Postmenopausal Medicine

A woman is considered to be postmenopausal when she has not had her period for an entire year, she has stopped ovulating, and hormone levels have decreased. As a women’s level of estrogen diminishes, postmenopausal women are at increased risks for a number of health conditions, such as osteoporosis, heart disease, and changes in the vagina and bladder. Women may also experience difficulties with their hormones, sexuality, and experience depression.

Hormones

Hormone replacement therapy is a treatment that is used to supplement the body with estrogen, or with estrogen and progesterone combined. Estrogen and progesterone are hormones that are produced by a woman's ovaries. When the ovaries are no longer able to produce adequate amounts of these hormones, hormone replacement therapy can be given to supplement the body with adequate levels of estrogen and progesterone hormones.

Hormone replacement therapy is recommended for the treatment of menopausal symptoms, as well as the prevention of osteoporosis and heart disease. Hormone replacement therapy is used to:

• control levels of female hormones, which can go up and down
• provide relief of hot flashes, mood swings, and urinary problems
• protection against osteoporosis, heart disease, and colorectal cancer
• relief of vaginal symptoms, such as dryness, itching, burning and discomfort with intercourse

Sexuality

A woman’s sexual drive and functioning may change due to the loss of estrogen following menopause. Menopausal and postmenopausal women may notice that they are not as easily aroused, and may be less sensitive to touch, which can result in decreased interest in sex. Lower levels of estrogen can cause a decrease in blood supply to the vagina. This decrease can affect vaginal lubrication, causing the vagina to be too dry for comfortable intercourse.

Depression

The drop in estrogen levels during menopause triggers physical, as well as emotional changes, such as depression. Depression is a condition that involves your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things.

Menopause can trigger feelings of sadness and episodes of depression.

Symptoms of depression may include:

• Depressed mood most of the day, nearly every day for 2 weeks or longer
• Loss of interest or pleasure in activities that the person usually enjoys
• Fatigue or lack of energy
• Restlessness or feeling slowed down
• Feelings of guilt or worthlessness
• Difficulty concentrating
• Trouble sleeping or sleeping too much
• Recurrent thoughts of death or suicide

Osteoporosis

Osteoporosis is a disease that weakens your bones, resulting in an increased loss of bone mass and strength.

There is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis. Early menopause (before age 45) and any prolonged periods in which hormone levels are low and menstrual periods are absent or infrequent can cause loss of bone mass.

Hormone therapy may help prevent or alleviate the increased rate of bone loss that leads to osteoporosis. It is generally recommended for postmenopausal women who:

• Undergo an early menopause
• Have a low bone mass
• Have other risk factors for osteoporosis, such as:
  • being petite
  • having a thin frame
  • family history of osteoporosis
  • medical problem associated with osteoporosis