FAQs

Confused about menopause and estrogen therapy? You are not alone. Here are several answers to common questions to help build your knowledge and improve your ability to make informed choices about estrogen therapy.

Menopause Questions

What are symptoms of menopause?
Physical signs attributable to hormone changes around menopause include hot flashes, night sweats and vaginal dryness. Other common body changes reported by women in midlife include insomnia, cloudy thinking, headaches, heart palpitations, mood swings, irritability, depression and anxiety.

At what age does a woman typically reach menopause?
The average age when women reach menopause is 51.

When is a woman considered to have gone through menopause?
Menopause marks the permanent end of menstruation and fertility. Women reach menopause on average at age 51. Spontaneous or natural menopause is typically confirmed when a woman misses her menstrual period for 12 consecutive months. In addition, there are some medical procedures that result in the immediate onset of menopause.

Can you provide a few valuable tips on how to manage hot flashes associated with menopause?
Lifestyle changes, including a well-balanced diet and regular exercise, can often diminish the mild physical symptoms associated with menopause. Estrogen therapy continues to be the gold standard for the management of moderate-to-severe hot flashes, the most common physical sign of menopause. Women may not be aware that advances in estrogen therapy options exist, including transdermal estrogen therapies (those applied to the skin). While more research is needed, emerging studies seem to be suggesting that transdermal estrogen therapies may have the potential to improve the risk/benefit profile of estrogen with respect to certain proteins that may affect blood clotting or possibly libido (sex hormone-binding globulin [SHBG]).

What are hot flashes and night sweats?
Hot flashes and night sweats begin as a feeling of intense warmth in the upper body. They usually begin in the head and spread down into the neck and chest. The skin becomes flushed and what follows is sweating, and then often a cold, clammy feeling. Some women experience fast heartbeats. Hot flashes and night sweats usually last from 1 to 5 minutes. The drop in estrogen during menopause is thought to affect an area of the brain that controls body temperature.

What is the recommended window for treating symptoms of menopause?
Guidelines from the North American Menopause Society (NAMS) indicate that estrogen therapy should be used at the lowest effective dose for the shortest amount of time, consistent with the treatment goals, benefits and risks for the individual woman. Emerging data reveal that the timing of estrogen therapy initiation in relation to proximity to the onset of menopause may be important. How soon treatment is begun after reaching menopause may have an impact on long-term health outcomes. More research on this topic is needed.

Estrogen Questions

Are there any differences between the available estrogen therapies?
There are several different types of estrogen therapies, including patch, pill, gel, lotion or vaginal rings. While all estrogen therapies have similarities, there are differences in dosage strength, delivery (patch, pill, topical products, or vaginal ring), indication (used for the treatment of menopause symptoms, such as vaginal dryness or hot flashes), and frequency (every day, twice a week, etc). In addition, some therapies include a combination of hormones, while others are estrogen-only.

What are the benefits of administration through the skin (transdermal)?
Whether it’s a gel, patch, or spray, the delivery of drugs through the skin is called transdermal administration.

Transdermal dosing allows estrogen to be absorbed through your skin and enter into the bloodstream directly, without first circulating through the liver, so it can be administered at lower doses than hormone pills. When taking pills, higher doses are often needed because some of the estrogen is broken down by your liver before it can affect your symptoms.

Another advantage is that a transdermal therapy provides continuous concentrations of estrogen throughout the day. This avoids the fluctuating estrogen levels that often occur after taking pills. Some women may find that it is easier to apply something to the skin than to take a pill.

I have heard there are risks with estrogen therapy—is that true?
There are both benefits and risks to using estrogen therapy, and these benefits and risks will be different for each woman. All estrogen hormone therapies, regardless of form, administration type and dosage, carry FDA warnings about potential but serious risks for some women:

• Increased risk of cancer of the uterus
• Increased risk of heart attacks, strokes, breast cancer, and blood clots
• Increased risk of dementia

These warnings are not meant to scare you, they are meant to underscore the importance of weighing the benefits and risks of estrogen therapy, while considering your individual needs, treatment goals, and personal and family medical history. Together with your healthcare professional, you can decide if estrogen therapy is right for you.

In addition, women who may be pregnant or who have unusual vaginal or uterine bleeding (that is, abnormal or cannot be explained), who have or have had certain cancers (including cancer of the breast or the uterus), who have had a stroke or heart attack within the last year, who have had blood clots, or who have had liver problems should not take estrogens.

Bottom line: talk to your healthcare professional about your treatment goals, personal and family medical history, and the potential risks of any and all medications you are currently taking or thinking about taking.^xv

What are the most common side effects associated with estrogen therapy?
The most common side effects for estrogen products are uterine bleeding (starting or returning), breast tenderness or pain (increased density and sometimes enlargement), nausea, abdominal bloating, fluid retention in extremities, changes in the shape of the cornea of the eye (sometimes leading to contact lens intolerance), headache (sometimes migraine), dizziness and hair loss. While these are the most commonly reported side effects, not everyone experiences these and some of these may be dose-related and may improve or go away if you switch to a lower dose.

Are there newer FDA-approved estrogen therapy options available that are bioidentical?
Yes, there are newer bioidentical estrogen therapy treatment options that are FDA-approved to relieve moderate-to-severe hot flashes, including night sweats associated with menopause. Many of these treatments are available in low-dose formulations and can be tailored to your individual needs.

Does estrogen therapy prevent osteoporosis?
The primary use of estrogen therapy is to treat menopause symptoms such as hot flashes. But, some estrogen therapies have been shown to increase bone mass. Some estrogen therapies may be used for the prevention of bone loss in women at significant risk of osteoporosis after non-estrogen medications have been considered.

There are a number of options available for the prevention of bone loss, so talk to your healthcare providers about which one is best for your individual needs.

Are there other natural treatment alternatives to estrogen therapy?
There are many products available that claim to relieve your symptoms naturally and safely. Some of the more commonly used herbal supplements include soy and isoflavones (other forms of plants that contain weak estrogens). They may be effective in reducing mild hot flashes to some degree. If you do get relief, however, many experts believe it may be due in part to a placebo effect.

It’s important to recognize that in the United States, supplements are not held to the same FDA regulations and standards that are applied to prescription medications. As a result, not all scientific evidence to support many of the claims made by these natural, herbal supplements is reviewed by the FDA.

You need to be aware that these supplements may cause side effects, and they may also negatively interact with other medications you may be taking. Unlike prescription medications that carry an FDA-mandated prescribing information detailing this safety information, herbal supplements do not. Before you do decide to use herbal supplements, please speak with your healthcare professional.

What are bioidentical estrogens?
Bioidentical is a marketing, yet medically acceptable, term used to describe estrogens that have been manufactured in the lab to have the same chemical structure as the hormones made naturally by your own body, specifically by your ovaries, before menopause. Bioidentical estrogens, such as estradiol, are derived from plants.

Although some oral tablet formulations contain bioidentical estradiol, all transdermal preparations contain bioidentical estradiol. Transdermal bioidentical estrogen therapies that are FDA-approved are available in a wide variety of dosages and forms, including gel, patch, spray and lotion.

Every woman is unique, so there is no one answer for which kind of treatment is right for you.

Questions to ask your healthcare professional about estrogen therapy:

• What treatment options are available to treat my symptoms?
• If I choose estrogen therapy, what are the risks?
• What side effects might I experience?
• How long will I have to use estrogen therapy?
• What lifestyle changes can I make to reduce my symptoms?
• What is transdermal estrogen?
• What is bioidentical estrogen?
• What are the differences in bioidentical estrogen?
• Are all bioidentical estrogen therapies FDA approved?