Menopause Symptom Management

I can help assess and address your bothersome perimenopausal and menopausal symptoms through testing and medications, including hormone replacement therapy (HRT).

What age do people go through menopause?

First, let’s start by reviewing some terminology. Perimenopause is the time when your body slows estrogen production which eventually leads to a cessation in periods. During this time period may become irregular and symptoms associated with menopause can begin. Once a menstrual cycle has been absent for 12 months, then you are considered menopausal.

While the number we have in mind for menopause is 50 years old, this is just the median age. The typical range is between 40 and 54 years old, though some may have perimenopausal symptoms as early as their mid-30s. Unfortunately, many who have symptoms on the early end of the bell curve are often dismissed and left without treatment. Blood tests can help confirm whether the symptoms you are experiencing are due to perimenopause or another condition affecting ovarian function.

What are common symptoms of menopause?

There are a multitude of symptoms associated with menopause. In fact, 90% of perimenopausal and menopausal people experience bothersome symptoms including:

  • Vasomotor symptoms

  • Hot flashes and night sweats - 80%

  • Headaches - 24%

  • Mood changes - 23%

  • Insomnia - up to 46%

  • Genitourinary symptoms

    • Vaginal dryness and discomfort - 85%

    • Urinary symptoms - 50%

    • Low libido - 52%

What options are available for symptom management?

Depending on the symptoms experienced, there are hormone replacement therapies (HRT), psychiatric medications, and symptom-specific options for treatment. While there are some perimenopausal and menopausal people who are mainly concerned with one symptom, many people benefit from a multifaceted approach which targets multiple symptoms at once. These medications come in many forms including oral pills, transdermal patches, vaginal rings, vaginal creams, vaginal pills, and subcutaneous pellets.

If you have a uterus and are considering HRT, you also need to take a progesterone method. This helps keep the lining of the uterus thin and protects against uterine cancer.

Is it safe to take hormone replacement therapy?

Unfortunately, there has been a reputation for hormonal treatments of menopausal symptoms being associated with increased breast cancer risk. This idea came from a study published in 2002 by Women’s Health Initiative (WHI). The study claimed that the risks of HRT outweigh the benefits and recommended against the use of these treatments.

However, since then the flaws in the study’s design have been scrutinized and disproven by more recent long-term studies. The 2002 WHI study contained a high percentage of older participants, used a combination of two medications which are not commonly used today, and overstated the frequency in which breast cancer was seen in participants. The North American Menopause Society has released a statement with their updated recommendation that people with bothersome menopausal symptoms under the age of 60 who have no other contraindications for HRT may start these medications to alleviate symptoms of menopause. 

Even though this update came too late to help many people manage their symptoms, it has allowed many people currently in perimenopause and menopause to improve their quality of life through HRT.

What are hormone pellets and how do they help?

Hormone pellets are one of the forms used to treat menopausal symptoms. They are bioidentical to the hormones produced by the body and help increase estradiol levels thereby improving bothersome symptoms. They are inserted into the subcutaneous tissue around the hip or buttock and slowly release the hormones over the course of months, keeping the hormone levels steady. The convenience of long-acting delivery methods such as this eliminates the need to remember daily estrogen pills or patches that get replaced every few days. I believe in having all treatment options available and helping patients make an informed decision about what treatment option is best to meet their needs.

Because the pellets come from compounding pharmacies rather than large manufacturers, they are not FDA approved and insurance does not typically cover the cost of the insertion. I can provide a cost estimate for those interested in pellets for menopausal symptom management.