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The Menopause and hormone replacement therapy

When a woman reaches menopause do you think that she should undergo hormone replacement therapy?

This Research Project is based on Menopause, the symptoms, effects, lifestyle changes and Hormone replacement therapy. The question, When a woman reaches menopause do you think that she should undergo hormone replacement therapy? will be answered by using information gathered from research as well as completed surveys on women of various ages, some having experienced menopause and others preparing for menopause. The purpose of this research project is to educate women who are about to experience or are already experiencing menopause and it is to act like a guideline for women. This project offers sufficient information which is easy to understand, yet includes all the possible symptoms and medical changes in a womans body during menopause.

Explanation of Menopause

Menopause represents the end of menstruation. While technically it refers to the final period, it is not an abrupt event, but a gradual process. Menopause is not a disease that needs to be cured, but a natural life-stage transition. However, women have to make important decisions about "treatment" including the use of hormone replacement therapy (HRT).1

Menopause is diagnosed when a woman has gone through 12 consecutive months without menstruation. It marks the last day of a womans fertile years and is commonly known as the "change of life" as it also indicates other changes that may begin to the body and mind. These changes are brought on as a result of the body producing fewer amounts of the hormones, oestrogen and progesterone. Menopause usually occurs in women between the ages of 45 and 55, with the average age being 51; however the menopausal period differs for individual woman. Menopause is a natural process in a woman's life, with a proper diet, nutritional supplements, and exercise, most of the unpleasant side effects of menopause can be reduced, if not completely eradicated.

Causes and Symptoms of menopause

A girl reaches puberty around the age of 9-13 years old. Each month her body prepares for a pregnancy and releases one of the many eggs that are stored in her ovaries. The lining of the womb (uterus) thickens in preparation of receiving a fertilized egg. If the egg is not fertilized, progesterone levels drop and the lining sheds and bleeds, resulting in a monthly period.

Age is the main cause of menopause.2By the time a woman reaches her late 30s or 40s, her ovaries begin to slowly shut down, producing less oestrogen and progesterone and releasing eggs less often. The gradual decline of oestrogen causes a variety of changes in the womans body. It has been said that the lack of oestrogen can make a woman more susceptible to osteoporosis as they become calcium deficient causing the density of the bones to become more fragile.

As the levels of hormones fluctuate, the womans menstrual cycle begins to change. Every womans menstrual cycle differs; some women may have longer periods with heavy flow followed by shorter cycles and hardly any bleeding. Others may begin to miss periods completely. During this time, a womans chance of getting pregnant decreases.

A woman can usually tell when she is approaching menopause as her monthly periods start changing. The medical terms used to describe this time are "perimenopause" and the "menopause transition."3

There is no definite explanation for what menopause is like for every woman, as it differs for each individual. Some women reach menopause with little or no trouble where as others experience severe symptoms which have drastic impacts on their lives. Menopause can start suddenly as a result of surgery, chemotherapy, or radiation.4

The most common symptom of menopause is a change in the menstrual cycle, but there are a variety of other symptoms, including:

* hot flushes

* night sweats

* insomnia

* mood swings/irritability

* breast tenderness

* memory or concentration problems

* vaginal dryness

* heavy bleeding

* itchy, crawly skin

* extreme fatigue

* depression

* hair changes

* headaches

* heart palpitations

* sexual disinterest

* urinary changes

* weight gain

Women often confuse the term perimenopause with menopause.5

Perimenopause is the period of time leading up to menopause and it can last between 1 and 14 years. Women may experience symptoms from the list above during this time.

Menopause is the last day of your last period ever. Once you are in menopause, youll be in it for the rest of your life.

Hormone Replacement Therapy (HRT)

Explanation of HRT

Hormone replacement therapy (HRT) is a well known medical treatment used to reduce the intensity and discomfort of the symptoms of menopause. A lot of women have found that using HRT drastically decreases the severity of menopause symptoms, allowing them to live a comfortable life once again.

HRT involves replacing the hormones which a womans body stops producing during menopause, namely oestrogen and progesterone, to their normal range.6 It is the reduced amount of these hormones which seem to cause the symptoms associated with menopause.

Types of Hormone Replacement Therapy

Hormone replacement therapy can be used in a variety of combinations to suit the individual needs, symptoms and health concerns of a woman.

Oestrogen and Progesterone: The most common type of HRT. It is designed particularly for women who have a uterus, eg: have not had a hysterectomy. During this therapy, oestrogen is given regularly, while progesterone is added in on an additional basis. The oestrogen used in the therapy is Premarin, as it is made from the urine of pregnant horses (PRegnant MAre's urINe). Progesterone is artificially created and is called progestin. A combination of the two hormones is given in order to prevent the overgrowth of the uterine lining as well as prevent any irritation of the lining, which could lead to endometrial cancer.

Oestrogen Only: Oestrogen therapy alone is usually given to women who have had a hysterectomy and lack a uterus. Due to the lack of uterus, the need for progesterone is minimal.

It is advisable for a woman who thinks she may be experiencing perimenopause, menopause, or any similar symptoms to consult a doctor before committing to any type of HRT.

Advantages of HRT

The effects of HRT are extensive and it is said to be an excellent treatment for reducing the symptoms of menopause. HRT can also significantly reduce the amount and intensity of the hot flushes and night sweats that a woman may experience. The oestrogen in HRT can assist refreshing a womans skin, improve her sleeping patterns and allow her comfort with few symptoms during menopause.

An additional benefit of hormone replacement therapy is the reduction of a womans risk of developing osteoporosis. Plant oestrogen is excellent for building bone mass in a womans body, making her bones stronger. Some studies have even shown that within five years, HRT can reduce the occurrence of bone fractures by up to 80%, as the bones are stronger and less brittle.

Disadvantages of Hormone Replacement Therapy

Whilst some research studies have shown HRT in a positive light, there are some factors which show that HRT may in fact be more dangerous than it is beneficial. HRT is prescribed to help prevent illnesses associated with menopausal women, including heart disease, breast cancer, and dementia. A long-term study by the Women's Health Initiative showed that HRT might actually increase a woman's risk of many of these diseases. Since these discoveries, HRT has been cast in a negative light in many countries.

Oestrogen is known to stimulate cell division, and it seems to increase the risk of breast cancer by up to 9%. HRT also appears to increase the risk of heart disease by 24%. Women who take HRT to reduce their risk of Alzheimer's disease may actually increase the risk by a small percentage. In order to prevent increasing the risk of certain diseases during menopause, it is suggested that women use HRT for no more than five years.

There are quite a number of side effects as well as risks related to HRT. It is very difficult to interpret the degree to which the actual therapy is connected to most of the side effects and risks due to the lack of long-term clinical trials comparing the different types of HRT.

Possible side effects and risks:

* Increased risk of endometrial cancer (women who have a uterus)

* Increased risk of breast cancer after 4 or more years of HRT.

* Increased risk of ovarian cancer.

* Slightly increased risk of blood clots and gallbladder diseases, associated with the ingestion of oestrogen

* Slightly increased risk of heart attack or stroke, both in women with cardiovascular disease and in healthy women.

* Nausea

* Bloating and fluid retention.7

Suitable candidates for HRT

HRT can be prescribed by gynaecologists, doctors and GPs. A womans medical history and a body examination will indicate if she is suitable for HRT and determine whether it is right for her. It is advisable for all women who are considering having HRT to consult their doctor before making any fixed decisions.8

Women must not have HRT if they are:

* Obese

* A smoker

* A heavy drinker

* Prone to migraines with aura

Women are advised not to use HRT, and rather opt for a natural remedy of sorts if they:

* Have cancer in their family background

* Have had cancer previously

* Have high blood pressure

* Are at risk of a stroke

Alternatives to HRT

There are many traditional or natural remedies believed to have the same effects as HRT, only they are said to be better for the body in terms of side effects.

Some alternatives include:

* Herbs, Vitamins and Minerals

* Soy and Phytoestrogens

* Homeopathy

* Aromatherapy

* Healthy lifestyle

Many women choose not to use HRT, or to use it for a limited amount of time. eg: 6 months to 2 years to reduce the intensity of hot flushes. If a woman does not want to, or cannot have HRT, there are ample supplements including herbs, vitamins, minerals and homeopathic remedies which some women find helpful. Changes in a womans lifestyle, diet, and exercise routine are also beneficial.

Herbs, Vitamins and Minerals

For women who want neither natural nor artificial hormone replacements, one approach is herbs. When used wisely, herbs have minimal, if any, side effects of drugs. Using remedies which aid the menopausal process rather than attempt to stop it, herbs help women keep in touch with the natural process of menopause. All foods have the potential for causing distress in some people; herbs are exactly the same and should be used with care and in correct proportions as to what a doctor has prescribed.

Botanical names of examples of herbs used

Soy products seem to help some women as they are high in phytoestrogens (plant compounds with oestrogen-like activity) and can relieve some menopausal symptoms. However, the evidence regarding soy is inconsistent. Clinical studies have shown that soy has little oestrogenic activity in the brain and, therefore, does not help much with hot flushes and night sweats. In breast tissue, soy may stimulate the growth of breast cells and thus soy is not advisable for breast cancer patients. Although phytoestrogens have some oestrogenic activity and may have some of the effects of HRT, their long-term safety is not clear and has not been sufficiently studied.

Homeopathy

Homeopathic medicines act in the same way as the human system's defence reactions. They stimulate the natural defences of the body in order to make them more efficient, thus working in conjunction with the body rather than against it. It is not the quantity of homeopathic medicine that counts, but its presence that determines the amount of activity able to take place. There are homeopathic remedies for symptoms associated with menopause such as PMS (Post Menstrual Syndrome), hot flushes, irregular bleeding, confusion, fatigue, migraines, depression and restlessness.

Aromatherapy

Aromatherapy is the using of plant essential oils in the treatment of mind, body and spirit. It is the use of essential oils through massage, aromatic baths or inhalation. It can have slight, but efficient effects on the mind and body. When properly used, they are very safe, but some oils have safety precautions which people using them should be aware of. Small amounts of oil can build up to a toxic level in the body over time, and some oils are very poisonous and must be avoided under certain conditions such as pregnancy. Working with a qualified practitioner is recommended when it comes to aromatherapy.

Aromatherapy offers multiple natural alternatives to hormone replacement therapy, to stimulate oestrogen production, regulate hormones and manage symptoms such as irregular menstruation, hot flushes and depression.

Healthy lifestyle

Exercise and good nutrition help prevent heart disease and osteoporosis, and the taking of vitamins, minerals and trace elements are even more important at this stage of life. Calcium supplements are advisable to protect a woman against osteoporosis, as they aid in the strengthening of the bones.9

Some suggestions on how to stay healthy and active through menopause are:

* Eat healthy foods. A diet which is low in fat, rich in fruits and vegetables, and provide sufficient calcium and vitamin D. Multivitamins and calcium supplements are helpful.

* Regular exercise. At least 20 minutes of exercise 3 days a week.

* No smoking.

* Limited alcohol consumption.

Prevalence of HRT in first and third world countries

It is to be expected that people living in first world countries have more knowledge about HRT than people living in third world countries. People in first world countries are generally more educated on what Hormone Replacement Therapy is, and are able to afford the treatment. Women in third world countries may have heard about the therapy, however may not have the financial aid to have the treatment, leaving them only the alternate options.

There are at least 20 million women living in developed countries who are estimated to be currently using hormone replacement therapy (HRT).10

Surveys

I decided to survey women within quite an extensive age group, between 40 and 75. As a result I received 10 surveys back from women of which 8 are presently going through and 2 have been through menopause. The information gathered from the surveys reflects on the following results which will later be linked and compared to the researched information.

Analysis & Evaluation of survey results

Symptoms experienced:

Symptom

From the results of symptoms, it is clear to see that mood swings; depression; weight gain; hot flushes and achy sore joints are very common symptoms of menopause as they occurred in more than half of the surveys. Women who are preparing to go through menopause should take note of the symptoms that they are experiencing and consult their doctor.

The data from the table is graphically presented below:

Hormone Replacement Therapy:

All the women who were surveyed were affluent South Africans. Although every woman may not have used HRT, they all knew about it, which proves that HRT is a widely known treatment for coping with menopause symptoms. 29% of the women who I surveyed had used HRT where as the other 71% had not. There were two women going through menopause currently, who were not on HRT for various reasons.

Physiological effects of HRT

Positive effects of HRT on the human physiology

According to the completed surveys, some of the positive effects are:

*

* No night sweats

* Reduced anxiety

* Better sleeping patterns

* Reduced hot flushes

* Decreased fatigue during the day

* Becoming a calmer person, not erratic

* Good skin

* Lighter periods

* Reduced depression

Negative effects of HRT on the human physiology

According to the completed surveys, some of the negative effects are:

* Breast tenderness

* Weight gain

Concerns about HRT:

*

* Said to increase chances of getting cancer. (mainly breast cancer)

* Has to be monitored correctly to decrease the risks.

* Many side effects and long term risks which only present themselves after stopping it.

* Some studies have indicated negative results and effects of HRT

* Increase the risk of heart attacks and strokes.

Alternatives to HRT:

*

* Progesterone cream

* Wild yam tablets

* Evening primrose oil capsules

* Ladyvite mature

Link between research and surveys

According to the research, Menopause is a time in a womans life which is inevitable. Some women battle terribly where as others are able to go through it with few symptoms. There is a vast age gap where menopause may begin, in some women it can be as early as 35, or as late as 60, it all depends on the individual woman.

Hormone Replacement Therapy (HRT) involves putting back those hormones that the females sex organs stop producing during menopause. It uses normal amounts of hormone supplements to return hormone levels to the normal ranges.Many women have heard of what HRT is, but some are uncertain on the details of what HRT entails.

It is important for women to understand fully what their body is going through during menopause, and if they need treatment to help subside the symptoms. Women are advised to explore all their options and only settle on one particular one once they are 100% satisfied with the terms and conditions of the therapy, whether it is HRT or an alternative treatment.

Conclusion

When a woman reaches menopause do you think that she should undergo hormone replacement therapy?

I believe that once a woman reaches menopause, if the need arises for treatment to relieve symptoms, hormone replacement therapy should be advised. However, if she is not suited for HRT a number of alternate options should be offered and tested to find which treatment works with her body, not against it.

There are a lot of options available nowadays for women experiencing menopausal symptoms. Women have the choice of a treatment if needed, however a consultation with their doctor first for the best advice on which treatment will work the best for them is advisable. The treatment must work with their bodies, not against them, and the main purpose of HRT is to restore the levels of hormones in the womans body.

HRT was invented to help women cope better with the symptoms of menopause as well as provide them comfort during with menopause. There are risks and side effects of HRT, however not every woman is susceptible to these. Every treatment, no matter what it is for, has some sort of risk; therefore I believe that women should undergo HRT before they judge the side effects and risks of it.

Menopause is a milestone in a womans life. It marks the end of her child bearing years and the beginning of a new, mature phase. Menopause should be something every woman can cope with without the hassle of night sweats or hot flushes. Hormone replacement therapy is a way in which women can enjoy life without having to stress about the dreadful symptoms of menopause affecting them.

Therefore I believe that women should undergo hormone replacement therapy if they have the option of it, as well as being able to afford it. HRT can help women through the rough times of menopause as well as maintain a healthy mind, body and soul.


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