Dr. Sharon Malone is the Chief Medical Officer of Alloy, and she’s one of the nation’s leading obstetrician-gynecologists with a focus on the specific health challenges associated with menopause. She’s certified by the North American Menopause Society and sends out a weekly “Hot Takes” newsletter with Alloy that covers important women’s health news. Below are excerpts from some recent editions; to get them delivered weekly to your inbox please sign up here.
What are the stages of menopause?
The march toward menopause usually begins in your early 40s, years before your periods end for good, when your ovaries go from reliable to fickle, from busy to sluggish. This is perimenopause. During this time, you may experience changes like irregular periods while your reproductive cycle is preparing to wind down and retire for good.
NOTE: Hide-and-seek menstrual cycles, sudden heat surges and other surprises caused by your hormones. This process is gradual and not-so-predictable, but the length differs for every woman (anywhere from a few months to 10 whole years).
You’ve officially reached menopause when you’ve gone 12 consecutive months without a menstrual period. This menopausal transition marks the end of your childbearing years. That means you are no longer ovulating and producing estrogen and progesterone from your ovaries. The average age to hit menopause is 51, but it really is different for everyone (anywhere from 40s to mid-50s is normal). The hot flashes, trouble sleeping, mood swings. vaginal dryness… don’t worry, that’s all included in this phase.
Our periods may be over, but a new period of possibilities has begun. After menopause, many women feel a sense of renewal, freedom and personal growth. You’ll spend about ⅓ of your life in this phase. While a new attitude might arrive, women are now more vulnerable to things like heart disease, osteoporosis and other health concerns. But there are treatments that can help-- and we can help you find what’s right for you.
What are the best treatments?
For the vast majority of healthy women, balancing your fluctuating hormones during perimenopause and supplementing your body’s natural estrogen during and after menopause provides the best relief for your symptoms and the most health benefits as you age. But hormonal solutions come in many forms, and choosing the best treatment for you can be tricky. Here’s a quick explainer:
- Should I choose low-dose oral contraceptives or menopausal hormone treatment (MHT)?
If it has been less than a year since your last menstrual period, and you are having menopausal symptoms, the better option is the low-dose contraceptives. Until you have gone more than a year without a period, although it is unlikely, you can still get pregnant. So in addition to relief of your menopausal symptoms, you get reliable contraception and cycle control.
- What if I don’t need contraception?
Regardless of whether or not you need contraception until you have not had a period for a full year, you are still perimenopausal. Low-dose oral contraceptives will relieve menopausal symptoms such as hot flashes and mood swings and will also regulate your menstrual cycles. So if you’re tired of not having any idea when or how heavy your next period is going to be, low dose birth control pills are helpful until we know for sure you’re menopausal. Even if your cycles are regular now, as you get closer and closer to your last menstrual period (menopause), your periods are likely to become irregular over time.
- I know I am menopausal (no period in a year). How do I decide whether to use the transdermal patch or the oral estradiol pill?
There are a few situations where the estradiol patch may be preferable to the oral estradiol pill. Bear in mind that both the oral medication and the transdermal patches are safe and effective for the overwhelming majority of women. Personal preference is not an unreasonable reason to choose one over the other. The patches are changed twice weekly and the pills are taken daily.
- I’ve had a hysterectomy. What options are right for me?
The good news is that if you have had a hysterectomy, you do not need to take Progesterone. You only need to take the estradiol either as a patch or as a pill. Aside from the considerations noted, choose which option you think would be easiest for you.
- I only have vaginal dryness and/or urinary symptoms. Do I need to take oral or transdermal hormones?
If you only have vaginal dryness, frequent urinary tract infections or urinary symptoms, you do not need to use oral or transdermal estrogen. To relieve your vaginal or urinary symptoms, topical cream estradiol is all you need. No hot flashes? No problem. Topical estradiol can be used as directed with almost no side effects or contraindications. With topical estrogen, no progesterone is needed even if you still have a uterus.
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