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Hormone Replacement Therapy

Natural menopause is the end of menstruation and childbearing capability that occurs in most women around the ages of 50 to 52. Known as the change of life, menopause is the last stage of a gradual biological process in which the ovaries reduce their production of female sex hormones estrogen and progesterone. Surgical menopause is the end of menstruation and childbearing capability that occurs as a result of the woman's ovaries and/or uterus being removed.

Ovaries begin to decline in hormone production during the mid-30s and typically continue to decline to around the age of 47- this phase is called perimenopause. During this phase, the process accelerates and hormones fluctuate more, causing irregular menstrual cycles and unpredictable episodes of heavy bleeding. By the early to mid-50s, menstruation ends; this phase is called menopause. Two or three years following menopause is the phase called climacteric.

During perimenopause, estrogen production is low and the ovaries stop producing eggs. As estrogen levels decline, certain signs (or symptoms) of menopause occur. The first sign is a change in the woman's menstrual cycle. Periods may skip or occur more often, and the flow may be heavier or lighter than usual. The most common symptoms are hot flashes, which may begin before a woman has stopped menstruating and may continue for a couple of years after menopause.

A hot flash can be defined as a sudden sensation of intense heat in the upper part or all of the body. The face and neck may become flushed with red blotches, appearing on the chest, back and arms. It is usually accompanied by perspiration and may last a few seconds to several minutes. For some women, the feeling of heat is followed by a feeling of chills. Hot flashes may be particularly disturbing during sleep.

Vaginal dryness is another common symptom of menopause. With advancing age, the walls of the vagina become thinner, dryer and less elastic. These changes may lead to discomfort and painful intercourse.

Four or five years after the final menstrual period, there is an increased risk of urinary tract and vaginal infections. The symptoms include having to go to the bathroom often, feeling an urgent need to urinate, not being able to urinate, or having to go often during the night.

Other symptoms of menopause may include headaches/migraines, mouth discomfort (pain and burning, altered taste sensations, dry mouth and sensitive gums), night sweats, fatigue, heart palpitations, anxiety, poor concentration, poor memory, loss of sex drive/sexual pleasure, breast tenderness, insomnia, mood swings and irritability.

The changes in menopause can be relieved by giving replacement estrogen in place of the hormone that is no longer made by the body. Estrogen Replacement Therapy (ERT) is a regimen of taking estrogen supplements to ease or diminish the discomforts of menopause. Additionally, ERT assists in protecting heart and blood vessels, reducing bone loss (osteoporosis), reinstating vaginal secretions and strengthening the urinary tract.

Progestin/progesterone used in combination with estrogen is called Hormone Replacement Therapy (HRT). ERT/HRT is an individualized choice, and the benefits and risks should be discussed thoroughly with the woman and her doctor before beginning therapy.