Understanding perimenopause, menopause, and hormone therapy

Menopause is a natural life transition that marks the permanent end of menstruation and fertility. It occurs when the ovaries stop producing eggs and estrogen levels decline. Menopause is confirmed after 12 consecutive months without menstrual bleeding. For most women, this happens around age 51, though it can occur anywhere between ages 45 and 56. The years leading up to menopause are called perimenopause or the menopausal transition. During this time, periods may become irregular and hormone levels fluctuate, causing symptoms related to menopause. Common symptoms include: • Hot flashes and night sweats• Vaginal dryness, burning, or discomfort during intercourse• Urinary urgency and recurrent urinary tract infections• Sleep disturbances• Mood changes and increased risk of depression or anxiety• Brain fog• Fatigue• Headaches• Changes in sexual function—decreased arousal and desire for intimacy • Skin and hair changes It is important to note that symptoms vary widely among women. Some experience minimal disruption, while others find their symptoms significantly affect their quality of life, work productivity, and personal relationships. Hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT), involves either replacing estrogen alone (for women who've had a hysterectomy) or estrogen combined with progestogen (for women with a uterus). HRT is the most effective treatment for symptoms of perimenopause and menopause, and can be delivered through a transdermal patch, cream/gel, or spray, a vaginal ring, or an oral tablet. HRT offers many benefits for women struggling with menopause symptoms, including relief from hot flashes, night sweats, and vaginal dryness. Additional benefits include preventing bone loss and reducing fracture risk, cardiovascular protection, a lower risk of type 2 diabetes mellitus, and a reduced risk of colorectal and breast cancer. HRT does not come without risks, and these should be discussed with your healthcare provider prior to starting therapy. Treatments may increase the risk of blood clots in the legs and lungs, stroke, and gallbladder disease. Exact risk factors can vary across different delivery systems. The balance of benefits and risks depends heavily on your age and how long it's been since menopause began. For healthy women under age 60 who are within 10 years of menopause onset and have bothersome symptoms, the benefits generally outweigh the risks. Women with unexplained vaginal bleeding, a history of certain types of breast cancer or other estrogen-sensitive cancers, a history of blood clots or stroke, active liver disease, or coronary artery disease should not pursue HRT. Rather, they can explore non-hormonal options to treat your symptoms, like medication, supplements, vaginal moisturizers/lubricants, cognitive behavioral therapy, and lifestyle modifications. Menopause is a natural transition, not a disease. While symptoms can be disruptive, effective treatments are available. Talk with your healthcare provider about your specific symptoms, health history, and treatment preferences. Together, you can develop a personalized plan that addresses your needs while minimizing risks. Erica Hermiller is a certified nurse practitioner with Blanchard Valley Obstetrics & Gynecology – Ottawa