Menopause – the permanent cessation of menstruation that occurs after the loss of ovarian activity – is a natural event that normally occurs in women between the ages of 45 and 55.
Dr. Donna Bennett, assistant professor of obstetrics and gynecology at the University of South Alabama College of Medicine and an obstetrician and gynecologist with USA Physicians Group, said menopause is not an event. Instead, it is a reproductive transition.
“In menopause, your ovaries stop making as much estrogen and progesterone in normal amounts,” she said. “A diagnosis of menopause can be made one year after your last period.”
The physical and emotional symptoms of menopause may disrupt your sleep, cause hot flashes, lower your energy or — for some women — trigger anxiety or feelings of sadness and loss. “But, you don’t necessarily have to suffer from it,” she said.
According to Dr. Bennett, the available treatments for menopause are “phenomenal.” They primarily focus on relieving your signs and symptoms.
Hormone therapy was once thought to have the long-term benefits of preventing heart disease. Use of hormone therapy changed when a large clinical trial found that the treatment could pose more health risks than benefits. As a result, hormone therapy is no longer recommended for disease prevention.
However, Dr. Bennett said hormone therapy, with estrogen alone or in combination with progestin, is the most effective therapy for relieving symptoms related to menopause in certain women. Hormone therapy treatment can be in the form of pills, patches, rings, shots, or pellets.
Oral preparations (pills) are easy to take and cheap. However, you have to remember to take it every day. To get the symptoms relief that you need, high doses are required. In addition, anything you take by mouth has to pass through the liver, where it is broken down. When the liver metabolizes estrogen, it can increase your risk of clotting.
Using a patch, gel, or cream is considered a transdermal form of estrogen, meaning “through the skin.” Transdermal is safer than pills because it avoids first pass liver metabolism. In addition, it is a low dose of pure estradiol. However, it is more expensive, not well tolerated in warm climates, and has variable absorption.
Other options of hormone therapy include the shot (an injection you get once a month) and the ring (a plastic circle that is inserted into the vagina).
Dr. Bennett considers hormone pellets the preferred treatment for selected patients when it comes to hormone therapy options. The pellets – made up of either estrogen or testosterone – deliver consistent, healthy levels of hormones for four to six months, depending on the dosage. They avoid the fluctuations of hormone levels seen with other methods of delivery. The pellet, which is a little larger than a grain of rice, is inserted underneath the skin, where it is absorbed over time. According to Dr. Bennett, it is a quick, painless procedure done under local anesthesia.
After the pellets are inserted, patients may notice that they have more energy, sleep better and feel happier. Muscle mass and bone density will increase while fatty tissue decreases. Patients may notice increased strength, coordination and physical performance. Concentration and memory may improve as will overall physical and sexual health.
“Hormone pellet therapy is the most amazing thing I have seen in my 18 years in this field,” Dr. Bennett said. “Pellets can increase your sense of well-being, and you really do feel like you can do almost anything.”
Menopause treatment options, including hormone pellets, are available at the USA Center for Women’s Health. To make an appointment with Dr. Bennett, call (251) 415-1496.
Dr. Bennett gave an overview of hormone replacement therapy at the March Med School Cafe lecture. To view the lecture in its entirety, click here.