Written by Jennifer Mackenzie
“Sometimes all we want is reassurance that we’re okay and that our symptoms aren’t abnormal” – and this can be especially true for women passing through menopause, explains Dr. Holland-Ellis, a board-certified family medicine physician with Jacksonville Internal Medicine & Primary Care.
Women’s health is a passion for Dr. Holland-Ellis, and she often talks about patients she calls “the forgotten women.”
“There is a subset of women who can go years and years without medical care,” she explains. “Typically, they are women who are no longer having children but are too young to suffer from multiple chronic conditions that require frequent follow-up. These women have their own unique health issues – with menopause often being a major part of that. I strive to be a compassionate, listening ear for them because women going through menopause really need to feel heard.”
Menopause is defined as the cessation of a woman’s menstrual periods for 12 consecutive months. The three most common symptoms are hot flashes, vaginal dryness and mood swings. Women in North America generally experience natural menopause around the age of 51. Some women, however, reach this phase as early as their 30s or as late as their 60s. Usually, women hit menopause around the same age as their mothers and grandmothers – in other words, your female ancestors hold the key.
Some women pass through menopause relatively quickly, while others may experience symptoms on and off for 10-15 years. “Menopause is not a sprint – it’s not like there’s a faucet that cuts off and your estrogen stops all at once,” Dr. Holland-Ellis explains. “Your body stops producing it, but you can still have estrogen in your system for years to come.”
But be assured, “there are things we can do to make your journey much more tolerable,” she says.
One of those things may be hormone replacement therapy (HRT).
The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society all take the position that menopausal women up to age 59, who are otherwise healthy and within 10 years of menopause, are candidates for HRT if they are bothered by moderate to severe symptoms. That does not mean there aren't risks associated with HRT, so every woman should get medical advice by a board-certified provider who has experience with HRT.
“Medicine is always both a science and an art, and we should always weigh the risks versus the benefits for each woman,” Dr. Holland-Ellis explains.
For example, before prescribing HRT, she makes sure a woman is not a smoker (smoking increases your risk of blood clots as well as heart attacks and stroke). She also wants to see that a woman’s blood pressure is well-controlled and that she has no history of breast cancer or blood clots as HRT can increase the risk of these conditions developing or recurring.
“Hormone replacement therapy is the gold standard, the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness, but it’s not for every woman, and not for long-term use,” she adds. There are other options besides HRT, such as diet and lifestyle changes (see sidebar), that can go a long way in helping.
Dr. Holland-Ellis does not routinely prescribe the compounded bioidentical hormones.
“The bioidenticals are no better than your regular generic hormone replacement, they just cost more and many insurance companies don’t cover them. And because you don’t need a provider to prescribe them, you don’t get that important due diligence to make sure you’re a good candidate for HRT in the first place,” she cautions.
The Endocrine Society advises women “to understand that FDA-approved hormones from pharmaceutical companies offer protections of purity, controlled manufacturing processes that products from less-regulated compounding pharmacies do not. In addition, many of the newer FDA-approved formulations can be described as bioidentical because they are the same molecules as hormones found in the body.”
If a patient decides to use HRT, a woman who still has her uterus “must take progesterone along with estrogen as protection from uterine cancer,” Dr. Holland-Ellis says.
As menopause can sometimes trigger or worsen existing symptoms of depression, she may also talk to a patient about a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). “These new drugs have been really beneficial in depression and anxiety, and have revolutionized the way we treat mental health,” she says.
The bottom line is, you don’t need to go through menopause without help, whether HRT is for you or not.
“I want women in this phase of their lives to know there are providers who are passionate about helping them through this change in their lives. So don’t be afraid to speak up and tell your provider what you’re feeling.”