What are the biggest concerns that patients express about menopause?
A: Women frequently worry about their emotional state, changes to sleep patterns, problems with memory and concentration, hot flashes and vaginal pain during intercourse. A decline in bone density and cardiovascular changes can also be a concern.
What are the benefits of hormone replacement therapy (HRT)?
A: Menopause is a normal state of hormonal deficiency. The main goal of HRT is to replace limited hormones just enough to control symptoms and to protect the bone tissue and vaginal lining. If started early, estrogen has a cardio-protective effect, reduces risk of colon cancer, reduces inflammation in the body, and much more.
Are there ways to treat menopause without hormones?
A: Absolutely. Some women prefer not to use HRT and in some women it is simply contraindicated. Alternative methods include herbal supplements, various classes of medications, exercise, meditation, acupuncture, physical therapy and gravitational wellness.
Can estrogen be used alone?
A: Estrogen can be used without progesterone if the uterus is absent. Progesterone "controls" the lining of the uterus and reduces its risk of pre-cancer and cancer. It is highly recommended that systemic estrogen is used together with progesterone when the uterus is in place.
What is the most significant side effect of HRT?
A: In my opinion, it is stroke. Patients with hypertension, cardiac conditions, diabetes, obesity and previous thromboembolism carry the highest risk of stroke. The selection of candidates for HRT needs to be highly individualized.
People are often afraid of breast cancer when on HRT. What are your thoughts on this?
A: Breast cancer risk is not increased in women on estrogen alone. The addition of progesterone increases this risk only slightly. Multiple studies have shown that the survival rate in patients who develop breast cancer while on estrogen is better that the survival rate of patients who are not taking estrogen.
It sounds like you highly recommend HRT for women.
A: This is true. I highly recommend carefully designed HRT in very well-selected cases. At times combining HRT with alternative methods minimizes the hormonal dose, while controlling the symptoms beautifully.
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