Natural menopause vs. surgical menopause

Natural menopause occurs gradually when your ovaries naturally stop producing the hormone estrogen. That's when fertility ends. So if you're between 45 and 55, menopause may be on your radar. Of course, it can happen earlier or later, but the average age is 51.

Surgical menopause occurs when the ovaries are removed, which is often performed as part of a hysterectomy. A hysterectomy is a surgical procedure where they remove part or all of your uterus and possibly your ovaries. When you have your ovaries removed, menopause begins immediately, because your ovaries are no longer producing estrogen. If you have not had your ovaries removed during a hysterectomy, you will experience menopause naturally.

Something you've probably heard a lot about in the news these days is perimenopause, which is a prelude to menopause and can last several years. These are the years when estrogen production from the ovaries starts to decline and symptoms, such as hot flashes, may begin to appear.

Much of the confusion surrounding the safety of hormone therapy comes from reports on a major study called the WHI or the Women's Health Initiative. What many people don't realize is that this study was set up to see if there are other uses for hormone therapy, like improving heart health. It was not designed to evaluate the proven benefits of hormone therapy for the relief of hot flashes, night sweats, and vaginal dryness.

The average age of the women who took part in the study was actually 63—well past the average age of menopause. Which means that the study doesn't give a clear picture of how hormone therapy can affect younger, menopausal women who are experiencing symptoms.

• Hormone therapy should not be used for the prevention of heart disease or dementia
• Physicians should prescribe the lowest effective dose for the shortest time possible

The WHI studied two types of hormone therapy:

• Estrogen-alone therapy—for women who have had a hysterectomy
• Estrogen-plus-progestin therapy—for women who still have their uterus

Take a look at this chart to review the risks associated with estrogen-alone therapy. In women with an average age of 63, the WHI reported a decreased risk for hip fractures and an increased risk for stroke and blood clots. There was, however, no significant increase or decrease in risk for breast cancer and heart attacks.

You can see from the chart below that in the estrogen-plus-progestin study, the WHI reported a decreased risk for hip and vertebral fractures, an increased risk for stroke, blood clots, and invasive breast cancer, and no significant increase or decrease in risk for heart attacks.

We are all individuals, not statistics. The fact of the matter is that hormone therapy is the most effective way to treat hot flashes, night sweats, and vaginal dryness. Did you know that hormone therapy has been used to treat menopausal symptoms for more than 60 years?

In fact, hormone therapy is the most effective FDA-approved option for relieving moderate to severe menopausal symptoms. It's up to you and your doctor to evaluate your symptoms and your health history, and to determine whether you should consider hormone therapy.