Menopause: Estrogen Therapy, Before Menopause

by Food and Drug Administration (FDA)

(Page 2 of 2)

Estrogen can produce uncomfortable side effects such as nausea and vomiting. It can enlarge breasts and make them tender. Women who use it can also retain excess fluid, which can aggravate conditions like asthma, epilepsy, migraines, and heart and kidney disease. A spotty darkening of the skin, particularly on the face, can occur.

For women who take progestin along with estrogen, menstrual-like bleeding and premenstrual symptoms often occur. Also under study is whether adding progestin counters the potential heart-protective effects of estrogen.

It is not known whether estrogen use increases the risk of breast cancer, or what effect adding progestin would have on this risk. In recent years, many studies on breast cancer and estrogen use have been conducted, with conflicting results, says Smith. Following the publication in June 1995 of opposing views in two of the nation's most prestigious medical journals, the New England Journal of Medicine and the Journal of the American Medical Association, NIH scientists advised women to consult their "medical caregiver for advice that is based on the individual's own personal health profile." Physicians urge women who receive estrogen therapy to have regular breast examinations by a health professional, perform monthly self-exams, and have yearly mammograms starting at intervals recommended by their doctors.

Before Menopause

The medical term for the usually gradual period of change leading into natural menopause is "perimenopause." The two to three years following the last period are called the "climacteric." According to the American College of Obstetricians and Gynecologists, the average age of menopause in the United States is around age 51. But some women go through natural menopause as early as age 35, while others don't experience it until their late 50s. Menopause occurs at any age with surgical removal of the ovaries.

During perimenopause, estrogen production is low and the ovaries stop producing eggs. As estrogen levels decline, certain signs may appear. The most common sign, the one that doctors sometimes call the "hallmark" of menopause, is the hot flash. A hot flash is a sudden rush of heat to the neck, face, and possibly other parts of the body that may last from 30 seconds to five minutes. Some women go from feeling hot to feeling cold. The hot flash may begin with a sudden tingling in the fingers, toes, cheeks, or ears.

Some people used to think the hot flash didn't exist, that it was "all in a woman's head," says Smith.

Ironically, it is in a woman's head — but it has a very real physical cause. The hot flash is an alteration in thermal stability, which is maintained by the hypothalamus, a brain region located above the pituitary gland on the brain's floor. The hypothalamus operates the body's temperature regulation system. Estrogen levels manipulate some functions of the hypothalamus. During menopause, as the ovaries produce less estrogen, the hypothalamus senses and responds to the lower estrogen levels by rapidly changing body temperature. The result may be a hot flash.

Perspiration, sometimes extreme sweating, can accompany hot flashes. Many of them typically occur in the middle of the night, which causes some women to have trouble falling back to sleep. How many women are affected by hot flashes has not been clearly determined, and the reported numbers depend in part on whether healthy populations or women in medical settings are surveyed. Some scientists say as few as 30 percent of women are afflicted by them; others believe the figure is much higher.

According to Morris Notelovitz, M.D., Ph.D., and colleagues in the text Menopause in Midlife Health, 85 percent of perimenopausal women experience hot flashes. Fifty-four percent of the women experience them in their climacteric years; 25 percent of these women experience hot flashes up to 10 years after the climacteric. About 10 percent of the women who continue to have hot flashes still have them for 10 years after the climacteric, according to Notelovitz.

Obese women are less likely to have hot flashes because they have more estrogen, which is converted from adrenal hormones by stored fat. Many women cope with hot flashes by trying to relax until the discomfort passes and by lowering the room temperature, dressing in light layers of clothing, avoiding spicy food, and cutting back on caffeine and alcohol.

Vaginal dryness is another symptom of estrogen decrease and may lead to painful intercourse, vaginal infections, and urinary problems. Over-the-counter vaginal lubricants (Replens and others) may help. Prescription estrogen replacement creams are approved by FDA to relieve these symptoms.

Other symptoms attributed to menopause include difficulty concentrating, depression, headache, memory loss, a feeling of insects crawling across the skin, and lower backaches, which may be related to osteoporosis.

Barbara Sherwin, Ph.D., at the University of Toronto, and colleagues have been researching an association between menopause and memory loss, even Alzheimer's disease, and whether estrogen can halt these problems. Sally Shumaker, Ph.D., of the Bowman-Gray School of Medicine, North Carolina, is leading a $16 million study, the Women's Health Initiative Memory Study, to determine whether estrogen treatment affects a woman's risk of developing dementia after age 65. Wyeth-Ayerst Laboratories is funding the study.

Probably the disease with the strongest link to menopause is osteoporosis. Scientists believe women can help control bone loss with weight-bearing exercises, including walking, running or weightlifting. A low-fat diet, rich in calcium and vitamin D, is also believed to be important, as are cutting back on alcohol and stopping smoking. FDA has approved a nonhormonal drug to treat osteoporosis. (See "Boning Up on Osteoporosis" in the September 1996 FDA Consumer.)

Despite its sometimes annoying, peripheral problems, more than ever before menopause is now seen as a natural process, not a disease. "There's nothing embarrassing about it," says Schiff. "It's healthy. It's physiologic."

It is such new thinking that best explains why at cocktail parties and other places baby boomers congregate that menopause is a hot conversation topic.

About the Author

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