Dr. Goodman Answers a Common Question Regarding Menopausal Symptoms
Through his practice, Dr. Goodman receives many questions from patients regarding menopause and bioidentical hormone replacement therapy. Below is a recent question from a patient and what follows is Dr. Goodman’s response:
I am wondering since I have not had a period in 5yrs why now am I experiencing hot flashes dryness and feeling irritable?
Pertinent question, Linda, and a situation that is not all that rare.
“Menopause” is the final menstrual period. More importantly, it is the cessation of ovulation, where you mature and ovulate an egg. An ovulating woman’s ovaries secrete estrogen in the form of estradiol (from the egg follicle), estrone (from the ovarian tissue) and progesterone (only if the follicle ovulates) and, if you don’t get pregnant, you have your period two weeks after you ovulate. Of course, you never know if any given menses is your last, so the “official” definition of menopause is no menses in a year.
By this definition, it certainly sounds like you’re in menopause. Women’s reactions to the internal ups and downs of estrogen levels accompanying the peri menopause and menopause vary according to many factors, including the degree of ups and downs in a given woman, her “sensitivity” to these changes, her mental state (anxiety and stress always make these symptoms significantly worse), her weight, and other factors. Women who are significantly overweight, as a group, seem to suffer fewer symptoms, as fat cells secrete estrogen-like substances, making symptoms milder (and risk of breast cancer slightly greater).
Some women’s estrogen levels experience wild variations and/or plummet, producing bothersome symptoms. Some women’s levels very gently diminish over time, meaning it may be years after their final period that their individual estrogen levels reach a critical level for them—a “tipping point,” if you will, where they become symptomatic. Also, the post-menopausal ovary (no more ovulation) secretes a variable amount of the estrogen hormone “estrone.” The more estrone you have, the less your symptoms. With more estrone comes a slightly increased risk of breast cancer, since estrone is stronger than estradiol and stronger than most low-dose hormone replacement products.
Simply put, you have been “let down gently” and now you’ve reached your own personal “tipping point.” Alternatives at this time include no therapy, herbs and botanicals, or low-dose transdermal (through the skin via patches, gels or creams) estradiol therapy. Low-dose transdermal is the safest way to take post-menopausal hormone replacement. If started within five years of menopause, the hormone replacement therapy can reduce your risk of cardiovascular death and cognitive decline by 30%, and definitively protect your bones from osteoporosis.
Ask your gynecological menopause specialist which path is best for you. Specialists can be found on the North American Menopause Society website: www.menopause.org. Good luck, and good health!
Learn more about menopausal symptoms, menopausal medicine and bio identical hormone replacement therapy at https://www.drmichaelgoodman.com/.