âœI thought one of the benefits of menopause was having no more periods!â This appears to be the number-one complaint about HRT from women who have not had hysterectomies. Yes, HRT the cycling of estrogen with progestin, just as your body did before menopause will probably bring back your periods. It also may help protect you against endometrial cancer. How much and when you bleed on HRT is a subject that you and your doctor must discuss. On average, your postmenopausal periods start the day following your last progestin tablet. If bleeding occurs at any other time, it is important that you contact your physician. No, periods are not forever even if it seems that way. They usually dwindle to nothing after a few years of HRT.
My PERIODS ARE LESS AND LESS PREDICTABLE. Can I START TO TAKE HRT CLOSE TO THE END OF MY PREMENOPAUSE AND AVOID THE ONSET OF SYMPTOMS ALTOGETHER?
Not usually. Your ovaries are still producing estrogen even though your periods may be episodic. Therapy might give you way too much estrogen, causing buildup of the lining of the uterus and possibly creating a precancerous condition. The premenopause can last from one year to even five years or longer. It isn’t considered to be over until you have gone a full year without a period. Most physicians say that you should not start on therapy until twelve months without a period have passed. However, I suggest you discuss this point with your own physician. Your medical history may enable you to use it sooner.
Life-style changes, with or without hormone replacement therapy, are often required in order to enhance the quality, not to mention the longevity, of our lives. We might consider paralleling our personal view with that stated in the International Plan of Action on Aging formulated at the United Nations meeting in Vienna: Diseases do not need to be essential components of aging.
According to the questionnaires that women voluntarily fill out and leave with us after the programs, an average of 70.2 percent wanted to know more about ERT. Women indicated that they wanted more knowledge about the psychological effects of menopause as well as the physical effects of menopause (64.2 percent and 62.4 percent, respectively). They sought more information concerning weight gain and anxiety/irritability (59.5 percent and 58.3 percent). They felt they needed to know more about insomnia (50.4 percent), mood swings/ depression (46 percent), vaginal dryness (45.2 percent), night sweats (42.8 percent), hot flashes (40.2 percent), and, last of those questions asked, sexual difficulties (38.9 percent). The percentages represent averages of the ten cities studied and yet also represent the information gleaned from women in any given city, showing little geographical differences in the order of the symptoms that women felt they needed to know more about.
What is not asked in the questionnaire, but is determined from the index card questions that the audience members pass forward for the panelists to answer, are specific questions about individual contraindications, or reasons against using ERT. Many of those questions are from women who want to know whether they can take estrogen if they have had breast or other kinds of cancer, or if there is a history of cancer in their families. Questions concerning cancer and ERT will be addressed in Chapter 7.
There are a number of other physical conditions that are of concern to women who are considering ERT. A delicately boned, smartly dressed woman approached the podium in Seattle and spoke to the physician panelist who had discussed ERT in his presentation. She said that she had a history of blood clots in her legs, but that her menopausal symptoms had gotten so bad that her physician had agreed to short-term ERT. Even this shortterm dosage was quickly stopped, however, when another blood clot developed. She wanted to know whether she could chance ERT again, because her menopausal symptoms were making her miserable. The doctor reminded her of the chart he had shown during his talk that indicated that ERT was not generally recommended for women with circulatory or vascular problems, but that some form of ERT might be able to be considered, depending on the patient’s medical history and problem. Then he explained to her that only she and her physician could work out the solution to her individual problem.
Many such personal questions are asked at the programs. Women need to take questions about estrogen replacement therapy and their personal or family history of phlebitis, varicose veins, stroke, uterine fibroids, fibrocystic breast disease, gallbladder disease, liver disease, and endometriosis to their own doctors, who are familiar with their unique medical histories and who can make decisions with the patient based on these pertinent facts. What I can do in this chapter is offer the current scientific thinking in regard to these questions. Remember, however: You are an individual with an individual problem. Only your own doctor can answer your particular questions.