Hormone Replacement for menopause
Estrogen and progesterone are the two main hormones used for hormone replacement therapy(HRT) in women. These hormones are responsible for the cycling during the menstrual cycle. These two hormones peak at different times during the menstrual cycle. They cause the uterine lining to build up for implanting of a fertilized egg and then to shed causing menstrual bleeding after their levels decrease. This cycling is overseen by two hormones from the brain produced in the pituitary gland called luteinizing hormone(LH) and follicle stimulating hormone(FSH). These hormones have direct effects on the ovaries to produce estrogen and progesterone.
At birth, the ovaries have all the eggs they will ever have. No more are added to the ovaries. In puberty, FSH and LH start cycling and stimulating the ovaries to cycle estrogen and progesterone to start the menstrual cycle. This will continue for most women until around age 50. Then the ovaries stop responding to the FSH and LH stimulation. At this point menstrual bleeding can become irregular. Also, other symptoms can occur. This is the start of menopause.
Signs of Menopause
Not all of these signs may be present in menopause.
The first obvious sign of menopause is a spectrum from irregular menstruation to stopping menstruation. The second sign occurs when the ovaries don't respond to FSH and LH stimulation. This causes the pituitary to make more FSH and LH. Higher FSH levels leads to the symptoms of hot flashes and night sweats. This can be measured in the blood by checking the FSH level. The third symptom is irritability. This occurs for a couple of reasons. First, hot flashes and night sweats are annoying. Second, the brain has receptors to female hormones. Without hormone production, those receptors aren't stimulated and the brain becomes agitated. This is when anxiety and irritability occurs. The final symptom is insomnia. This occurs from the night sweats and hot flashes and the irritability. When insomnia occurs, a lot of women experience fatigue, as well.
What to expect with hormone replacement
The idea of hormone replacement therapy is to replace the estrogen and progesterone that the female ovaries are not making which is causing the above symptoms. We use bioidentical hormones in low doses for safety and efficacy. These are identical to the estrogen and the progesterone that were being produced before menopause. Therefore, no products are given that the body hasn't seen before. Low doses are used for long term safety with respect to breast cancer and cardiovascular disease.
As far as efficacy, the expected results are symptom reduction. Women should see hot flashes and night sweats diminish to completely disappearing. Sleep and insomnia should be much improved. Finally, much of the irritability and anxiety should be resolved.
If the dosing is too high, then breast tenderness will occur. Therefore, the sweat spot of HRT dosing is symptom relief and no breast tenderness.
Hormones are available by prescription and you should consult your physician if you are interested in hormone replacement.
As always, if the situation becomes overwhelming, seek professional help regarding your physical and mental symptoms.
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