Women's Health Through Menopause and Perimenopause

Women’s Health Through Hormones and Aging

Hormones and Aging

For over 50 years women have been receiving estrogen replacement therapy for treatment during menopause. Researchers looking for the clues to aging have documented the decline of other important hormones as well, though such decline is less abrupt and universal than with menopause. In the next few sections we will discuss these hormones, their effects, and the rationale behind their use as anti-aging therapies.

Bio-identical Hormones: Estrogen and Progesterone Replacement

Choosing to replace estrogen and progesterone is an important decision for any woman. When to start and which preparations to use are just a few of the questions that women today are asking. In addition, the recent results of the Women's Health Initiative Trial (WHI) have caused women and doctors some anxiety and concern. Doctors are refusing to start Hormone Replacement Therapy (HRT) on women experiencing the symptoms of menopause because of this trial, and even worse, many women's medications have been discontinued even though they have been doing well on these medications for years. Despite headlines critical of HRT, physicians who understand the results of the WHI have spoken out against the generalization of the results to woman considering HRT. The WHI results only apply to the two drugs that were studied, Premarin and Provera and the majority of the women in the trial were 65 years old and had not been treated for the first 10 to 15 years of their menopause. In addition, patients on HRT previously received a variety of doses, preparation and regimens, often raising their hormone levels to concentrations far in excess of normal physiologic levels and without regular monitoring of levels. Our program includes individual evaluation, dosing and regular monitoring of these hormones and their physiologic levels to restore youthful, physiologic, early adult levels of estrogen and progesterone, the current ’state of the art’ in BHRT.

What are Menopause, Pre-Menopause, Peri-Menopause and Post-Menopause?

Menopause, pre-menopause, peri-menopause as well as post-menopause are the terms describing a woman's transition from having regular periods to none at all. Pre-menopause refers to the years before any menstrual irregularities occur. Peri-menopause marks the interval in which your body begins its transition into menopause. Menopause is the permanent end of menstruation and fertility and refers to the time when periods have recently stopped for good. Post-menopause refers to the years after this transition and through the rest of a woman’s life.

The Menstrual Cycle, A Quick Review

In order to better understand what happens to a woman’s reproductive system as she grows older and the reasoning behind optimal BHRT, it is necessary to understand the basic, normal menstrual cycle. The purpose of the menstrual cycle is to prepare the lining of the uterus for implantation of a fertilized egg, the beginning of pregnancy. To accomplish this, the pituitary gland begins releasing follicle stimulating hormone (FSH) to stimulate the ovaries to begin producing Estradiol (the principal estrogen of the menstrual cycle). Among other things, Estradiol stimulates the cells lining the uterus to proliferate and cause thickening of the uterine wall in preparation for a possible fertilized egg. FSH stimulates a follicle in an ovary to become a mature egg. In addition, as Estradiol continues to be produced for the next 14 days, it causes a surge in the pituitary hormone called luteinizing hormone (LH) which causes the release of the matured egg or ’ovulation’. The egg travels down the fallopian tube to the uterus in anticipation of being fertilized. Meanwhile, the part of the ovary from which the egg left (the corpus luteum) starts to produce progesterone which stabilizes the lining of the uterus and readies it for implantation after fertilization. If it is not fertilized, it does not implant. The corpus luteum stops producing progesterone after about two weeks and without this support, the lining of the uterus sheds. The cycle ends and begins again.

A Woman’s Menstrual Cycle Throughout Her Lifetime.

This normal cycle does not continue unchanged from a woman's first period to her last. As a woman enters her mid-thirties, her reproductive capacity (her ability to get pregnant and subsequently deliver) begins to decline. Her production of estrogen may decrease slightly and her progesterone production in the second half of the cycle can decrease. During this time she usually continues to ovulate and her menstrual cycle generally remains regular and normal even though her reproductive capacity has decreased. Over the next 5 to 10 years, however, her menstrual cycle can become disrupted and estrogen levels can swing from very high to very low. This can result in alternating sensations of enlarged and tender breasts with bloating and irritability when estrogen is dominant; and hot flashes, confused thinking or lack of concentration, memory difficulties and vaginal dryness when the estrogen level plummets. Along with this are cycles in which no ovulation occurs and therefore no progesterone is produced to counteract the effects of the estrogen and to regularize periods. This leads to times with no bleeding (often leading to worry that pregnancy has occurred or menopause has began), and can then be followed by heavy bleeding accompanied by severe cramps.

In the past few years, the term "peri-menopause" has been adopted to denote these symptoms that occur in the 2 to 8 years prior to menopause. This stage of a woman's reproductive life begins several years (2-10) before menopause, when the ovaries gradually begin to produce less estrogen. Perimenopause ends when a woman has gone 12 months without having her period. This is known as menopause. Some signs that a woman is transitioning into menopause can include hot flashes, breast tenderness, worsening PMS, decreased libido, fatigue, irregular periods, vaginal dryness, dry skin, mood swings, difficulty concentrating and memory problems. After five years, the period referred to as post-menopause, a woman’s body settles into a lower estrogen state. During this time many rates increase such as cardiovascular disease, osteoporosis and fractures, diabetes and Alzheimer's disease.

Advanced Preventative or Anti-Aging/Age Management medicine intervenes before the actual menopause to treat the symptoms and long term consequences that result from less-than-optimal hormone levels.

What are the Side Effects and Cancer Risks of HRT?

Some women have been reluctant to start HRT even when they are aware of all the benefits because of concerns about side-effects and increased breast cancer risk. In today's medical world, side effects are virtually eliminated by proper dosing to achieve youthful physiologic levels, trans-dermal administration, the use of only bio-identical estradiol and progesterone and by monitoring blood levels closely. Importantly, the increased incidence of breast cancer reported in recent studies was found in groups of women taking oral, non bio-identical estrogen replacement therapy without proper blood level monitoring to achieve youthful physiologic levels of estrogen.

or more information on Bio Ientical Hormone replacement therapies and to address our symptoms of hormone decline, contact the Youhful Aging Center today. We are here to help.

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