Menopause is the point in a woman’s life when there is permanent cessation of
menstrual periods. This is a natural event that occurs following the loss of ovarian activity. The average age
of menopause in this country is approximately 51 years old, although women who smoke usually begin several years
earlier.
The perimenopause
is the time period immediately before and after the menopause. This is a time that marks the transition from the
reproductive years to the postmenopausal years. The effects of the perimenopause are related to waning ovarian
function and include: disturbances in menstrual pattern, vasomotor instability (or "hot flushes"), mood
swings, and other physical symptoms.
Unfortunately, over the years, the menopause has been associated with negative
symbolism, when in fact this should be viewed as a point in a woman’s life where she has decades of productivity
and healthful living ahead of her. For many women hormone replacement therapy is the cornerstone of this transition.
Hormone replacement therapy (or "HRT") means the replacement of the
female hormone estrogen in physiologic doses. Modern therapy involves daily oral estrogen tablets, with the addition
of the hormone progesterone for women who still have their womb. Older therapies include estrogen injections, and
sub-dermal pellets. HRT can alleviate most of the annoying effects of the menopause, as well as provide numerous
health benefits.
The Nurses’ Health Study, which is a 16-year study of 60,000 postmenopausal women,
has shown that during the first 10 years of hormone use, the chance of dying was 37%
lower among women who used estrogen verses women who did not. This difference was primarily
due to the 53% reduction in risk of death from heart disease among estrogen users. Other health benefits include
a 32% reduction in risk of death from stroke, a reduction in the occurrence of osteoporosis (brittle bones), and
a 29% reduction in the risk of death from cancer. An interesting finding in this study was that women who used
estrogen had a 24% reduction in the risk of dying from breast cancer. This is despite other smaller studies which
have found slight increases in the overall occurrence of such cancers.
Alzheimer’s disease affects twice as many women as men. A study by the National
Institute on Aging, published last year in the journal Neurology
found that women who used estrogen reduced their risk of Alzheimer’s disease by 54%. Although
the authors felt that further studies are needed on this issue, this is nonetheless very encouraging news.
In summary, the decision to take or not to take replacement hormones remains a
very personal one. A woman should discuss this with her physician before reaching any conclusions. But, it is obvious
that a growing body of evidence supports the use of such therapy after the menopause.
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