[ September/October 2003 ]
More on Menopause
by Bethany Buchanon
Several issues ago (May/June 2003), I wrote about how the beginning of peri menopause can cause depression in women. While the cause is often hormonal, it is frequently diagnosed by the medical profession as chemical depression, for which anti-depressants are prescribed. If the onset of depression is in the forties, menstruating women may relate their depression to the decline of estrogen. This depression is often described as a loss of self-esteem, feeling overly sensitive to comments directed at them, tearing easily, or crying for seemingly no reason. Estriol is a very weak bio-identical hormone that doesn’t seem to affect monthly bleeding (periods stay the same), and can be safely taken to ease this type of depression.
So, what happens in the next phase of menstrual cycle changes? First, periods may begin to change. Menstruation cycles may become heavier and closer together, or they may become lighter and further apart. Either way, unpredictable periods are a common hallmark of peri-menopause. Usually, with depression comes irritability. The decline in estrogen signals the pituitary to begin to stimulate the ovaries to produce more estrogen. This results in a surge of estrogen through the system, which can make women feel cranky and irritable (read: angry and bitchy). When the estrogen drops again, it brings on feelings of sadness and depression. These ups and downs become more pronounced. Hot flashes and their evening accompaniment, night sweats, begin to appear.
Vasomotor changes and emotional issues are often the first common signs of imminent menopause. Other common symptoms may be difficulty with memory, poor sleep, fatigue, dry skin, dry hair, increasing wrinkles, and vaginal dryness. Sometimes this happens while women are still menstruating monthly, but usually it happens around the time when cycles are no longer reliable in timing.
All women are concerned about the use of hormones, especially in light of women’s health studies, and I don’t blame them. Many women are choosing to be hormone free during this time in their life. I find that healthy women who eat well, exercise, and are height-weight proportionate often sail through menopause with little difficulty. Women who have always struggled with their health or hormones (PMS, fibroids, and painful periods, etc.), however, often have a more difficult time with menopause.
For women who need something to ease their symptoms, bio-identical hormones offer an option worth considering. They have been studied, but not to the extent of Premarin. This is because no patent can be obtained; hence, there is a lack of money spent on studies as there is no profit to be made. These bio-identical hormones thus remain an “alternative” hormone replacement as opposed to becoming mainstream.
The body makes three types of estrogen; estradiol, estrone and estriol. They are found in the following percentages: estradiol, ten percent; estrone, ten percent; and estriol eighty percent. Local pharmacies compound (make what we tell them to make) these estrogens into a variety of strengths. Triest (triple estrogen) is the name of the bio-identical hormone that is frequently given to women with acute menopausal symptoms. The beauty (and art) of this type of replacement is that it can be completely individualized. Compounding pharmacies will make creams, pills, troches, suppositories or gels in any combination you can imagine. They can also combine two or more hormones in the same cream or pill
Taking Triest for menopausal symptoms is easy: if you have symptoms of estrogen deficiency, then take more Triest until the symptoms have eased. If you get too much Triest, then you will begin to have symptoms of excess, and less medicine is taken. Common symptoms of too much estrogen include breast tenderness, fluid retention, cranky and impatient feelings, irritability, and headaches. Common symptoms of not enough estrogen include hot flashes/night sweats, depression and poor sleep.
Biest is another common combination using estradiol and estriol. I often recommend this for women who have higher estrogen needs, such as those who have had a hysterectomy or when transitioning women off Premarin or other stronger synthetic estrogens.
Along with estrogen, I also use bio-identical progesterone. This can be used therapeutically for PMS, to control bleeding, to regulate the period, and help with symptom management with menopausal symptoms. Bio-identical oral progesterone is the only form of progesterone that has been studied in clinical trials to test the effects on increasing the HDL (or good cholesterol) and protecting the uterus from estrogen. Some small studies have shown that progesterone increases bone density as well (unlike estrogen, which prevents further bone loss). Because progesterone has beneficial effects on the cholesterol and the bones, some women opt to simply take progesterone for relief of the menopausal symptoms. For more mild menopausal symptoms, progesterone can be safely taken alone and it often significantly helps hot flashes and especially sleep. This is a great option, especially if women are uncomfortable taking any type of estrogen.
Bio-identical hormones remain a healthy option for women struggling with symptoms of peri menopause and menopause. They can be safely taken for a short period of time to relieve symptoms and provide some therapeutic benefit as well. Geneva Woods has regular ongoing classes to learn more about this option. The classes are $25; if interested call 297-1111 in Anchorage or 376-8200 in Wasilla for a schedule.
Bethany Buchanan is a family nurse practitioner and co-owner of Avante Medical Center, where she practices. Contact her at 770-6700 or by email at email@example.com.