Gynecology

Polycystic Ovary Syndrome

Anywhere between 6-12% of individuals with a uterus who are of childbearing age will develop Polycystic Ovary Syndrome, or PCOS. The symptoms associated with PCOS are caused by a hormonal imbalance–your body starts producing too much of some hormones and not enough of others. While the underlying and root cause of this imbalance is not well understood, PCOS symptoms can be successfully managed and several therapeutic approaches exist.

Polycystic Ovary Syndrome can cause complications throughout your body, including infertility and obesity. If you think you might have PCOS, you can work with your OBGYN or Midwife to develop a treatment plan and find strategies that help you successfully manage your condition.

What Are the Symptoms of PCOS?

For most menstruating individuals, Polycystic Ovary Syndrome develops around puberty. This usually occurs around the time when you have your first period.  Diagnosing PCOS can be tricky as it is not uncommon for menstrual periods to be somewhat irregular for the first 2-3 years after you have your first menarche (first period).  For others, symptoms may develop later in life, sometimes in response to weight gain. Most people don’t know they have PCOS until they visit their doctor. This usually occurs during their 20s or 30s when they have trouble becoming pregnant.

The most common symptoms of PCOS include the following:

  • Weight gain: In approximately half of cases, polycystic ovary syndrome can cause obesity.  However, individuals of normal weight can also have PCOS.
  • Acne: Acne may be more widespread and persistent than expected. Often resistant to treatment. 
  • Hair growth: As the hormone androgen rises throughout your body, you may notice that you start growing significantly more facial and body hair on your chin, neck, back, chest, breasts or abdomen. 
  • Polycystic ovaries: Sometimes the ovaries can appear to have many small follicles or cysts noted on transvaginal ultrasound.  However, this can also be a nonspecific finding and without the presence of other symptoms, may not be suggestive of PCOS.
  • Your periods become irregular: As your hormone levels fluctuate, your periods may become sporadic – sometimes months without periods and sometimes periods that happen too often. It’s not unusual for those with PCOS to have only 9 periods per year, for example.
  • Darkening of skin: Some people who develop PCOS may also notice a darkening of their skin called acanthosis nigricans. This may occur broadly or in patches. 
  • Skin tags: Also known as acrochordons, these are small areas of excess skin that may develop and often around the area of darkening skin.

Only your doctor can diagnose polycystic ovary syndrome. But if you’re experiencing multiple symptoms as noted above, it’s worth bringing your concerns to the attention of your OBGYN or Midwife.

Can PCOS Cause Complications?

Over the long term, PCOS can cause complications in a variety of ways. Some of the most common are the following:

  • Metabolic syndrome or prediabetes
  • Type 2 diabetes, often linked with PCOS-caused weight gain
  • Depression
  • Liver inflammation
  • Infertility
  • Abnormal uterine bleeding
  • Miscarriage
  • Premature birth
  • Gestational diabetes

In general, those with PCOS may experience trouble becoming pregnant. That’s because the hormone imbalance may sometimes interfere with ovulation–and if there’s no egg to become fertilized, one cannot conceive. 

Additionally, you may experience metabolic complications due to your PCOS. This could increase your overall risk of cardiovascular disease and high blood pressure.

None of these complications are inevitable. There is a great deal of variability in terms of who experiences complications and who does not. The best way to avoid complications is to work closely with your OBGYN or Midwife to manage symptoms

What are the Treatments for Polycystic Ovary Syndrome?

In general, the approach to treating PCOS is to help you manage your symptoms as well as possible. As new symptoms may (or may not) pop up, your OBGYN or Midwife will work with you to manage those as well.

As a result, PCOS may be treated in the following ways:

  • Infertility and trouble conceiving: These symptoms may sometimes be addressed with fertility treatments. This will increase the rate of your ovulation–or bypass the process altogether. If you have PCOS and want to get pregnant, your provider may refer you to a fertility specialist. Your OBGYN or Midwife may also prescribe medication designed to help you ovulate.
  • Menstrual irregularity: To help your monthly bleeding stay on track–and be more predictable–your OBGYN or Midwife may prescribe birth control options that are designed to regulate your menstrual cycle. This could include birth control pills, vaginal rings, and IUDs.
  • Weight gain: If your weight gain begins to interfere with your health or impact you in negative ways, your OBGYN or Midwife may take a tiered approach to your treatment. First, they may recommend increasing your daily activity or decreasing your daily caloric intake (or both). In other cases, medication might be used to help regulate the way your body stores fat.
  • Acne: To help improve your acne, your provider may refer you to see a dermatologist who may prescribe prescription strength face wash and other topical medications designed to help you keep your skin clear. Sometimes birth control or other prescription medications can be given to help with acne as well. 
  • Excess hair: Removal of excess facial or body hair often involves cosmetic methods which may include bleaching, waxing, shaving, laser or electrolysis. 
  • Diabetes and insulin related complications: Many individuals with PCOS are insulin resistant, making it challenging to address and manage diabetes that may occur. To help you control your blood pressure and avoid insulin-related complications, your OBGYN or Midwife may prescribe metformin, a diabetes drug that will lower your insulin resistance. This drug can also help regulate your ovulation and improve your weight loss prospects.

Your OBGYN or Midwife will help you manage the symptoms of your PCOS. There’s no cure for the overall condition, but with the right approach, you can still live a very full and healthy life.

Common PCOS Questions

Many people will have questions about their polycystic ovary syndrome. Among the most common are the following:

Will PCOS go away after menopause?

In some ways, your polycystic ovary syndrome will no longer impact you after menopause–in particular the aspects related to infertility and conception. However, your hormonal imbalance will still remain in place. And the life-long complications will still be with you. So, you’ll still have to work with your provider to manage any symptoms that remain.

If I become pregnant, will PCOS Impact my pregnancy?

It could. Polycystic ovary syndrome can increase your chances of gestational diabetes, hypertensive disorders in pregnancy, pregnancy loss, and preterm birth. If you know you have PCOS and you become pregnant, you will want to work closely with your OBGYN or Midwife to monitor your pregnancy.

How will my doctor diagnose my PCOS?

A diagnosis requires a multitude of factors. In general, your OBGYN or Midwife will perform a physical exam and order blood tests. A pelvic exam and pelvic sonogram (ultrasound) may also be performed. Based on the results of all of these tests, your provider may be able to determine whether you have polycystic ovary syndrome and in some cases may refer you to meet with an endocrinologist who specializes in diagnosing, treating and managing metabolic disorders including PCOS.

Talk to Your OBGYN About PCOS

Polycystic ovary syndrome impacts almost one in ten people of childbearing age. This occurs in varying degrees of severity. So, it’s important to understand that, even though there is no cure for PCOS, many people are able to successfully treat this condition on a daily basis.

If you have questions about PCOS, or think this condition may be impacting your fertility, talk to your OBGYN or Midwife today! Contact us at our Wilmette or Glenview locations to schedule an appointment.

How Menopause Changes Your Body

In popular culture, menopause is often reduced to a simplistic set of symptoms, such as ill-timed hot flashes or wild changes in mood. In reality, however, menopause–and the perimenopause that comes before–is a time of transitions. Some of these transitions are significant, some minor. Knowing how menopause changes your body can help prepare you for this entirely natural part of your life.

Many people may look forward to menopause, as it signals the end of menstruation. Menopause won’t change who you are, what you love, or your fundamental personality–but it can change the way your body looks and behaves.

The Stages of Menopause

Menopause does not occur at the flip of a switch. It’s a long process as your body prepares for its post-reproductive years. In general, physicians break down the menopause experience into three distinct categories:

  • Perimenopause: This is when your body starts transitioning into menopause. For many individuals, perimenopause will begin in their 40s, when estrogen production starts to wane. Symptoms of perimenopause could include headaches, mood changes, hot flashes, night sweats, sleep disturbances, menstrual irregularities and more.
  • Menopause: You officially enter menopause when you’ve experienced at least 12 months without having your menstrual cycle without the aid of birth control or other medications. Once you experience menopause, you can no longer become pregnant.
  • Postmenopause: Your postmenopausal period is everything that occurs after menopause. After you experience menopause, then, you will be considered “postmenopausal.” 

These boundaries between these stages are somewhat artificial, but they help your OBGYN or Midwife ascertain how menopause affects your body, where you are on your menopause journey, and the best treatments to relieve discomfort.

How Menopause Changes Your Body

The primary–but not the only–means by which menopause will impact your body is by lowering the total amount of reproductive hormones (estrogen and progesterone, for example) you produce. This can have large impacts on how your body functions and how you generally feel. 

For most, menopause can change your body in some of the following ways.

Weight distribution:

As your metabolism slows down, the ways in which your body stores excess fat can change significantly. For most pre-menopausal individuals, fat is distributed mostly to the hips and thighs–below the waist. This changes with perimenopause as your hormones change. Fat will tend to stick to your abdominal areas above the waist. 

In more common terms, menopause will often cause some people to go from pear-shaped to apple-shaped.

Changes In Your Hair

As the hormones change within your body, you may notice some transformations when it comes to hair:

  • You may grow more facial hair. This is caused because your estrogen production is lower–so the ratio of estrogen to testosterone changes. With relatively more testosterone in your body (even though you aren’t producing more), you may experience hair growth in areas where you haven’t before.
  • The hair on your head may begin to thin. Again, this is caused by changes in your hormone levels and doesn’t impact every individual who becomes menopausal. 

Changes in Your Mood

The stereotype in popular culture is that menopause makes you cranky. And that’s sort of true. It’s more accurate to say that menopause may cause general moodiness of a wide variety of types. Those who are experiencing perimenopause, especially, may notice moods as varied as depression, irritability, and happiness. When these moods shift rapidly or for no rational or observable reason, this may be due to hormonal changes.

Trouble Sleeping

Insomnia is one of the most common–and often troubling–symptoms of perimenopause and menopause. There are a few primary reasons why you might have trouble sleeping:

  • Changes in your hormone levels: Drops in estrogen and progesterone hormones can impact how you’re able to sleep. Usually, hormonal changes can interrupt your sleep cycle, making it more challenging for you to fall asleep–or stay asleep.
  • Hot flashes and night sweats: Both of these symptoms can be quite uncomfortable on their own. Together, they often form a one-two punch that wakes you up throughout the night (and keeps you awake no matter how tired you are).

When you don’t get enough sleep, your overall mood and functionality may be negatively impacted for the rest of the day.

Drying Skin 

It’s somewhat well known that menopause can cause vaginal dryness. The hormones that help keep your vagina lubricated are less present. This can make sex painful and other impacts on your daily life. 

 

But menopause can also cause dry and itchy skin all over! That’s because there’s less estrogen stimulating the production of collagen, and without collagen your skin tends to lose more moisture over time. While this dry skin may be most noticeable in some common areas (such as your elbows), it may quickly become something that happens over your entire body.

This can cause widespread (and uncomfortable) itchiness. But there are treatments which can help mitigate these symptoms.

Can You Find Relief from the Changes of Menopause?

You can never go back to being pre-menopausal. As your body produces less estrogen, you’ll eventually find yourself at a postmenopausal new-normal. However, there are some ways that your OBGYN or Midwife will be able to make the process less unpleasant and the transition easier.

The first step may be treating some of your symptoms. For example, if your skin is dry, your OBGYN or Midwife may recommend specific moisturizers that can help prevent dry and itchy skin. Trouble sleeping can sometimes be mitigated with specific sleep aid therapies (i.e. mindfulness, meditation, cognitive behavior therapy for insomnia) or by adopting new behaviors. (aka sleep hygiene) Hot flashes may be treated with specific medications designed to diminish the impact that they have and use of a fan at night and wearing light layers of clothes can also provide relief.

Should You Get Hormone Therapy for Menopause?

Some women will be good candidates for hormone therapies. These hormones will attempt to supply your body with estrogen. That way, you and your OBGYN or Midwife can work to wean your body through your perimenopausal transition. This approach may help relieveyour symptoms.

Not everyone is a good candidate for hormone replacement therapies. Your OBGYN or Midwife will review your medical history to determine if starting hormones is appropriate or not.That’s because, in some cases, use of hormone therapy over long periods of time has been linked to the possible development of certain types of cancers, although this risk is lower if you no longer have a uterus. 

Talk to your OBGYN or Midwife to find the most effective–and safest–solutions for your menopause.

You Don’t Have to Suffer Through Menopause Symptoms

While some symptoms will certainly be less comfortable than others, menopause can still be a joyful and happy time in your life. Your body will change, but many individuals find positives within that transition. Those less comfortable symptoms can be successfully managed, making your journey through perimenopause into menopause less uncomfortable.

If you have concerns or questions about how menopause changes your body–and what you can do to manage any bothersome symptoms–contact your Wilmette or Glenview OBGYN or Midwife to schedule a consultation. 

 

Your First Menstrual Cycle

It’s very normal for your first menstrual cycle (aka menarche) to be a little scary. You’re not sure what to expect from your body or in terms of the discomfort you’ll feel–and you don’t know how long that discomfort will last. The more information you have, the better you’ll be able to navigate both your first period and the ones that follow.

For most individuals who menstruate, the menstrual cycle will become simply another aspect of your daily life. For some, your period may be more severe and intense; others may hardly notice it. Periods can be very consistent or frustratingly dynamic (heavy one month and light the next). Everyone’s periods will be slightly different, and your first menstrual cycle may not necessarily be predictive of what you will experience to follow.

As you navigate your first menstrual cycle, it’s important to know that this is a normal part of life–and that you can develop habits or find therapies that will make your future periods easier to handle.

What Happens During a Menstrual Cycle?

Menstruation is the result of normal processes within the uterus. When you’re young, the uterus has only a very thin lining. But as you approach puberty, your body begins producing more estrogen. This estrogen does many things, one of which is helping the uterine lining grow thicker. This thicker lining is intended to help fertilized eggs attach to the wall of the uterus to enable a pregnancy to begin. When that fertilized egg does not result in a pregnancy after a period of time the lining of the uterus is shed–and a new lining grows to replace it to prepare for your next menstrual cycle and possibility of pregnancy.

The shedding of the old lining is what causes menstruation–the broken-down lining is moved out of your uterus, and this results in bleeding and cramping. The duration of a menstrual cycle varies–not only from individual to individual but also from month to month. In most cases (and without other interventions), periods will be a normal and semi-monthly part of your life from puberty to menopause. 

Your Period vs. PMS

Your menstrual cycle may often be preceded by something called “premenstrual syndrome,” or PMS. These symptoms could include:

  • Back pain
  • Soreness
  • Fatigue
  • Soreness of the breasts
  • Bloating
  • The development of acne
  • White or clear discharge from your vagina
  • Constipation or diarrhea 
  • A general sense or irritability

The number of these symptoms you experience–if any–could vary from month to month or be a fairly consistent signal that your period will arrive shortly. 

Common Questions After Your First Menstrual Cycle

It’s very common for many people to have questions about their menstrual cycle–whether it’s their first or fiftieth. Some of the most common questions about your first menstrual cycle usually include the following:

  • When do I start getting my period? In most cases, your period will start between the ages of 11-12. For some it’s a little earlier or a little later (a couple of years before and after this age range is not unusual). 
    • How long do periods last?  The typical period will last anywhere between 2-8 days. Your period may be very regular; or it may vary wildly. Things such as stress, eating habits, and other medications can impact the duration of your period, as well.
  • How much pain or discomfort do periods cause? This will vary from person to person and, often, from month to month. For example, menstrual cramps for some individuals can be light. For others, cramps can be severe and impact your daily activities. You should talk to your OBGYN or Midwife about managing pain and discomfort caused by periods and PMS.
  • How often will I get my period? The broad rule of thumb is that you’ll get your period every 28 days or so. However, there is a wide degree of variability there. Sometimes the gap between periods can be as much as 45 days. In other cases, your period may come sooner than you expect. It may also take up to six years after your first period for your menstrual cycle to normalize and become more predictable.
  • Should I use pads? And how often should I change them? Pads are a great way to keep menstrual bleeding from ruining your clothing. You’ll usually need to change your pads every four to eight hours depending on how heavy your bleeding is. A good rule of thumb is to change your pads whenever they feel full, uncomfortable, or wet. 
  • Should I use pads or tampons? The answer to this question will likely depend on your preferences and daily activities. Tampons, for example, are wonderful for swimmers. Pads tend to be slightly more comfortable in a day-to-day setting–but this is somewhat subjective. If you don’t know which to choose, talk to your OBGYN or Midwife. Whether you use pads or tampons, however, do not use scented feminine products, as these can sometimes unbalance your vaginal pH levels and lead to infections.
  • What other menstrual products can or should I use? There are a wide variety of products available to help those who menstruate feel more comfortable. Newer examples of products include menstrual cups (which look like little silicone bells) and menstrual underwear (a pair of underwear with moisture wicking properties). These products are reusable, making them particularly appealing for those who are environmentally conscious. The broader point, however, is that there are options beyond tampons and pads, so you can find what works for you, your body, and your preferences. Talk to your OBGYN or Midwife if you’d like to know more about alternative menstrual products. 
  • How much blood will I lose during my period? For most people, the very first periods tend to be quite light, in some cases no more than light spotting. As your hormones begin to ramp up, you may experience heavier flow. Bleeding on the heavier side isn’t necessarily something to be concerned about, but if you feel light-headed or get the sense that you’ve lost too much blood, talk to your OB GYN or midwife and if you happen to be at school, you can speak with your school nurse.

How to be Prepared for Your Next Period

It’s easy to be surprised by your period, even if it’s not your first one. That’s why many people will create what they call a “period kit.” This is a small kit of supplies that you carry with you wherever you go; you can keep it in your backpack or locker. A typical period kit may include:

  • Extra pads and tampons (enough of each to get you through a day)
  • A clean pair of underwear (just in case)
  • Wipes (for clean up)
  • Pain relievers, such as Ibuprofen or Tylenol (comment, motrin or advil are forms of ibuprofen that are more effective for menstrual cramp pain) (this can help with minor or moderate discomfort)

If your period catches you unawares, there are some things you can do. For example, you can create a temporary pad out of several layers of toilet paper. Placing that temporary pad in your underwear can help absorb blood just until you are able to replace it with a pad or tampon. 

If you’re in school when your first period occurs, ask to talk to the nurse. It’s okay–we can guarantee your nurses have been asked about this before! And they’ll likely have spare pads or tampons for you to use.

Other Changes in Your Body

For many, the first menstrual cycle is both a rite of passage and a metaphor for starting to grow up. So every family may celebrate differently (or not celebrate at all). From a medical standpoint, once your period occurs, you may want to talk to your doctor about your reproductive health. The American College of Obstetricians and Gynecologists recommend that adolescents visit with a gynecologist for the first time between the ages of 13-15. 

As you grow up, you can discuss the changes in your body as well as how best to control your symptoms.

Talk to your OBGYN

Your first period can be exciting–and more than a little intimidating. But it’s important to remember that just around half of the world’s population of adults has gone through exactly what you’re going through. 

Talking to your OBGYN or Midwife can help you manage menstrual symptoms and associated discomfort. And talking about your reproductive health can also ensure you are able to prioritize your long-term wellness. For most, the first menstrual cycle transitions easily into a monthly period that you can manage and fold into your life.

If you have questions about your first menses–or your child’s first menses–schedule an appointment with an OBGYN or Midwife to discuss what to expect. Contact our Wilmette or Glenview offices today to schedule an appointment.

IUDs – What You Need to Know

If you’ve been doing your research, you are probably already aware of the different forms of birth control. From the pill to the patch and the good (or not-so-good) condom options, they may all seem like they are less-than-ideal.

Maybe you’ve even tried the pill or other options, but don’t love the idea of having to remember to take something every day or even every month.

Have you ever thought about getting an Intrauterine Device (IUD) for birth control? There are many IUD choices on the market, some of which are newer, and you may not know about.

Read on for more information about what IUDs are, how they work, how they differ, and how you can make the best decision for yourself concerning IUDs as the ideal birth control option.

What Exactly is an IUD?

IUDs are small devices that are permanently placed in the uterus to prevent unwanted pregnancies. Unlike most other options, IUDs are both long-term and reversible.

And as far as birth control effectiveness goes, they are also believed to be at least 99% effective, if not more. Unlike condoms, they are not prone to breakage, leaks, or other types of human mistakes that can affect their overall efficacy.

They are also not “forgettable”, that is, they are permanent and working all the time, so you can’t forget to insert them or take them, as you could a diaphragm or pill, respectively. You can have one inserted and forget about it for years.

It’s important to note that IUDs do not protect against STDs.

How Safe Are IUDs?

IUDs got a bad rep back in the day when they were first introduced, and there were some complications. But since then they’ve come a long way.

Strict screening also comes along with wearing an IUD so that on the very small chance of infection, your gynecologist can treat it right away.

Some people might wonder if the copper in IUDs like ParaGard could cause problems in the body, but there shouldn’t be much to worry about as there is no evidence that there’s enough copper for it to be toxic. Of course if you’ve had a bad reaction or known allergy to copper in the past, you should be sure to disclose that information to your provider when discussing IUD options.

Side effects like pain, cramping, spotting, and irregular periods, as well as regular periods, do happen with some IUD users. These should only occur in the first several months.

There is a risk of expulsion, that is, the IUD may come out of the vagina. While there is only a small chance of this (though it may be more likely for younger women), most experts conclude that IUDs are a safe and effective birth control method and that the risks of unwanted or dangerous pregnancies associated with other methods far outweigh the very low risks associated with the IUD.

Getting an IUD Inserted

If you’re wondering what getting an IUD feels like, here’s a bit of an overview. Some women will feel more discomfort than others, of course. In addition, sometimes you may be offered medicine to help open the cervix and numb the pain.

With a speculum, a gynecologist will put the IUD in through the cervix and into the uterus. It only takes a few minutes on average and can be done at any time. Some women feel pain or cramping as it’s being inserted, and if this is the case, pain medication can be prescribed.

There’s a small chance that you will feel dizzy or have more severe cramps after the time of insertion, and for this reason, your gynecologist will recommend that someone pick you up after the surgery.

Most of the time there is no recovery time, but you may have cramps so treat it like a period and schedule some rest just in case.

The Different Types of IUDs

There are a few different types of IUDs. Some IUDs are hormone-free, and some secrete low doses of progesterone to prevent pregnancy. All of them essentially “kill” sperm on the way to the uterus, making pregnancy impossible.

ParaGard is a copper, non-hormonal option and is the most effective–it can even serve as emergency contraception if you get it five days after unprotected sex, and in this case, you can also opt to keep it in.

The other four are hormonal and use progestin (like progesterone) for pregnancy prevention. If size is an issue, newer models are coming out with smaller sizes than earlier models, so ask your doctor if you think a smaller option may be a better fit.

How Do IUDs Work?

Most IUDs will typically work in one of two ways.

  1. Hormone-based IUDs will effectively thicken mucus n the cervix. This makes it difficult for sperm to reach the egg and begin the fertilization process. Additionally, the hormones will thin the lining of the uterus while also partially suppresses ovulation. These two processes, together, help ensure fertilization does not occur. Mirena, Liletta and Kyleena are examples of a hormone-based IUD.
  2. Copper-based IUDs will instead produce an inflammatory response in the local area of the body. This inflammation creates an environment that is inhospitable to sperm cells. Because the sperm cannot survive, fertilization and pregnancy is prevented. ParaGard is an example of a copper-based IUD.

Both hormone and copper based IUDs work to prevent fertilization from occurring at any point.

However, if fertilization does occur while an IUD is in place, there is a high chance for the development of an ectopic pregnancy, so you should talk to your OBGYN if you think you might be pregnant or have taken a positive pregnancy test.

What Are The Benefits of IUDs?

IUDs are a popular contraceptive option for a wide variety of reasons. Some of the most significant reasons include:

  • Long term birth control: You don’t need to think about taking a pill every day or interrupting sex due to the need for contraception. What’s more, most IUDs can remain in place for anywhere between 5-10 years (depending on the type).
  • Regulation of severe periods: Many women who have heavy periods end up using IUDs to help manage their discomfort and symptoms (for somewhere around 20% of women, IUDs will eliminate their period altogether).
  • You can remove an IUD at any time: Your OBGYN can remove your IUD at any time (you may want local anesthesia depending on your comfort level). Once your IUD is removed, your normal fertility will usually return within a few days.
  • You can also use your IUD while breastfeeding: Most physicians recommend waiting 6-8 weeks after you deliver your baby to insert a new IUD, however.
  • IUDs are contraceptives that do not require partner participation: This means you remain in control of your reproductive choices. For many women, this is a significant and much appreciated benefit.
  • IUDs do not use estrogen: IUDs are often a safe and effective option when other options are not able to be used because they do not use estrogen. Estrogen methods of birth control can be contraindicated in individuals with hypertension, smokers, history of bleeding disorders and other medical conditions.

To learn more about IUDs and other contraceptive options, contact us today at our Wilmette or Glenview locations to schedule an appointment with a gynecologist.

HRT in Perimenopause

You’re having hot flashes, or maybe you’ve noticed changes to arousal and your sex drive has decreased. Over the past few months, you just haven’t quite felt like yourself. These could be just a few signs that you are in perimenopause. 

In this article, we cover the basics of perimenopause, including main symptoms. Then, we’re going to delve into hormone replacement therapy (HRT): what it is, how it could help, and the risk factors associated with it.

What is Perimenopause?

Perimenopause is the term for the time that begins with transitional phase through complete entry into menopause and the whole process start to finish can take as long as ten years, though you’ll likely not pick up on all of it. Every woman is different, so it’s hard to pinpoint how long perimenopause could last for you. Perimenopause is a hormonal shift in the body and results in some specific changes within the body.

Common symptoms of perimenopause include:

  • Fatigue
  • Irregular Periods, sometimes with heavier than average bleeding
  • Vaginal Dryness
  • Increased Urinary Frequency and Urgency
  • Mood Fluctuations, such as increased irritability or Depression and Anxiety
  • Hot Flashes or Night Sweats
  • Sleep Disturbances

What is HRT?

Hormone replacement therapy, or HRT, can be used to reduce the symptoms of perimenopause. The primary indication for HRT is the vasomotor symptoms more commonly known as “hot flashes.” HRT typically means taking two hormones, estrogen and progestin.

Estrogen naturally decreases with age and contributes to most of the perimenopausal symptoms. Taking progestin alongside estrogen in HRT reduces the possibility of developing uterine cancer, which is associated with taking estrogen alone. Estrogen may be prescribed on its own in specific cases where the patient has no uterus. This is referred to as “estrogen therapy.”

When you discuss HRT with your OBGYN, you’ll likely talk about the best way to deliver your therapy for your needs. There are two common delivery methodologies used by OBGYNs today:

  • Low Dose Vaginal Delivery Products – Typically reserved for patients who are only experiencing urinary or vaginal symptoms of menopause, vaginal delivery products come in the form of creams, rings, and tablets. As the name suggests, these preparations dole out low doses of hormones, and as result they produce limited effects. 
  • Systemic HRT – When patients have more widespread symptoms and need a more comprehensive symptom relief, physicians will deploy what’s known as a “systemic HRT.” These delivery devices include rings, creams, pills, patches, and sprays, and more. You’ll be able to discuss which of these applications is most suitable for your situation and your presentations. The higher doses of estrogen these methods offer are absorbed evenly by the body, so they can be used to treat more widespread and common perimenopause symptoms. 

How Can HRT Help in Perimenopause?

Hormone replacement therapy has been shown to reduce vaginal dryness. It is also supported as the most effective treatment for hot flashes and night sweats. A positive side effect of HRT is that it can also help protect against bone loss and prevent spine and hip fractures, which are associated with menopause, though we don’t specifically prescribe it for these indications.

There are many different forms of estrogen available, including patches, gels, sprays, and pill form. Progestin can be administered separately from estrogen or combined in a pill or skin patch. If vaginal dryness is your main concern, you also have the option of local treatment using a ring, tablet, or cream.

Are There Any Risks Associated with HRT?

If you are considering HRT, it is important to be aware of the risks. Estrogen-only therapy (ERT) is not recommended to women who have not had their uterus removed, as this is associated with uterine cancer.

There is a small risk of heart attack on HRT. This is influenced by other factors, such as age and pre-existing medical conditions. There’s also a small increased risk for breast cancer, stroke, and deep vein thrombosis (formation of a blood clot). Some oral forms of HRT come with a slightly greater risk for gallbladder disease.

Less serious adverse effects commonly associated with HRT include nausea, breast tenderness, bloating, weight gain, and breakthrough bleeding. These typically last a short time at the beginning of your transition into HRT.

How to Manage Risks Associated with HRT

Because HRT has been associated with certain long term risks and complications, most patients and physicians discuss concrete ways that those risks can be reduced. Patients can help manage HRT risks by:

  • Checking in regularly with your OBGYN or healthcare provider. Scheduling regular conversations about benefits and risks can help you know when to complete your treatments.That’s why most OBGYNs will encourage regular follow-up care when you’re on HRT.
  • Take the lowest dose possible to manage your symptoms. Patients can help manage risk by working with their OBGYN to ensure they aren’t taking any more hormones than they need to. To be sure, symptom relief is the priority–that’s what makes HRT successful. But successfully managing symptoms with the lowest possible dose can help you minimize many of the long term risks associated with HRT.
  • Keep a healthy lifestyle: Maintaining a healthy diet and regular exercise regimen can help you minimize your overall risk of adverse impacts. 

Managing your risks will depend on your situations and your symptoms, so the best approach is often one that has been individualized for you. Talk to your OBGYN about the best ways to minimize and manage your risks around hormone replacement therapy to help you ensure you minimize any possible risks.

Contraindications to HRT

Some conditions are contraindicated with HRT. In these unique cases, HRT may not be the best way for you to treat your symptoms of perimenopause. These conditions include endometriosis, fibroids, porphyria, active liver disease, hypertriglyceridemia, and thromboembolic disorders.

If you have a history of breast cancer or endometrial cancer, HRT may not be right for you.

Before starting HRT, your health professional should adequately screen, counsel and test to ensure you are a good candidate for this kind of treatment.

If any of the above conditions resonate with you, don’t be discouraged. There are other avenues you can explore to lessen the symptoms of your HRT. If your perimenopause symptoms impact the quality of your life, ask your health professional about your other options outside of HRT.

How to Know if HRT is Right for You

If you’re considering hormone replacement therapy, you should be evaluated by a medical professional. A baseline should be established by analyzing your blood and urine closely. Tests may also include ultrasonography, electrocardiography, and mammography.

Your health professional may also test your serum follicle stimulating hormone (FSH) levels. This helps with monitoring, especially in women who intend to take HRT orally. Serum estradiol levels may also be looked at. This helps monitor women who continue to have symptoms even after they begin HRT.

There’s a Lot to Consider

There are proven benefits to HRT in perimenopause, but there are also some risk factors to consider. If you’re considering starting hormone replacement therapy, discuss it with your healthcare professional thoroughly so that you can decide with confidence whether or not it’s suitable for you.

If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.

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