Part 2: Hormone Replacemnet Therapy Is a Personal Choice

Appointments with Dr. N can be made by calling (248) 644-7200 and speaking to Caroline

Whether you choose to use hormone replacement therapy must always be your personal choice.  Your physician should never be able to tell that you can or that that you can't.

The key to making the appropriate decision is based on both the knowledge of what menopause represents in terms of its potential impact on health, quality of life and sexuality and an understanding how hormone replacement options differ in their potential benefits and risks.

Without this knowledge, a woman cannot effectively participate in her own healthcare decisions. In essence, she becomes the passive recipient of her doctor’s store of knowledge and individual bias.

Acquiring the necessary information may be difficult for most women as the physician is the source she usually turns to for information. Doctors may have only scant knowledge of the menopausal process, its global nature, or the extent of its potential impact on health and quality of life. In addition, most physicians are not aware of what constitutes an optimum hormone replacement regimen.

Menopause 101

A “natural menopause” is characterized by cessation of the monthly menstrual cycle and occurs because of an expected age-related failure of the ovaries to continue to produce estradiol, the biologically-active form of estrogen. Most often, this will occur between the ages of 48-52. It is the rise in the estradiol level at puberty that is responsible for the physical and mental metamorphosis from a young girl to an adult female. This includes all the changes that that we characterize as “secondary sexual characteristics.”

An early or “premature menopause” is one that occurs prior to age 40 and can be the result of genetic factors or autoimmune processes. An “induced menopause” can be due to surgical removal of the ovaries with or without a hysterectomy, by chemotherapy or radiation.

After menopause, estradiol concentrations in the blood fall to their prepubertal level. The aging process is accelerated as the hormonally-dependent tissues that have relied on estradiol for their support begin to regress and their ability to function optimally is compromised. Virtually every organ system is affected including the vagina, bladder, brain, skin, skeleton and cardiovascular.

Hormone Deficient

Many women think in terms of “going through menopause.” What they usually mean is that they have stopped having symptoms such as hot flashes, sweats and insomnia. However, unless a menopausal woman chooses to use hormone replacement she will spend the remainder of her life in a hormone-deficient state. The central issue for most menopausal women is whether to use hormone replacement.

Menopause - assuming it is a “natural menopause” - is normal. There is no “right choice” for everyone. Whether a woman chooses to live in a hormone-deficient state or use hormone replacement is a personal decision. In most cases, menopausal symptoms such as hot flashes, sweats and insomnia will disappear within 2 years. However, long-term consequences of estrogen deficiency cannot be predicted on an individual basis, but many women on the surface do not seem to be affected.

If a woman has experienced a premature or induced menopause the effects are magnified. Those who have had their ovaries removed are at greatest risk of osteoporosis, cardiovascular disease and atrophic changes of the vagina, urinary system and skin especially when this occurs prior to an expected natural menopause.

Women who choose to use hormone replacement have a better quality of life according to a recent pole conducted by The Gallup Organization. This is not meant to imply that postmenopausal women who are not on hormone replacement are incapable of a fulfilling life and sexual experience. They are capable of both. We have all heard about “Aunt Sadie” who never touched a hormone, or any other medication for that matter, yet lived to age 94, remained “sharp as a tack,” had a sexually satisfied boyfriend thirty years younger, drove a car every day and mowed her own lawn. However, the point is that it is unlikely that anyone, regardless of gender, can function optimally in a hormonally deficient state.

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.