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Update on Timing of Hormone Replacement Therapy in Menopause

Update on Timing of Hormone Replacement Therapy in Menopause

In 1964, Dr. Robert Wilson, a gynecologist in New York City, advocated in his book Feminine Forever that all menopausal women should receive hormone replacement therapy (HRT).  The outrage of the feminist movement led the National Institutes of Health (NIH) to fund the Women’s Health Initiative (WHI) in 1991 to determine if HRT could safely protect women’s cardiovascular and bone health.  In July 2002, the trial was prematurely canceled due to findings of a statistical increase in both breast cancer and stroke.  Based on these findings and the resultant publicity, millions of women stopped their HRT, and doctors stopped prescribing HRT.  As a result of this precipitous change, the majority of menopausal women have gone without HRT for more than a decade.

Doctor, Why Does It Hurt Down There?

Doctor, Why Does It Hurt Down There?

Over 60% of women in menopause complain, often silently, of vaginal dryness and pain during intercourse. As a consequence, they may seek to avoid that level of intimacy, a behavior that can impact negatively on their relationships and, for some, may lead to loneliness and depression. Why?

Understanding Menopause

Understanding Menopause

Recent advances in the biology of menopause have helped clarify the importance of female hormones in women’s overall health. Improved patient education that allows women to engage in formal conversations with their care providers helps clinicians to individualize menopause management for their patients. In essence, while menopause is a complex process, it can be understood at a basic level by viewing it simply as a process of hormone withdrawal.  And the hormone of most importance is estradiol, cyclically produced in large amounts by the ovaries during the reproduction years, reflecting the high numbers of eggs that rapidly decrease in number as one approaches menopause. 

Hair Today, Gone Tomorrow. What's Testosterone Got To Do With It?

Hair Today, Gone Tomorrow. What's Testosterone Got To Do With It?

For women in menopause, hair loss threatens one’s self-image and social confidence. Termed androgenic alopecia (AGA), or “female pattern hair loss,” it is misinterpreted as “going bald.” Even if a woman is reassured that this is not the case, or that it affects men as well, the phenomenon evokes fear and even depression.

Progress In Safety Of Hormone Delivery

Progress In Safety Of Hormone Delivery

Women depend on their reproductive hormones in many ways. During the reproductive years, estradiol, the most powerful of the estrogen family, is produced largely by the ovaries. While it is important for menstrual cycles and pregnancy, we now know that estradiol plays a key role in keeping your body in an uninflamed state. Estradiol accomplishes this by depressing the ability of your fat cells and immune cells to produce a number of inflammatory proteins that are linked to many of the menopausal symptoms women describe. Even in the several years leading up to that one year without a menstrual period (a window of time called the Menopause Transition), fluctuations in ovarian production of estradiol cause the release of these inflammatory proteins. These fluctuations explain why mood swings, hot flashes, skin changes, and loss of libido may be encountered, even as the menstrual periods still are occurring.