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Menopause is a time in a woman's life when her period stop and she can no longer have children. It's a natural event in a woman's life.4 During menopause, women experience variety of signs and symptoms.2 Hormone replacement therapy is a treatment used to relieve some of these symptoms of menopause by replacing or providing the body with necessary hormones that ovaries have stopped making. It's beneficial to many women and improves the quality of life but it has negative effects that can be harmful to the body. HRT is associated with a number of risk and side effects but it's hard to determine to which extend HRT is associated with theses effects because there hasn't been enough long time clinical trials.  Many women are prescribed or choose to use HRT because they cannot bear the menopausal symptoms that they are going through. The purpose of the research is to find out if the side effects of hormone replacement therapy outweigh the benefits or whether it's worth ignoring the negative effects. Another aim of the project is to find out whether the women who use HRT are aware of the side-effects.
Menopause is a natural event in women's lives when the reproductive change takes place in women.1 [iii] The end of their fertility is indicated by the permanent stopping of their period.1 2 The ovaries (reproductive organs) stops functioning and the transition begin with varying length of menstrual cycle and finish with a final period. Menopause can be diagnose by observing the absent of period for 12 months.1 
Menopause is experienced by each women is differently.  The extent and the severity of the symptoms differ from women to women. Some women experience several physical and psychological symptoms while others suffer from few or none.1Symptoms of menopause are
Hot flashes and night sweat2 5 6
Vaginal dryness/itching2 5 6
Irritation or pain during intercourse1 [iv] 6
Irregular vaginal bleeding1 5 6
Urinary symptoms1 5 6
Dry skin and skin changes( winkles/ adult acne)1 6
Hair thinning or hair loss2 6
Weight gain1 5 6
Joint and muscle pain1 6
Increased risk of osteoporosis1 6
Depression1 5 6
Breast tenderness1 6
Mood swing2 5 6
Fatigue and tiredness1 5 6
Anxiety/ panic attacks1 6
Insomnia/ sleep disturbance2 6
Problems with concentration or memory2 6
Irregular period cycles2 6
Low libido3 6
Hot flashes and night sweat: This is a common symptom experienced by most women.  A hot flash is a warm feeling which spreads over the body and most prominent in the head and chest.1 Hot flushes are caused by a combination of hormonal and biochemical fluctuations that occur due to decreasing level of estrogens.1 Sometimes hot flashes are followed by night sweats which can cause insomnia and waking up at night.1
Vaginal symptoms: They occur due to the decrease in thinness, dryness and elasticity of the lining tissue of vagina as estrogen levels fall.1 Symptoms are vaginal dryness, itching or irritation or pain during intercourse.1
Urinary symptoms: The need to urinate more frequently or leakage of urine is due to the decline in the thickness, moisture and elasticity of urethra.1
Emotional symptoms: Women suffer from mood swings, memory problems and irritability due to the hormonal change in the body. 1They may also suffer fatigue and tiredness.1
Physical symptoms: Most of the women experience weight gain during menopause because metabolism slows down with age [v] and fat will be stored more in the waist and abdominal area than other body parts.1They may also have changes in their skin such as wrinkles and adult acne.1 Hair growth on the chin, upper lip, chest, or abdomen may also occur.1 Postmenopausal osteoporosis is a progressive loss of bone mass due to estrogen deficiency.1 2 It result in inefficient support and increase the risk of fracture.
Age of menopause
The average age that women reach menopause is 51 years old.1  most women reach menopause between the ages of 45 and 55 but menopause may occur when the women are in their 30s or it may not occur until a woman is in her 60s.1 Timing of menopause is determined by a mixture of genetics and lifestyle. 
Factors that influence the timing of menopause
Some medication and surgical conditions can affect the age a women reaches menopause. Removal of ovaries by surgical means causes immediate menopause. This is also known as induced menopause. After the surgery, the woman will experience the symptoms of menopause but she will not go through pre-menopause. Removal of ovaries along with the removal of uterus (hysterectomy) will cause immediate menopause while removal of uterus alone will only stop the menstruation. The ovaries will still produce the hormones and the woman will experience symptoms of menopause at a normal age.1
Cancer and the treatment of cancer can also affect the timing of menopause. Depending on the type and location of cancer, chemotherapy and radiation therapy can cause menopause if an ovulation woman is treated with these treatment. Then, the symptoms of menopause may start during the treatments or the months following the treatments.  Other factors that influence the timing of menopause are smoking, drugs or traumatic experiences. 
Certain disease or genetic factors can cause premature ovarian failure where a woman reaches menopause before the age of 40.  6
Treatments for menopause
Hormone replacement therapy (HRT)
What is HRT?
Hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT) is the medication used relieves the symptoms of menopause caused due to the decline in estrogen levels. The treatment replaces or provides the hormones that the ovaries have stopped making. An individual assessment is necessary before using hormone replacement therapy. The symptoms that are experienced by an individual determine whether she should get a long-term treatment or a short-course. Once the HRT is prescribed, the patient should be monitored from 4 to 6 weeks to evaluate any side effects and complications. They patient should also have at least yearly mammograms 
There are three types of HRT: 
Pharmaceutical synthetic or artificial HRT drugs such as Premarin.
Herbal or plant base alternative such as soy estrogens.
Bio-identical/ natural hormones which includes estrogens, testosterones and progesterone
Forms of HRT
Hormone therapy is available in 
Patch and spray
Vaginal ring insert or gel  2
Cream or gel form
How is HRT taken?
Cyclical or cyclical combined HRT is where estrogen is taken every day but progesterone is taken for only a few days of each month. It's also known as sequential HRT. 
Continuous or continuous combined HRT is where both the estrogen and the progesterone are taken every day. 
The dosages of the HRT treatments are prescribe depending on a woman's individual needs. The length of the treatment is determined by the patient's response and the reason for taken HRT.
What hormones are used in HRT?
HRT consists of estrogens which includes estriol, estradiol, estrone sulphateor and tibolone. HRT can be a combination of estrogens and progesterone.  Progesterone includes noresthisterone acetate, medroxyprogesterone acetate and levonorgestrel acetate.
Where do these hormones come from?
The most popular synthetic estrogen Premarin comes from pregnant horses.  10 The method of extraction of estrogen causes the horses a great deal of suffering. They are left in the dark stalls where they cannot lie down or even turn around due to the rubber bags fitted to them. They are also re-impregnated again and again just to just the estrogen rich urine.  1
Bio-identical hormones are chemically created in laboratory. Herbal and plant based HRT comes from plants and it can be included in the women's' diet through certain foods such as chickpeas, pumpkin and soybeans. 
Positive effects of HRT
If it's used correctly, HRT can be very helpful in relieving the symptoms of menopause. HRT is usually used to treat hot flashes and night sweat, vaginal symptoms, pain during sex, mood swing and mild depression problems. Short term HRT is prescribed to treat hot flashes and night sweat.  Bone loss can begin four years before the menopause and women who are going through menopause has 10% lower bone mass than women who are not going through menopause. HRT decrease the risk of postmenopausal osteoporosis or cardiovascular diseases.  813 HRT is also delay and reduce the risk of Alzheimer disease. 
Risk and side effects of HRT
The treatment of HRT can be harmful to the body, especially if the treatment is used for a long time.  Studies have shown that women who take daily tablet of synthetic estrogen and progesterone have 29 per cent higher rate of heart attack, 26 percent higher rate of breast cancer and a 41 per cent higher rate of stroke than women who doesn't take HRT.  813 Studies have shown that medroxyprogesterone acetate when taken every day along with synthetic estrogen causes breast cancer.  HRT can also increase the chances of  8
gall bladder diseases
It can also cause 
Using lower dosages of HRT treatment can reduce the side effects. 
Who should not take HRT?
Women who have:  8
Family history of Cancer
Problem with vaginal bleeding
History of heart attacks or strokes
Think they are pregnant
Use of HRT in developing countries and developed countries
There're at least 20 millions women using HRT in the developing countries.  4 One third of post-menopause American women use HRT.  5 Studies have shown that the usages of HRT in developing countries are not as common as it is in developed countries but the numbers are increasing due to the advertising of HRT in the media. However, women in the developing countries don't have enough knowledge about menopause and might not be aware of the side effects of HRT.  16 It's shown that most of the women with higher education and better socio-economic status in urban population use HRT.  This is because they are well informed and are able to afford the treatment unlike the women from developing countries.
Alternative treatments for menopause
During menopause, healthy diet and lifestyle is very important. Menopausal women shouldn't drink too much or smoke. They should have a well- balanced diet that includes lots of fruits and vegetable (especially soy as it contains estrogens) and essential fats. Exercise is also important to prevent heart diseases which accompany menopause and to relax the mind.  8
Sometimes anti- depressant are prescribes to menopausal women to control the hot flashes.  8
Women can take supplements to ease the symptoms of menopause. They can take vitamin C and E to reduce hot flashes and vaginal dryness and vitamin B and magnesium to help with the mood swings and irritability. They can also use herbs to help them with the symptoms of menopause. agnus castus and black cohosh can be used for hot flushes and vaginal dryness.  7