Menopause

Menopause refers to the permanent cessation of menstrual periods, which can occur either naturally or as the result of medical or surgical intervention (such as a hysterectomy with removal of both ovaries). Menopause is not a disease but is a normal part of the life-cycle. Natural menopause is traditionally defined as having occurred after an absence of menses for 12 consecutive months and 'perimenopause' is the clinically ill-defined interval preceding menopause during which ovarian function is declining and is marked by irregular ovarian function and fluctuation in hormone levels. Physiologic (natural) menopause refers to the end of menstruation, which usually occurs in women aged between 45-55 years old. It is a natural event resulting from the ovaries' decreased production of the sex hormones estrogen and progesterone. The symptoms associated with both menopause and perimenopause are hot flashes, night sweats, insomnia, irregular menses, vaginal dryness, decreased cognition, fatigue and an irritable or depressed mood.

A 48-year-old woman comes in for her first office visit complaining of irritability, depressed mood, insomnia and hot flashes. She has been having irregular menstrual periods that are occurring every 28 - 40 days and sometimes as far apart as 60 days with a menstrual flow that varies from moderate to heavy bleeding lasting up to 10 days. She has been experiencing irritability, a depressed mood, fatigue, difficulty sleeping and hot flashes.

After a thorough intake including an assessment for risk factors associated with breast cancer, cardiovascular disease, an annual gynecological exam and lab evaluation I created a treatment protocol involving bio-identical hormone replacement.

Pertinent Lab

• Ferritin (Iron storage marker) = LOW
• DHEA-S (Precursor to estrogen and testosterone, made by the ovaries and adrenal glands) = LOW
• Estradiol (Most potent estrogen our body makes) = Low
• Progesterone = LOW
• FSH = High

This patient's lab results and symptoms are consistent with perimenopause marked by the decreased production of estradiol and progesterone as well as the elevated FSH (follicular stimulating hormone). She also has deficient iron stores due to the irregular but heavy menstrual bleeding.

This woman was given nutritional advice and exercise recommendations in addition to a bio-identical hormone replacement treatment plan and iron supplementation. The hormone replacement consisted of two types of estrogens taken daily and progesterone used during half of her cycle. Once on the protocol, her symptoms improved within 2 weeks and continued to further improve over the next few months.