The menopause or change of life is essentially that time of life when women go from their fertile years of regular menstruation to the era of absent periods free from the risk of pregnancy.
The different elements of this time zone have a confusing terminology. To the doctor, the menopause is actually the time of the cessation of periods, and the first 6 months afterwards. This is a time where hormonal patterns and bleeding and the need for contraception are uncertain.
To the patient the menopause generally indicates a variable time of life from when the periods become irregular and often heavier, until the time when they actually cease and beyond. This is medically known as the climacteric. Some people have a very long history of these symptoms, and so not all irregular and heavy periods of course are associated with the beginnings of the onset of the change of life.
The variable time either side of the menopause is the peri-menopause, and this is a time of heightened symptoms.
The post menopausal period is essentially the time after the cessation of periods when menopausal symptoms occur, and in some patients this can represent the rest of their life. For many people the symptoms will either not be a problem at all, or will settle down over the first 6 months to 2 years.
Most treatments for Oestrogen deficiency symptoms are forms of hormone replacement therapy (HRT), even those claiming to be "natural alternatives". This is for the very logical reason that the symptoms come about because the oestrogen receptors in the different tissues of the body are not being stimulated by oestrogen. To cure the symptoms one must stimulate these receptors.
Natural human Oestrogens (oestradiol the active human form of oestrogen, oestrone, the storage form, or oestriol, the pregnancy form) all have this effect and are used in various chemical versions, with many different doses and delivery systems being used.
The original oestrogen used for HRT was Ethinyl Oestradiol, the "pill" oestrogen which has a longer duration of effect than normal oestrogens. Horse oestrogens were the original "natural" oestrogens used, and are still in common use. Plant oestrogen like chemicals called Phytoestrogens are much less potent, and are available in many foods, or as concentrates.
SERMS, or chemicals which specifically stimulate oestrogen receptors in specific organs, can be used to stop some of the unwanted effects of oestrogens.
The main unwanted effect of oestrogens (including phytoestrogens) is stimulation of the uterine lining, This can lead to instability resulting in bleeding, lining overgrowth (hyperplasia) or, in extreme cases, cancer. For that reason, all oestrogen therapy should include a method of avoiding this. This is usually achieved by one of the progesterone like agents given in combination unless the womb has been removed. The exceptions are the SERMS with no uterine stimulating effect.
Delivery systems include the obvious ones (tablets and capsules orally), and patches for skin absorption, but also creams, gels, sniffers and lozenges or troches.
Non hormonal treatments are usually aimed at hot flushes and are mostly medications that effect brain or blood vessel activity. Unfortunately, they are less commonly adequate.
Download Menopausal Hormone List as a .PDF File
Colin Pearse
