Menopause & Hormones

Scroll below for Gynecology & Hormone Health Services provided to our patients related to Menopause & Hormones. To book an appointment to see female doctor and gynecologist Dr. Kashyap about a Menopause & Hormones related issue, please call our office at 702-983-2010 or click on a Book Appointment link.

Bioidentical Hormone Replacement Therapy

What is menopause?

Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovariesstop making estrogen. Estrogen is a hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.

What is perimenopause?

The years leading up to menopause are called perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries begins to fluctuate. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should report them to your health care professional. Abnormal bleeding may be a sign of a problem.

What is hormone therapy?

Hormone therapy can help relieve the symptoms of perimenopause and menopause. Hormone therapy means taking estrogen and, if you have never had a hysterectomy and still have a uterus, a hormone called progestin. Estrogen plus progestin sometimes is called “combined hormone therapy” or simply “hormone therapy.” Taking progestin helps reduce the risk of cancer of the uterus that occurs when estrogen is used alone. If you do not have a uterus, estrogen is given without progestin. Estrogen-only therapy sometimes is called “estrogen therapy.”

How is hormone therapy given?

Estrogen can be given in several forms. Systemic forms include pills, skin patches, and gels and sprays that are applied to the skin. If progestin is prescribed, it can be given separately or combined with estrogen in the same pill or in a patch. With systemic therapy, estrogen is released into the bloodstream and travels to the organs and tissues where it is needed. Women who only have vaginal dryness may be prescribed “local” estrogen therapy in the form of a vaginal ring, tablet, or cream. These forms release small doses of estrogen into the vaginal tissue.

What are the benefits of hormone therapy?

Systemic estrogen therapy (with or without progestin) has been shown to be the best treatment for the relief of hot flashes and night sweats. Both systemic and local types of estrogen therapy relieve vaginal dryness. Systemic estrogen protects against the bone loss that occurs early in menopause and helps prevent hip and spine fractures. Combined estrogen and progestin therapy may reduce the risk of colon cancer.

What are the risks of hormone therapy?

Hormone therapy may increase the risk of certain types of cancer and other conditions:

• Estrogen-only therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer.
• Combined hormone therapy is associated with a small increased risk of heart attack. This risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy.
• Combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke and deep vein thrombosis (DVT). Forms of therapy not taken by mouth (patches, sprays, rings, and others) may have less risk of causing deep vein thrombosis than those taken by mouth.
  Combined hormone therapy is associated with a small increased risk of breast cancer.
• There is a small increased risk of gallbladder disease associated with estrogen therapy with or without progestin. The risk is greatest with oral forms of therapy.

Can plant and herbal supplements help with menopause symptoms?

Plants and herbs that have been used for relief of menopause symptoms include soy, black cohosh, and Chinese herbal remedies. Only a few of these substances have been studied for safety and effectiveness. Also, the way that these products are made is not regulated. There is no guarantee that the product contains safe ingredients or effective doses of the substance. If you do take one of these products, be sure to let your health care professional know.

Can bioidentical hormones help with menopause symptoms?

Bioidentical hormones come from plant sources. They include commercially available products and compounded preparations. Compounded bioidentical hormones are made by a compounding pharmacist from a health care professional’s prescription. Compounded drugs are not regulated by the U.S. Food and Drug Administration (FDA). Compounding pharmacies must be licensed, but they do not have to show the safety, effectiveness, and quality control that the FDA requires of drug makers. The American College of Obstetricians and Gynecologists recommends FDA-approved hormone therapy over compounded hormone therapy.

Hot Flashes

What are Hot Flashes?

Hot flashes—A hot flash is a sudden feeling of heat that rushes to the upper body and face. A hot flash may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.

What causes Hot Flashes?

Healthcare providers are still studying the exact causes of hot flashes during menopause, but current research suggests that that the rapid changes in temperature result from a decrease or fluctuation of estrogen hormone level in the body.

During perimenopause and menopause, the body must adjust to the changes that result from lower estrogen levels. Lower estrogen levels are thought to trick the part of the brain that regulates body temperature into reacting as though the surrounding environment is very hot. This triggers attempts to cool the body off, including dilation of the blood vessels, causing flushing and sweating.

Women who experience abrupt menopause when their ovaries are surgically removed often suffer severe hot flashes that start right after surgery and typically last longer than those in women who undergo natural menopause.

What can I do about Menopausal Hot Flashes?

There is no estimated length of time that perimenopausal and menopausal women will have to endure hot flashes and night sweats. Some women will experience only a handful of them at the onset of menopause, while others will have them for life. The good news is that generally hot flashes tend to decrease in severity over time.

While you probably cannot completely prevent menopausal hot flashes, there are some known triggers that you can avoid to decrease their impact on your life:

• Hot Environments
• Spicy foods
• Alcohol
• Caffeine
• Cigarette smoke
• Tight clothes
• Stress

Keep your bedroom cool at night and wear light pajamas made with natural fibers, like cotton. You may also find that daily exercise eases hot flashes. If you’re not used to exercising, you could try activities that are easy on your body, like swimming, biking, and walking.
Relax and reduce stress. Slow and deep breathing and meditation are techniques that can help relieve stress and reduce hot flashes

Vaginal Dryness / Atrophy

What is vaginal dryness or atrophic vaginitis?

Atrophic vaginitis is not caused by an infection but can cause vaginal discharge and irritation, such as dryness, itching, and burning.

This condition may occur any time when female hormone levels are low, such as during breastfeeding and after menopause.

Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet.

A water-soluble lubricant also may be helpful during intercourse.

Can vaginal moisturizers and lubricants help with vaginal dryness?

These over-the-counter products can be used to help with vaginal dryness and painful sexual intercourse. They do not contain hormones, so they do not have an effect on the vagina’s thickness or elasticity.

Vaginal moisturizers can be used every 2–3 days as needed. Lubricants can be used each time you have sexual intercourse.

Source: The American College of Obstetricians and Gynecologists

Bleeding

What are some of the common changes that occur in the menstrual cycle during perimenopause?

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.

How can I tell if bleeding is abnormal?

Any bleeding after menopause is abnormal and should be reported to your health care professional. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care professional if you notice any of the following changes in your monthly cycle:

• Very heavy bleeding
• Bleeding that lasts longer than normal
• Bleeding that occurs more often than every 3 weeks
• Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

• Polyps—Polyps are usually noncancerous growths that develop from tissue similar to the endometrium, the tissue that lines the inside of the uterus. They either attach to the uterine wall or develop on the endometrial surface. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.
• Endometrial atrophy—After menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.
• Endometrial hyperplasia—In this condition, the lining of the uterus thickens. It can cause irregular or heavy bleeding. Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause

Incontinence & Urinary Problems

What is urinary incontinence?

Urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.

What other symptoms occur with urinary incontinence?

It is common for other symptoms to occur along with urinary incontinence:

• Urgency—Having a strong urge to urinate
• Frequency—Urinating (also called voiding) more often than what is usual for you
• Nocturia—Waking from sleep to urinate
• Dysuria—Painful urination
• Nocturnal enuresis—Leaking urine while sleeping

What are the types of urinary incontinence?

Urinary incontinence in women can be divided into three main types:

1. Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, runs, or exercises.
2. Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. Women with this type of urinary incontinence may leak urine on the way to the bathroom. If you have an “overactive bladder” (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
3. Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.

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