faqs
 
 

Most women have many, many questions about menopause. Your doctor is the best place to find answers to your questions. However, here are some answers to a few of the most frequently asked questions about menopause and its treatment.

What is Menopause?

Menopause is defined as a permanent cessation of menstruation characterized by 12 consecutive months without a menstrual period.

When does menopause usually happen?

On average, women go through the menopausal stage of life between the ages of 45 and 55. Menopause itself, or the last menstrual period, occurs on average around age 51.

How will I know if I’m “starting” menopause?

When menopause occurs naturally, it usually begins with irregular menstrual cycles. That is the basic sign that the estrogen levels in your body are beginning to decline or become out of balance. This irregularity can last for years. But typically, the menstrual cycles will gradually get further and further apart until they stop altogether.

What is a hot flash?

A hot flash is the feeling of warmth that occurs, usually around a woman’s face. Hot flashes vary in intensity, but most involve some sweating. Hot flashes that occur at night are called night sweats.

What is estrogen?

Estrogen is a hormone that contributes to the control of a woman's menstrual cycle and to the functioning of her sexual organs. It also contributes to sex drive, vaginal secretions, and helps slow the breakdown of bone matter in older people. Bone loss, or osteoporosis, due to diminished estrogen levels is a common symptom of menopause.

Can a hysterectomy cause menopause?

Yes. Unlike natural menopause, which usually comes on gradually, if you have a hysterectomy, it causes an immediate onset of menopause. This is known as surgical menopause, rather than natural menopause. You are likely to begin experiencing the symptoms of menopause right away.

Do I have to go through menopause?

All women go through menopause as a natural part of aging, or because they have a hysterectomy. It is a normal part of life. You can treat the unpleasant symptoms, but menopause happens to all women.

What is estrogen therapy?

Lower estrogen levels in menopause may lead to hot flashes. To help with these problems, women are often given estrogen. Like all medicines, estrogen therapy has risks and benefits. Talk to your doctor, nurse, or pharmacist about estrogen. If you decide to use estrogen, use it at the lowest dose that helps. Also use it for the shortest time that you need it.

Important Safety Information and Black Box Warning
Elestrin is indicated for the treatment of moderate-to-severe vasomotor symptoms associated with menopause.

Estrogens, with or without progestins, should not be used for the prevention of cardiovascular disease or dementia. Estrogen and progestin therapy has shown an increased risk of breast cancer, heart attack, and blood clots. Estrogen therapy, with or without progestins, increases the risk of stroke and dementia. Estrogen therapy alone increases the risk of endometrial cancer. The most frequently reported adverse events in clinical trials were nasopharyngitis, breast tenderness, upper respiratory tract infection, and metrorrhagia.

ESTROGENS INCREASE THE RISK OF ENDOMETRIAL CANCER Close clinical surveillance of all women taking estrogens is important. Adequate diagnostic measures, including endometrial sampling when indicated, should be undertaken to rule out malignancy in all cases of undiagnosed persistent or recurring abnormal vaginal bleeding. There is no evidence that the use of “natural” estrogens results in a different endometrial risk profile than synthetic estrogens at equivalent estrogen doses.

CARDIOVASCULAR AND OTHER RISKS Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia.

The Women’s Health Initiative (WHI) estrogen alone substudy reported increased risks of stroke and deep vein thrombosis (DVT) in postmenopausal women (50 to 79 years of age) during 6.8 years and 7.1 years, respectively, of treatment with oral conjugated estrogens (CE 0.625 mg) per day relative to placebo.

The estrogen plus progestin WHI substudy reported increased risk of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5.6 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) per day relative to placebo.

The Women’s Health Initiative Memory Study (WHIMS), a substudy of the WHI study, reported increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 5.2 years of treatment with CE 0.625 mg alone and during 4 years of treatment with CE 0.625 mg combined with MPA 2.5 mg relative to placebo. It is unknown whether this finding applies to younger postmenopausal women.

Other doses of conjugated equine estrogens with medroxyprogesterone acetate and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials and, in the absence of comparable data, these risks should be assumed to be similar. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.

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A Survey of 300 untreated menopausal women reveal what they want from the application of transdermal estrogen therapy†:

"I want a product I can apply and forget it."

"I’d rather just rub the product in and forget it’s there."

"For me, it’s easier to get into a daily habit."

"I like the control of applying [it] right on my upper arm."

"Make it clear and easy to apply."

†A blinded survey of 300 women with hot flashes to evaluate the importance of various attributes of transdermal estrogen therapy and the preference for various topical estrogen therapy products. Azur Pharma; 2009.