The median age for menopause, the period after which menstruation has stopped for more than 1 year, is 51 years. The period before, when the gradual decline of the secretion by the ovaries of female hormones such as estradiol starts, is often called climacterium or perimenopause. This phase may last 3-5 years. There is a strong geographic and cultural variation.
In some women in their forties menopause starts prematurely or may be induced by the removal of the (functioning) of the ovaries. In all these cases the decline in estrogen concentrations is associated by acute and long-term effects.
Symptoms of menopause
Acute symptoms which are very common are: hot flushes, primarily of face, neck and chest,
sudden sweating, mostly at night, vaginal discomfort (dryness, itchiness) and loss of libido. Also less specific secondary symptoms such as headache, backache, palpitations and psychological disorders as poor concentration, irritability, tiredness, sleeplessness and depression occur.
An established long term consequence from the decline of estrogens is an increased risk of bone fractures due to osteoporosis and maybe, a higher risk for cardiovascular disease.
Most products contain estradiol alone or in combination with progestin. Estradiol is the most potent natural estrogen.
An estrogen/progestin combination product is indicated in the beginning of menopause (perimenopause), still in the fertile phase. A combination product is often used during this phase when menstruation is irregular and night sweats and flushing are troublesome.
The first two weeks only estrogen is used, then two weeks estrogen plus progestin. This is called sequential therapy.
Conjugated estrogens (Premarin) is a mixture of estrogens derived from pregnant mares.
Estriol is a weak estrogen and used for topical treatment of vaginal atrophy.
Tibolone (Livial) is a steroid that has a combined estrogenic and progestagenic/androgenic effect useful for the treatment of loss of libido and after the removal of the ovaries.
All kinds of administration have been developed by the industry of which oral, transdermal and vaginal are the most used.
On theoretical grounds transdermal or topical application should be preferred: the hormones pass directly into the blood and don't pass the liver and gut first, as with the oral forms. Therefore the dosage of transdermal and vaginal preparations is lower than of tablets. Patches may be changed 1-2 times a week, tablets have to be taken every day.
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