Menopause usually starts between 45 and 53, very few women have menopause after age 53. Its a time where fertility goes away.   Its also  a time of increased illness and reduced function, even for those who eat well and exercise.  Its also a time where the estrogen goes low and the normal testosterone persists.  Menopause risks and symptoms can be treated with pills and patches. 

Complications from untreated menopause can include:

• Significant reduction in lean muscle mass (especially in the legs).  

• 20% of a woman’s fat moves from under the skin and goes into the abdomen(“visceral adiposity”) which causes diabetes and cardiovascular disease.  

•  5% weight gain (8 pounds for a 150 pound woman), and this fat also goes to the belly (so the woman ends up with skinny  legs and a big round belly).

• Facial hair can develop and persist.

• Fatigue and malaise (despite normal lab tests).

• Hot flushes interfering with sleep & daily function, (although fortunately they’re usually gone after a few years). 

• Depression (25% of all women going through menopause suffer from a clinical depression). 

• Skin thinning - over time women without hormones lose up to 90% of skin thickness, causing the skin to bruise and tear easily. 

• Increased dementia risk (up to a 41% reduction in dementia by taking estrogens) 

• Insomnia (40% develop new or worsening insomnia).  

• Anxiety, irritability, hostility - either new or worse.

• Heart attack and stroke risk equals a man’s risk  (its rare for a woman to have a heart attack before menopause).. 

• Frequent urinary tract infections, urinary incontinence, vulvar itching and painful intercourse.

• Memory deterioration, especially the ability to find words.

• Focus, attention, & concentration deteriorate (although brain function can improve after the menopause is over).  

• Bone loss and osteoporosis (approximately 1/3 of women who sustain a hip fracture will be dead in 6 months).

Estrogen can have negatives.  The scientific literature is confusing and conflicting.  The “Women’s Health Initiative” study from the early 2000's showed that women in their 60's who have never taken estrogen, and then took estrogen in their 60's had a 7 per thousand increase in breast cancer, heart attacks and strokes for 2 years before the risk went away.   This study said nothing about taking hormones during or after menopause, although many people concluded this.  There is a long-term study on women who took estrogens - the SWAN study - but it won’t gives us good answers for a long time.  1 in 8 women lifetime will get breast cancer, and 17% die within 10 years - this is without taking hormones at all.   There may be an increased breast cancer risk from estrogens - particularly over time.  Estrogen can also cause blood clots that at times can be fatal.  We just don’t know how to balance potential risks versus benefits scientifically yet.  The decision is up to the patient.

Women who are terrified of hormones, have some forms of breast cancer, have the BRCA gene or a clotting disorder, or have a sister or mother who have breast cancer should avoid them.

Topical estrogens can be used twice weekly to reduce urogenital symptoms.  Black cohosh is no better than placebo for the hot flushes, the antidepressant Prozac (fluoxetine) and Effexor (venlafaxine), and the epilepsy medication gabapentin sometimes help reduce hot flushes.  “Bioindentical hormones” really means replacing your lost hormones with human hormones, unfortunately that term is often  means plant or other animal products - make sure they are human hormones!