Balancing act: Menopause and hormone replacement therapy

When Maureen began feeling light-headed, fatigued and moody, she wondered if these were typical symptoms of aging or if she might be experiencing early menopause. Now in her late 40s, menopause was certainly a process of life she knew she couldn’t avoid. And as her symptoms became more severe, she decided it was time to have her hormone levels tested.

Menopause, while an unavoidable process of aging, doesn’t have to be an unpleasant experience. In fact, knowledge is power and knowing what symptoms are related to menopause can help map a course of treatment that can make all the difference between suffering through and enjoying the process without annoying and often life-altering symptoms.

Menopause is described as the normal process when the female body begins to fluctuate the levels at which the ovaries produce female hormones, like estrogen and progesterone, which can then lead to certain symptoms.

Menopause usually occurs between the ages of 40 and 55, with the average of American women being around age 51. The time between the onset of menopausal symptoms and the actual final period is called menopausal transition or perimenopause, and may begin several years before the final menstrual period. Once menopause is determined, perimenopause might then last for another year after the final period.

Certain classic symptoms are experienced during perimenopause and include:

Changes in the menstrual cycle: One of the early signs of perimenopause is a change in the duration or frequency of your period. Signs for concern that require a doctor visit might include periods that are closer together, heavier bleeding, spotting between cycles or periods lasting longer than a week.

Hot flashes: Typical symptoms of menopause, hot flashes are likely caused by the changes in estrogen levels. A hot flash is a sudden feeling of heat in the upper body. The face and neck may become flushed, red blotches might appear on the surface of the skin and you may experience heavy sweating followed by cold shivering. Most hot flashes last between 30 seconds to several minutes and may occur anytime, day or night (called night sweats).

Problems with the vagina and bladder: Changes in estrogen levels can cause the genital area to become drier and thinner. Sexual intercourse may become uncomfortable and the bladder might be weakened, causing leakage of urine during exercise, sneezing, coughing or running.

Interrupted sleep patterns.

Changes in sexual desire: Diminished libido or increased sexual desire during menopause is common.

Mood swings.

Altered physical appearance: muscle tone relaxes and muscles might begin turning into fat, skin starts thinning.

Many of the above symptoms of perimenopause are blamed on the decreased levels of estrogen and progesterone.

Losing estrogen during menopause can lead to other problems, including osteoporosis and heart disease, according to the National Institute of Aging.

The body consistently breaks down old bone and replaces it with new healthier bone. But the loss of estrogen, the hormone that controls bone loss, during menopause can lead to osteoporosis because more bone is lost than is being replaced. Bones become weak and can break easily. A bone density test can determine if you are at risk for osteoporosis.

Heart disease is yet another concern for menopausal women.

Lowered amounts of estrogen are contributing factors.

High blood pressure and increased weight also are common factors that can lead to heart disease.

Blood pressure, blood sugar levels and cholesterol should be tested regularly for menopausal women.

Patients typically seek the advice from their physician once these symptoms begin affecting their daily lives. At that time, hormone replacement therapy is often discussed as a viable next step in dealing with menopausal symptoms.

Hormone replacement therapy includes medications that contain female hormones and are used to replace those the body no longer makes during menopause.

According to the Mayo Clinic, hormone replacement therapy used to be the standard treatment for women who experienced typical menopausal symptoms, like hot flashes. Hormone therapy also was thought to have long-term benefits for preventing heart disease and possibly dementia.

Risks have been associated with these hormone replacements, particularly after a clinical trial found the treatment posed more health risks than benefits for certain types of hormone therapy, especially when used in older postmenopausal women. Doctors became less likely to prescribe it.

Because hormone therapy is still considered the best defense against certain menopausal symptoms, many women have sought more natural alternatives.

Enter the bio-identical hormone therapy, which is described by Harvard Health Publications ( as “hormones that are identical in molecular structure to the hormones women make in their bodies.” It is often called “natural hormone therapy” because they act just like hormones the body produces.

The body cannot distinguish bio-identical hormones from those produced by the ovaries. However, bio-identical hormones should be monitored when taken by symptom reduction in the individual patient.

Dr. Danny Abbruzzese, a general medicine physician for nearly 30 years who practices in the Oak Hill Hospital ER, is a strong advocate for bio-identical hormones. Abbruzzese also is the practicing physician at Clarity MedSpa in Land-o-Lakes where he works with bio-identical hormone therapy.

Abbruzzese said the body’s slowdown in producing certain hormones actually begins around the age of 25 and peaks in the mid 30s. Certain symptoms, like hot flashes, reduced sexual libido, vaginal dryness, weakened bone and muscle density, etc. become stronger as the patient reaches full menopause.

The older the patient, the less the body is making of its own natural hormones. “Then things abruptly go downhill,” he said.

Hormone therapy replaces those hormones the body stops making, thereby reducing symptoms associated with menopause. “We are replacing the hormones they are losing,” he added. “But it has to be done in a skilled way.”

He used the metaphor of a traffic jam resulting from an unknown accident. To determine the cause of the traffic jam, investigators must first uncover the source. It is the same technique, in a sense, with hormone replacement. “We are trying to trace the source of the problem and finding that one thing may be causing another.”

Hormone replacement therapy is a specialty, he said, because it requires a specific way of approaching the desired outcome in a healthy way. “It has to be balanced.”

Patients usually seek treatment when symptoms become uncomfortable. Abbruzzese usually evaluates the patient through consultation, observation and blood work to determine levels of specific hormones.

“If hormone levels come back low, we can begin treating,” he said. When levels are determined to be normal or near normal, Abbruzzese will likely do more extensive clinical testing.

Those interested in learning more about bio-identical hormone therapy should consult their physician for more information or to determine if bio-identical hormone therapy is a good option for them.

Abbruzzese has been practicing hormone therapy at Clarity MedSpa for five years and enjoys the clinical setting that also offers many medical procedures under the same roof.

“I do a little bit of everything because it all ties in to the general well-being of my patients,” he said.

From Smart Liposuction to Botox treatments to weight management and nutritional counseling, Clarity MedSpa addresses several concerns under the direct supervision of a practicing physician.

For more information, visit their website at

The facility is located at 19401 Shumard Oak Drive in Land O’ Lakes.

Contact them at (813) 388-6818.

Hernando Today correspondent Kim Dame can be reached at

Balancing act: Menopause and hormone replacement therapy
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