FABEN OB/GYN in Jacksonville, FL, offers treatment for menopause symptoms, perimenopause, and post-menopause, including osteoporosis diagnosis and hormone replacement therapy (HRT)

As physician members of ACOG, the American College of Obstetrics and Gynecology, we believe their information (www.acog.org) is paramount to share with you. 

The monthly menstrual cycle prepares a woman’s body for a possible pregnancy. The cycle is defined as the first day of menstrual bleeding of one cycle to the first day of menstrual bleeding of the next cycle. Your ovaries are organs that contain the eggs necessary to get pregnant and make hormones, such as estrogen, progesterone, and testosterone. We listen carefully to your concerns about menstruation and menopause and encourage patients to share their thoughts during this journey. Each FABEN physician wants to ensure every patient understands the risks and benefits of menopause treatments. We will answer all of your questions about menopause and discuss options for treatment.

What is menopause

Each woman may have a different menopause experience, when the ovaries stop making estrogen and the menstrual cycle stops permanently. Menopause may naturally begin at the average age of 51 when estrogen, the female hormone produced in the ovaries that helps control the menstrual cycle, begins to lower, and you begin perimenopause. 

What is perimenopause

Perimenopause is the time leading up to menopause, when the production of estrogen produced by the ovaries begins to fluctuate or change, usually in the 30s and 40s. You may skip periods altogether. Your flow may now range from mild or light to heavier than normal or even severe – each woman is different. Always call your FABEN physician to check for menopause or a sign of a problem resulting from abnormal bleeding.

Common signs and symptoms of perimenopause

You may experience these during your journey:

  • Hot flashes are a sudden feeling of heat rushing to your upper body and face, which may last a few seconds or longer. They can occur a few times a month, several times a day, or give you night sweats, causing you to wake up feeling tired and sluggish the next day.
  • Sleep problems can cause insomnia (trouble sleeping) or waking before your usual time may occur. Night sweats can disrupt sleep patterns, too.
  • Vaginal or urinary tract changes occur when estrogen levels decrease resulting in the vagina becoming thinner, dryer, and less elastic.
    • Vaginal dryness may cause pain during sex.
    • Vaginal infections may occur more often due to the urethra becoming drier, inflamed, or irritated, causing more frequent urination and increasing the risk of a UTI (urinary tract infection).

Bone changes post-menopause and osteoporosis

After 35, a small amount of bone loss is normal. Within 4-8 years after menopause, more bone loss occurs rapidly because decreased estrogen or hormonal levels. Osteoporosis occurs if too much bone is lost, resulting in the risk of bone fracture, most often of the hip, wrist, and spine.

Other health risks during perimenopause and menopause

Less estrogen may result in a higher risk of heart attack or stroke. Midlife often results in higher risk factors for heart disease, such as high cholesterol levels, high blood pressure from less physical activity. 

Hormone therapy or hormone replacement has options

Hormones are substances made in the body that control cell and organ function. Estrogen or hormone therapy offers options.

  • Systemic therapy may include pills, skin patches, gels, or sprays applied onto the skin. Estrogen is released into the bloodstream and travels to the organs and tissues where it’s needed. 
    • A Rx of “local” estrogen therapy may be delivered via a vaginal ring, tablet, or cream – each releases small doses of estrogen into the vaginal tissue.
    • A Rx of progestin, a synthetic form of progesterone similar to the hormone naturally made by your body, may be given separately or combined with estrogen in the same pill or patch.

Benefits of hormone therapy or hormone replacement

Systemic estrogen therapy with or without progestin is the best treatment to relieve hot flashes and night sweats. These therapies help to protect against bone loss occurring in early menopause and prevent hip and spine fractures from osteoporosis. 

  • Systemic and local types of estrogen therapy relieve vaginal dryness
  • Combined estrogen and progestin therapy may reduce the risk of colon cancer

Risks of hormone therapy

Hormone therapy may increase the risk of certain types of cancer and other conditions. Estrogen-only therapy has a small increased risk of heart attack and is related to:

  • Age
  • Existing medical conditions
  • The time therapy begins

Combined estrogen-only therapy and hormone therapy have a small risk of stroke and deep vein thrombosis (DVT) causing a blood clot to form in the leg veins or other areas of the body.

  • If combined therapy is not taken by mouth (patch, spray, rings, etc.), there may be less risk of DVT as well as a small risk of breast cancer.
  • If taken by mouth (orally), there is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin.

Other medications may relieve menopause symptoms

Rx antidepressants (drugs to treat depression) may reduce hot flashes and ease sleep problems during menopause. They include:

  • Gabapentin (an anti-seizure medication) 
  • Clonidine (a blood pressure medication)

Rx SERMS (selective estrogen receptor modulators) act on tissues that respond to estrogen to relieve hot flashes and pain during intercourse caused by vaginal dryness.

Plant and herbal supplements include soy, black cohosh, and

Chinese herbal remedies.  

  • These are not regulated, and few studies have shown safety and effectiveness.
  • These carry no guarantee of safe ingredients or effective doses.
  • It’s always best to check with your FABEN physician before use.

Bioidentical hormones (plant-sourced)

* The American College of Obstetricians and Gynecologists (ACOG) recommends FDA-approved hormone therapy over compounded hormone therapy

These are commercially available products and are not regulated by

the FDA.

  • Compounded preparations require a healthcare professional’s Rx and are made by a licensed compounding pharmacist in a licensed pharmacy.
  • These products are not required to show safety or effectiveness and are not quality controlled by the FDA, which requires drug makers to meet their strict standards.

Vaginal moisturizers and lubricants

These over-the-counter products do not contain hormones or affect

the vagina’s thickness or elasticity. They include:

  • Moisturizers – used every 2-3 days, as needed
  • Lubricants – used each time during intercourse

How to stay healthy before, during, and after menopause

Dedicate yourself to a healthy lifestyle and focus on:

  • Nutrition – eat a balanced diet and include calcium and vitamin D to help maintain strong bones
  • Regular exercise – slow down bone loss and improve overall health by including:
    • Weight-bearing exercises, such as walking, to help keep bones strong 
    • Strength training using an exercise band or handheld weights to increase muscle and bone strength by resisting against weight (your body)
    • Balance training by doing yoga or tai chi to help  avoid a fall, which could result in broken bones
    • Kegel exercises to strengthen your pelvic floor muscles 
  • Urine checks to see if there is any color change coming from your urethra, the tube-like structure where urine flows out of your body
  • Annual vagina exams are important because this tube-like structure is surrounded by muscles and leads from the uterus (the muscular organ in your pelvis where, during pregnancy, holds and nourishes the fetus) to the outside of your body
  • Routine health care may help detect problems early

So, maintain annual exams and tests by your FABEN doctor, and don’t forget to include dental and eye check-ups

FABEN physicians are here to help and answer any questions you may have. As a FABEN patient, our continued relationship during your lifelong health journey is of utmost importance. Feel free to call us – anytime!