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Menopause And Hormone Replacement

by Charles Cavo, D.O.



The medical issues that result from declining estrogen levels may start well before the onset of menopause, which is defined by not having a menstrual cycle for one year.  Prior to the absence of the period, there can be issues with depression, joint pain, insomnia, inexplicable weight gain, hot flashes, brain fog and more.  These signals are commonly misread, leading to the mismanagement of these symptoms.  Treatments, such as antidepressants, sleeping pills, and NSAIDs are commonly used as Band-Aids to manage the symptoms.  These issues may be explained by declining estrogen levels and that is the root cause that should be targeted by treatment.   

When you replace estrogen in a suffering woman there can be a complete resolution of the undesirable side effects. Women are often told these symptoms are part of the aging process and to “deal with it.”  These various issues can last for years if left untreated.  

In fact, any woman presenting in their forties complaining of depression, joint pain, insomnia, or reduced libido may be suffering from a reduction in their estrogen.  Blood work evaluating a day-five FSH and estradiol level will help in making this diagnosis. 

A lot of the misunderstanding of hormone replacement therapy resulted from a clinical trial called the Women’s Health Initiative, which changed the perception of hormone replacement due to media coverage and misrepresented conclusions.  In fact, the researchers involved in this study have been trying to retract some of their conclusions admitting that they may have gotten some things wrong. And yet their concerns for the misleading conclusion does not get nearly the same publicity as the original misleading headlines got when the study was published.   

This study created fear that hormone replacement therapy (estrogen and progesterone) causes an increased risk of developing breast cancer.  Since that study was published, there have been many other studies that disprove this claim.  Click here or here for more in-depth readings on this topic.

There are many potential benefits of hormone replacement therapy when used appropriately.  In addition to alleviation of the symptoms described above, hormone therapy can play a role in the reduction of the risk of heart disease. This is the number one leading cause of death and women are at a greater risk of developing it.  It also can reduce the risk of Alzheimer’s dementia by 20-50%.  Proper hormone therapy can prevent bones from aging and in turn reduce the risk and complications of osteoporosis.  Lastly, as estrogen levels decline as women age, insulin resistance may worsen, which results in abnormal weight gain.  Controlling the relationship between estrogen and insulin resistance can help combat weight gain and there have been studies demonstrating that estrogen replacement reduces the risk for type 2 diabetes. 

Hopefully, as a whole, we can improve the education we have to offer with regards to recognizing the signs of menopause and providing the appropriate hormone replacement to treat these symptoms and debunk the fears associated with it.   



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