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What is menopause?

Menopause marks the end of a woman’s reproductive years as the ovaries stop making estrogen and menstrual periods cease.  The average age of menopause for women in the United States is 51 years. Most women experience a transitional phase in the years leading up to menopause called perimenopause.  As a women’s body enters menopause, estrogen levels fall and some women may experience uncomfortable symptoms that may benefit from medication such as hormone replacement therapy (HRT).  Hormone replacement therapy is certainly not for everyone but may be helpful for some women having severe menopausal symptoms.

When to treat:

Although treatments are effective, it is recommended to reserve treatment for severe cases–when symptoms are interfering with daily life/activities and when benefits of treatment outweigh possible risks. If you are wondering if HRT therapy is right for you, talk to your provider.  He or she will review these risks and benefits with you as there are many factors which play a role in to HRT treatment and decision making.

Treatment options:

There are two main types of HRT—estrogen alone therapy, and combination estrogen-progestogen therapy.  These HRT options can be administered as oral pills, topical skin applications, or vaginal creams and inserts.  For women need pills and who have never had a hysterectomy, the combination estrogen-progestogen therapy is required to protect the uterine lining from developing cancer.

Oral pills and skin applications are designed to treat the whole body, primarily the hot-flash symptoms and bone decay. Vaginal therapies target local symptoms such as vaginal dryness.

Overall, HRT should be reserved for short-term treatment severe perimenopausal symptoms, and at the lowest dose for adequate relief of symptoms.

Realizing that almost all women experience a natural gradual tapering off of menopausal symptoms, your provider will try tapering your medication gradually as well. Eventually, you should be able to do well without hormone therapy.

Risks and benefits:

The benefits to HRT include improvement in hot flashes, sleep, vaginal dryness, and pain with intercourse. In addition to relief of menopausal symptoms, estrogen can be very effective for bone density preservation.  Like any medication, HRT also comes with some risks, including major vessel blood clots and breast cancer.  Your provider will discuss the risks and benefits of treatment options.

Prevention and alternative treatment:

There are alternatives to hormone management of menopausal symptoms.  Exercise, healthy lifestyle, and proper sleep also help symptoms. Calcium supplementation and exercise can help with bone health issues related to menopause.   Arbor ObGyn does not prescribe compounded or bioidentical hormone replacement medications.

Please call to schedule a consultation to help decipher the best treatment for you.


The North American Menopaus Society (NAMS).  Be sure to visit the MenoNotes page:

The American College of Obstetricians and Gynecologists, Menopause fact sheet :

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