Menopause, often called the "change of life," is a normal part of women?s aging process. During this period, a woman?s body makes fewer hormones. Among other things, hormones regulate the monthly menstrual cycle, which includes the "period" or menstruation. During the menopausal transition, periods are less regular, and eventually they stop. Women are considered to be menopausal once they no longer have a period for at least 1 year. Although menopause typically occurs in women between the ages of 45 and 55 years, it may occur in a woman?s 30s or as late as her 60s.
During menopause, the ovaries make less estrogen and progesterone. Earlier in life, these hormones control monthly periods and the development of breasts and body hair. They also protect bones, which explains why women may develop thinner bones, called osteoporosis, after menopause.
Because menopause affects women in different ways, it is important to be aware of the possible signs and symptoms that mean that you are starting to go through menopause. Typically, women report changes in their menstrual periods, which may include heavier or lighter periods, shorter or longer periods, or infrequent periods. As women move further through the menopausal transition, they may no longer have menstrual periods at all.
Many women experience hot flashes, which is the feeling of heat usually around the head and chest areas. They can last from 30 seconds to several minutes and may be accompanied by sweating. Women who experience hot flashes may also experience night sweats. Night sweats occur while sleeping and can be drenching. Other symptoms may include:
Your health care provider may suggest a treatment called hormone therapy (HT) to help treat symptoms such as hot flashes and vaginal dryness, as well as to prevent bone loss, associated with menopause. An important study called the Women?s Health Initiative showed that HT should be used carefully, and it should not be used by itself to prevent heart disease. In addition, women with a history of breast or uterine cancer, blood clots, liver disease, or heart disease should not use this therapy. Women who have not had surgery to remove the uterus (called a hysterectomy) who are treated with HT should take a combined estrogen plus progestin regimen to help prevent cancer of the lining of the uterus (called endometrial cancer). Women who no longer have the uterus may be safely treated with estrogen only. These hormone products are available in a variety of formulations to meet patient-specific needs, including:
A treatment called Angeliq is available. It contains the hormones estradiol (a form of estrogen) and drospirenone (or drsp), which is a unique progestin. Most progestins are related to the male hormone, testosterone; drsp, however, is related to spironolactone, and is a product more similar to the hormones in your body.
Because Angeliq contains the two types of hormones estrogen and progestin, it should only be used in women who have not had their uterus removed. It is approved to treat moderate to severe hot flashes, and to treat moderate to severe vaginal changes that can produce dryness, itching, and burning, associated with menopause. Angeliq is available as a tablet and should be taken by mouth once daily. Taking the tablet either before or after routine daily activities such as brushing your teeth may help you to remember to take it. In addition, this medication should be stored out of the reach of children.
Angeliq is not for everyone. It should not be used to prevent heart disease, heart attacks, or stroke. If you have a history of liver disease, breast or uterine cancer, blood clots, heart disease (such as a heart attack or stroke), kidney disease, family history of dementia, or adrenal gland disease, discuss whether you should take Angeliq with your physician, because HT may increase the risk of these problems. The unique progestin, drsp, in Angeliq may raise potassium levels and/or lower sodium levels in the body. If you have kidney, liver, or adrenal gland disease and are treated with Angeliq, the risk for high levels of potassium increases. Common side effects of Angeliq include headache, nausea and vomiting, breast tenderness, bloating, irregular vaginal bleeding or "spotting," and hair loss. Other side effects associated with estrogen may include high blood pressure, liver problems, high blood sugar, bloating, yeast infections, and development of fibroids, or benign tumors on the uterus.
If you experience unusual vaginal bleeding, slurring of speech, severe headache, chest pain, difficulty breathing, vision changes, or leg pain, you should notify a health care provider immediately. You should always discuss all the medications you are taking, including prescription medicines, over-the-counter and herbal products, and any changes in your medications, with your health care provider to protect your health. Follow up with your health care provider regularly to determine if you still need to keep taking Angeliq, and never stop taking the medication without notifying your health care provider.
Although your body may be going through changes, you may be able to help treat some of your menopausal symptoms. Ask your health care provider if HT is right for you.
The Oncology Care Pharmacist in Health-System Pharmacy
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