What Is Menopause?

Menopause is a normal stage in a woman’s life and is defined as the point in time when you have not had a menstrual period for 12 months. Perimenopause is the time leading up to the permanent cessation of your period. Perimenopause typically goes on for an average of five years in your late 40s or early 50s. During this time your monthly cycle will begin to change, hormone levels become unpredictable and the number of stored eggs decreases. Many women find the physical and emotional changes of perimenopause challenging.


Menopausal symptoms are individual and vary from person to person. Along with changes in bleeding pattern, you may experience some new and perplexing symptoms such as:

  • Vaginal dryness
  • Bladder leakage
  • Hot flashes/night sweats
  • Disruption of sleep patterns
  • Low mood, decreased memory
  • Weight gain
  • Fatigue
  • Aches/joint pain
  • A change in sexual desire


Treatment of menopausal symptoms is tailored to your individual symptoms. It should be noted that no direct correlation has been found between levels of hormone and the need for supplementation.

There is often some degree of trial and error with hormone therapy, and we will go over the potential side effects of various treatments, such as irregular bleeding, rare G.I. upset, or breast tenderness.

There have certainly been some pendulum swings in the use of hormone therapy care. The primary indication for hormone therapy is management of moderate to severe menopausal symptoms, and vaginal therapy is used to treat vaginal symptoms like dryness and painful intercourse.

Commonly prescribed hormone therapies include:

  • Transdermal estrogen along with micronized progesterone
  • Oral estrogen in the form of estradiol plus micronized progesterone
  • A combined pill containing conjugated estrogen

Side effects

Oral estrogens can elevate triglyceride levels and may cause some stomach upset. Transdermal estrogen does not increase triglyceride levels and may help with daily mood swings and headaches. Patients who do shift work may have trouble remembering a pill daily, but may find a transdermal patch that they apply twice per week easier to use.


Contraindications to hormone therapy are unexplained or undiagnosed vaginal bleeding, known or suspected breast cancer, acute liver disease, active thromboembolic disease [for estrogen use], and pregnancy.

Transdermal estrogen does not increase venous thrombotic episode risks as much as oral estrogens. Other cholesterol levels are the same for both estrogen types.

Hormone therapy is not contraindicated in smokers, diabetics, or people with hypertension and migraines.

Hormone therapy should not be started more than five years after menopause due to increased risk of cardiovascular events, and it also should not be prescribed to prevent cardiovascular disease or prevention of dementia. If you have a uterus, you need both estrogen and progesterone supplementation.

Hormone therapy:
Adapted from The North American Menopause Society.
adapted from: Dennerstein et al., 2000; Woods et al., 2005; Asplund et al., 2005.