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Menopause occurs when there are no
menses for one year
The ovaries become dormant and stop
making estrogen
95% of women complete menopause
between ages 45-55, with a mean age
of 51 years
A lucky few breeze through with minimal
ill effects….
But the majority of women experience
some degree of menopausal symptoms
› Hot flashes
› Mood lability
› Trouble sleeping
› Vaginal atrophy
The vaginal tissues are very sensitive to
estrogen, and estrogen deficiency leads
to thinning of the tissues. This is called
vaginal atrophy or “atrophic vaginitis”
Symptoms of atrophic vaginitis
› Dryness
› Itching
› Burning
Pain with intercourse
Urinary frequency
Frequent urinary infections
Taking medications which contain
estrogen (with or without progesterone)
when the body no longer makes it
Hormone replacement is the best way to
alleviate the undesirable effects of
A clinical trial showed that in some
women, hormone therapy may increase
risk of
› Cardiovascular problems (heart attack and
› Blood clots
› Breast cancer
› Uterine Cancer
Women who have moderate-severe hot
 Women who suffer from symptoms of
vaginal atrophy
 Women who have NO personal history of
Breast, Ovarian, or Endometrial Cancer
Heart Attack
Blood clots
Liver Disease
Women who went through menopause
prior to age 45
 Some women with osteoporosis
 Women who do not smoke
 Ideally, women who are younger than 60
Women with a family history of breast cancer need
to have a conversation with their doctors to weigh
their own personal potential risks and benefits
Oral tablets
 Patches
 Vaginal creams*
 Vaginal tablets*
 Vaginal rings*
The vaginal preparations work better for vaginal
atrophy and in low dose preparations, probably
have less systemic side effects
Hormone replacement therapy is not all
good, but it is NOT all bad!
You should take the lowest effective
dose, for the least amount of time
› Most women do well with 1-2 years of
› Ideally less than 5 years
Some women cannot, or elect not to,
take hormone replacement therapy
Keep cool!
Minimize caffeine and alcohol intake
Keep weight down
Don’t smoke
Some medications used for depression
can help with mood swings and even
hot flashes
› Soy, isoflavones, red clover, flaxseed
› Compounds found in many plants, fruits,
› Mimics estrogen effects in the body
Black Cohosh
› Mimics estrogen effects, especially on the
breast. Therefore it is not safe for those with
breast cancer or high risk.
Evening Primrose Oil
› Has not been proven to be effective
None have been proven to be more
effective than placebo for alleviating
menopausal hot flashes
They may increase breast cancer risk or
encourage tumor growth
Bottom line – probably not worth the
Hormone replacement therapy is not for
everyone, but can be very safe and
effective for many women!
Talk with your doctor!