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Symptoms of Perimenopause & Menopause

Perimenopause may begin in the forties or even in the mid thirties in some women. Hormones fluctuate wildly, periods can be irregular, extra long, light or extra heavy. The average duration of perimenopause is about 4 years but can be as long as ten. This time can be extremely debilitating mentally, emotionally and physically. You may even feel like you are falling apart, your life is falling apart and your relationships are strained. Many women require medical leave from work to manage complex symptoms. This does improve on hormone therapy and support services and becomes less fluctuating once menopause begins. Hormone Therapy is a very appropriate treatment for these symptoms and you do not have to wait until your periods stop to begin.

Menopause begins technically when you have not had a period for 12 months. Prior to this you may experience menorrhagia - extremely heavy periods where you might not be able to leave the house or go to work. The average age of menopause is 51, but it may be as late as 55.

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There are over 20 signs and symptoms of perimenopause and menopause in the literature that correspond directly with loss of estrogen:

  • hot flashes

  • night sweats

  • menstrual irregularities

  • full body pain/achy joints

  • increase in frequency and severity of headaches/migraines

  • low libido (sex drive) / difficulty to reach orgasm, painful sex

  • weight gain in the abdomen (fat accumulation around the abdominal organs)

  • hair loss

  • muscle loss/ muscle weakness

  • mental health changes: mood swings, tearfulness, anxiety, panic, rage, low coping, easily overwhelmed

  • brain fog, forgetfulness, trouble concentrating or problem solving

  • sleep disturbance- trouble falling asleep, staying asleep or waking too early

  • dry skin, itchy skin, sensations of crawling on the skin

  • tinnitus ( ringing in the ears) or itchy ears

  • vertigo

  • burning tongue

  • problems with digestion (constipation, heartburn, food intolerances)

  • crushing fatigue

  • heart palpitations, chest pain, dizziness or vertigo

Menopause Hormone Therapy

Menopause hormone therapy (MHT) is a hormone regimen that helps reduce the symptoms of menopause. It does not "replace" the exact levels of fluctuating hormones your body produced as a younger woman. Allegra Concierge Menopause Care routinely prescribes hormones that are developed from plant estrogens and progesterones and are pharmaceutical grade and regulated by Health Canada. We do not prescribe "compounded " hormones from independent pharmacies as these medications are not standardized or regulated and cannot guarantee their safety or efficacy.

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Estrogen can be prescribed as a tablet, skin patch, topical cream or vaginal cream/ capsule. Each formulation addresses different aspects of menopause symptoms and individual patient risk factors. Your NP will prescribe the appropriate method and dose of estrogen therapy depending on your needs and individual risk factors.

Progesterone is prescribed as a capsule, usually taken at bedtime. Progesterone is prescribed with oral estrogen if you have a uterus. This is to protect from overgrowth of the uterine lining. Compounded progesterone creams have not been proven to provide adequate uterine protection.  Progesterone also helps with certain other menopausal symptoms including insomnia, anxiety and low mood.

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Testosterone is usually prescribed as a gel, applied to the skin. Women naturally have testosterone which decreases dramatically in menopause. Testosterone cream is generally utilized to treat low libido in menopausal women  if estrogen/progesterone is not sufficient, however, testosterone therapy can also help with additional symptoms of menopause as well. You may be required to routinely check testosterone blood levels to ensure safety of your prescription.

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The truth about "Bioidentical Hormones"

Bioidentical hormone therapy (BHT) refers to manufactured hormones that are identical in molecular structure to the hormones produced by the body ( 17 beta-estradiol, micronized progesterone, testosterone). They are derived from soy and yams and chemically altered to be a therapeutic agent for humans. Claims by custom compounding pharmacies that BHT is "natural"  and "identical" to the hormones in the body are not true. This is a marketing scheme and not scientifically accurate. Compounded hormones are also NOT safer than commercially prepared hormones and there are no scientific studies to date proving that they are.  Compounded hormones are not subject to government regulations and are not inspected or tested for safety. Compounded hormones contain several other hormones such as estriol not approved by Health Canada, and may have hormone ingredients imported from other countries by distributors.  For almost all women suffering with menopause symptoms, commercially available, Health Canada approved pharmaceutical grade hormone therapy will provide appropriate relief.

Hormone Testing

The purpose of prescribing hormone therapy to women in perimenopause or menopause is to relieve symptoms. There is not always a role for blood testing as natural hormone levels fluctuate wildly during this time and are not a reliable predictor of a woman's experience. Saliva testing for "individualized" approaches to hormone prescribing is not supported by any medical evidence, is not in any menopause guideline  and not recommended by the Canadian Menopause Society. Your menopause prescriber at Allegra Concierge Menopause Care will carefully evaluate your medical history and symptom inventory to best decide which hormone therapy options are right for you. You may be suggested to complete other lab tests to best predict your risk of other associated conditions of menopause.

Health Risks Associated with Menopause

Increased risk of heart attack and stroke:

  • Heart disease (heart attack and stroke) is the number 1 killer of women after menopause. The risk of heart attack increases 3- fold in menopause due to loss of estrogen starting at age 55. Loss of estrogen causes an increase in the inflammation of the blood vessels, an increase in high cholesterol, increase in blood pressure and increase in weight.

 
Increased risk of developing diabetes:

  • Women who take estrogen have a 20% less risk of developing diabetes. Loss of estrogen makes your body less receptive to your own insulin production causing an increase risk for acquiring Type 2 diabetes. Hormone therapy can lower this risk.

 
Increased risk of developing osteoporosis:

  • After menopause 50% of women will experience a bone fracture in their lifetime. Of the women experiencing hip fracture 1 in 3 will die within 12 months.

  • ​Loss of estrogen CAUSES osteoporosis. Vitamin D and Calcium supplementation without estrogen replacement does NOT reduce risk of osteoporosis.

  •  Hormone therapy is the only approved treatment for osteoporosis PREVENTION.

 
Increased risk of developing Alzheimer's dementia:​

  • Women are twice as likely as men to develop Alzheimer's due to a lack of estrogen causing neuroinflammation in the brain.

  • Estrogen can reduce your risk of developing Alzheimer's by 50%!!

 
Loss of muscle mass and risk of Sarcopenia:​

  • Reduced longevity due to loss of muscle in menopause due to a lack of estrogen.

  • Sarcopenia increases frailty, risk of falls and fractures, decreases strength and mobility.

  • Loss of muscle mass can increase risk for arthritis and chronic pain as well as weight gain.

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Genitourinary Syndrome of Menopause (GSM):​ 

  • Loss of estrogen causes anatomical and physiological changes to the vulva, vagina, urethral and bladder tissues causing chronic pain and dysfunction. Inner labia will shrink and can disappear all together and the vagina loses elasticity.  Blood flow is reduced. The bladder is prone to chronic recurrent urinary tract infections, incontinence and painful urination. The only treatment for prevention of GSM is vaginal estrogen which is safe for 99.9% of women and should be taken for life. Vaginal lubricants do not reduce the risk of GSM.

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