternative to HRT in preventing osteoporosis. Depending on each woman’s personal history and problems, these alternatives may or may not indicated.
Bisphosphonates: Fosamax (alendronate) and Actonel (risedronate) – this class of drugs is used in both preventing, and treating osteoporosis. These are not hormones, so does they do not influence the risk for breast cancer. Nor have they any of the benefits of estrogen, such as lowering blood pressure or cholesterol.They are the most effective drugs for women who have a significant decrease in bone density. The National Drug Association (NDA) approved of the administration of an increased dosage of fosamax once a week.


- Few side effects

- Very efficient

- Non-hormonal products

- Without cancer risks

- Without vaginal bleeding

- Administration once a week


- Do not relieve hot flashes

- No cardiovascular benefits

- Must be taken with a lot of water

- It is obligatory standing half an hour after administration


Evista (raloxifene) – is effective in preventing and treating osteoporosis and it seems to decrease serum level of cholesterol. From these two points of view, the effects are identical to those of estrogen. On the contrary, they don’t have the same effect on the breast and uterine tissues , which means that we do not have to take extra progestin (cycrin or provera) and it does not increase breast cancer risk (in fact, it actually reduces the risk). No vaginal bleeding occurs.


- Few side effects

- Prevents the decrease of bone density

- Possible cardiovascular benefits

- May decrease the risk of breast cancer

- No vaginal bleeding


- May increase hot flashes

- It is a new drug with little clinical experience.


Endometrial cancer – There is a small but doubtless increase in the risk of endometrial cancer only in estrogen substituted women. This risk can be virtually eliminated by adding progestin (synthetic progesterone). For these reasons, women are substituted for both estrogen and progesterone. Hysterectomised women should not take progestin for they have no risk of endometrial cancer.
Heart diseases – are cause number one for women death, and there are recorded twice more many deaths from cardiac causes, than because of all cancers combined. The estrogen improves the serum levels of cholesterol by increasing the level of HDL (High-density lipoprotein ) cholesterol (“good” cholesterol) and lowering the levels of LDL (Low-density lipoprotein) cholesterol (“bad” cholesterol). There are reasons for us to believe that estrogen decreases the risk of heart failure, but it is still not sure. On the other hand, there are other ways to reduce risk of heart attack, such as a low-fat diet, exercise and medication. Women at high risk for cardiovascular diseases, should discuss with their doctor these treatment options.


Breast cancer – Most recent problems are related to the possibility of a link between HRT(hormone replacement therapy)  and breast cancer. Studies show a 30% increase of the risk of breast cancer after ten years of estrogen replacement. For example, a woman with breast cancer risk of 9:100, will have a risk of 12:100  after an estrogen replacement of 10 or 15 years.
Madness or Alzheimer’s disease – Although several studies have shown lower rates of madness in substituted women, this has not yet been demonstrated. In the case of women with early Alzheimer’s disease, the estrogen seems to improve the process. At this point, we do not know if estrogen replacement decreases the risk of Alzheimer’s disease.


Treatment schemes

There are two basic schemes: the cyclic scheme in which estrogen is taken daily and progesterone for 1-12 days per month, and the scheme continues, in which estrogen and progesterone are taken daily. Some doctors and use other treatment schemes as well.

Estrogen may be administered per os (orally) or as a patch changed 1-2 times per week. Patches are more expensive and may have adverse effects such as skin irritation at the level where it was applied.

The cyclic scheme

Estrogen (E) daily

Progesterone (P) 1-12 days / month



Day 1 E + P

Day 2 E + P

Day 3 E + P

Day 4 E + P

Day 5 E + P

Day 6 E + P

Day 7 E + P

Day 8 E

Day 9 E

Day 10 E

Day 11 E

Day 12 E

Day 13 E

Day 14 E

Day 15 E + P

Day 16 E + P

Day 17 E + P

Day 18 E + P

Day 19 E + P

Day 20 E

Day 21 E

Day 22 E

Day 23 E

Day 24 E

Day 25 E

Day 26 E

Day 27 E

Day 28 E

Day 29 E

Day 30 E


The scheme continues

Estrogen daily

Progesterone daily


Risks and benefits of hormonal substitution


The following table shows the risks and benefits of hormonal substitution and the effects on various organs:


Estrogen and progesterone




risk -


Medium benefit +

High benefit + +

Side effects

Although some women report no side effects, possible side effects are:

1. Estrogenic

- nausea

- bloating

- breast sensitivity

- cephalea (headache)

2. Progesteronic

- fluid retention

- mood disorders

- weight gain

- headache


HRT is not recommended for women with a history of breast or endometrial cancer. It may or may not be recommended to women with recent heart failure history or venous thromboembolism. It may be recommendation to women with heart failure, hypertension or diabete antecedents. Women with heart failure antecedents are not recommend estrogen replacement in order to prevent further heart attacks, but to prevent osteoporosis and hot flashes.


Alternative treatments for menopausal symptoms

Some women prefer the non-pharmacological treatments of hot flashes and other menopausal symptoms. Hot flashes are the most common symptoms of menopause. It must be known the fact that a therapeutic method is not useful in all cases. It can be tried either one of the alternatives presented for 8-12 weeks and if it does not work, it can be tried another one. Some women can still have hot flashes even during estrogen substitution. If you smoke, giving up smoking is the best decision in your life and it can relieve hot flashes. Reducing stress (if you can), a healthy diet and an adequate sleep are other ways to feel better.

There is a small study group of phytoestrogens or plant estrogens on menopause. Phytoestrogens are called isoflavones. It seems that isoflavones improve menopausal symptoms if taken in the quantities below. It is believed that they do not increase the breast cancer risk. Japanese women have a diet rich in isoflavones and have fewer hot flashes and lower risk of breast cancer than American women.

It is unclear whether isoflavones have a positive effect on the bone or whether they prevent osteoporosis. Also it is unknown whether they affect cardiovascular disease risk. There are some promising studies, but we do not recommend you isoflavones alone if the density of your bones is significantly lower (measured by osteodensitometry).


Foods that contain isoflavones

Soybeans 40mg/mug

Soy flour 25mg/mug

Soy milk 40mg/mug

Soy food 30mg/mug

Soy Cheese 4440mg/mug


Other isoflavones

Some women can not eat this food based on soy daily. You can try other soy powder (read the label to see the content of soy). These powders can be mixed with grain or other food, being more easily ingested. Another alternative would be eating products containing only isoflavones which have been extracted from proteins. For example – Promensil, a tablet containing 40 mg of isoflavones derived from clover, or Healthy Women, a tablet containing 50 mg of isoflavones extracted from soy.


What doses are recommended?

For the beginning, 40-50 mg / day are recommended. If hot flashes are not improved,  the dose may be increased to 150 mg (with the doctor’s permission).


What about herbal remedies?

Some studies were made  in Germany about Cimcifuga Racemosa (“black cohosh”) on menopausal symptoms. It is found in the product called Reminefim. For the subject to comply with the daily dosage it is recommended to read the prospectus carefully. There are available other natural remedies as well but we know very little about them. We recommend you to consult a specialist in herbal medicine if Cimcifuga Racemosa and isoflavones are not useful.



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