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Frequently Asked Questions

Updated: May 7

Q: What is perimenopause, and when does it typically start?

A: Perimenopause is the transitional phase leading up to menopause, characterized by hormonal fluctuations and changes in menstrual patterns. It typically starts in a woman's 40s but can begin earlier or later. PMDD and perimenopause symptoms can overlap, but a hormonal top up works quite well.

Q: What are the main symptoms of perimenopause?

A: Common symptoms of perimenopause include irregular periods, hot flashes, night sweats, mood swings, fatigue, and changes in libido.

Q: How long does perimenopause last?

A: Perimenopause can last for 4

months to 10 years.

Q: Can perimenopause affect fertility?

A: Yes, fertility declines during perimenopause as ovulation becomes less predictable. However, pregnancy is still possible, so it's essential to use contraception if pregnancy is not desired.

Q: What is menopause?

A: Menopause is the point at which a woman has not had a menstrual period for 12 consecutive months, marking the end of her reproductive years.

Q: What are the typical age range for menopause?

A: Menopause usually occurs between the ages of 45 and 55, with the average age being around 51 in the Australia. Asian ethnicity may experience menopause earlier.

Q: What are the common symptoms of menopause?

A: Common symptoms of menopause include hot flashes, night sweats, vaginal dryness, mood swings, sleep disturbances, and changes in libido.

Q: How can menopause affect bone health?

A: Menopause can lead to a decrease in bone density, increasing the risk of osteoporosis and fractures. It's essential for women to maintain a healthy lifestyle and consider bone density testing. Hormone Replacement Therapy improves bone mass and strength.

Q: What is hormone replacement therapy (HRT)?

A: Hormone replacement therapy (HRT) is a treatment that involves taking estrogen or estrogen plus progestin to relieve menopausal symptoms such as hot flashes and vaginal dryness. It can also help prevent bone loss.

Q: What are the potential risks and benefits of HRT?

A: The benefits of HRT include relief from menopausal symptoms and protection against bone loss. @@@

Q: How can women manage menopausal symptoms without HRT?

A: Women can manage menopausal symptoms through lifestyle changes such as regular exercise, healthy diet, stress management, and adequate sleep. Over-the-counter remedies are not thoroughly regulated they don’t fully manage symptoms. Besides, they are not biologically active like HRT, so their effect is only symptoms relief; it’s like taking panadol for headache without addressing the underlying cause of the headache. Besides, alternative remedies like black cohosh can cause liver problems especially when taken at high doses and for prolonged periods of time, St John’s Wort interacts with other medications.

Q: Can menopause affect mental health?

A: Yes, menopause can impact mental health, leading to mood swings, irritability, anxiety, and depression in some women. It's essential to seek support from healthcare professionals and loved ones if experiencing mental health challenges during menopause.

Q: What is the role of diet and exercise in managing menopausal symptoms?

A: A healthy diet rich in fruits, vegetables, whole grains, and lean proteins, along with regular exercise, can help manage menopausal symptoms such as weight gain, mood swings, and sleep disturbances. Exercise also promotes bone health and overall well-being.

Q: How does menopause affect sexual health?

A: Menopause can lead to changes in sexual health, including vaginal dryness, decreased libido, and discomfort during intercourse. Open communication with a partner and exploring different lubricants or therapies can help improve sexual satisfaction.

Q: Can menopause affect heart health?

A: Yes, menopause is associated with changes in cardiovascular risk factors, including an increase in cholesterol levels and blood pressure. It's essential for women to maintain a healthy lifestyle and discuss cardiovascular health with their healthcare provider.

Q: What is early menopause, and what are its potential causes?

A: Early menopause, also known as premature menopause, occurs before the age of 40 and can be caused by factors such as genetics, autoimmune disorders, surgery, or certain medical treatments like chemotherapy. Women with a history of autoimmune conditions like Hashimoto’s disease (under active thyroid), coeliacs disease, MS, Chrohns and Colitis, are likely to experience earlier menopause. Premature menopause will have profound negative effects of your current and future health. This included menopause symptoms, higher risk of metabolic syndrome and eventually diabetes, future osteoporosis and possibly dementia down the line.

Q: How does menopause affect urinary health?

A: Menopause can lead to changes in urinary health, including an increased risk of urinary tract infections, urinary incontinence, and overactive bladder. Pelvic floor exercises and lifestyle modifications (like eliminating caffeine) may help manage these symptoms. However, vaginal estrogen works really well. Women say, “it’s magic”. Vaginal estrogen is a very low dose tablet/cream inserted into the vagina.

Q: Can menopause affect skin health?

A: Yes, menopause can lead to changes in skin health, including dryness, thinning, and loss of elasticity. Skincare routines that include moisturizing and sun protection can help maintain skin health during menopause. HRT improves collagen and overall skin health.

Q: Are there support groups or resources available for women going through perimenopause and menopause?

A: Yes, there are various support groups, online forums, and resources available for women going through perimenopause and menopause, including informational websites, books, and local support groups facilitated by healthcare professionals. Balance-menopause is a fantastic resource.

Q: Is it too late to start HRT

A: No, in the hands of an experienced menopause clinician, any woman of any age can benefit from HRT.

Q: Does menopause cause headache

A: Yes, Headaches can be linked to fluctuating hormones in perimenopause and eventually lack of hormones in menopause. The brain doesn’t like the sharp decline in estogen, testosterone and progesterone associated with perimenopause. If your headaches are severe or progressive, worse with coughing and sneezing or baring down (like straining to open bowels), associated with new visual symptoms like blurring, double vision or being affected by light, you need further assessment and imaging by your doctor. Hormonal headaches respond fully to balanced hormones.

Q: Do I have to stop HRT?

A: No, you can take HRT forever, unless there’s a good reason not to. Menopause is a state of estrogen deficiency, estrogen is produced by immature eggs. When we stop having periods, it is a sign that your eggs have run out. By age 32, we have about 7.5-10% of our eggs supply remaining. Most women will experience PMDD from this age. We lose 1000 eggs daily, we are born with 1.2-1.6 million eggs.

Q: Can I take HRT with a history of breast cancer?

A: Yes

Breast cancer is very common. 1/7 women will get breast cancer in their lifetime. Taking body identical HRT will not increase your risk of breast cancer above your baseline risk. For example, a woman with a history of Breast cancer, has a slightly higher risk compared to a woman who has not had breast cancer. However, taking body identical estrogen or progesterone will not increase this risk much further.

Synthetic progestogen is the main culprit in breast cancer risk. Body identical progesterone has a 0% increase in the risk of breast cancer for 5 years, and beyond the 5 years, the risk is not much more.

Q: What is one of the breakdown products of progesterone?

A: One of the breakdown products of progesterone is allopregnanolone.

Q: How does allopregnanolone contribute to sleep?

A: Allopregnanolone plays a role in modulating the activity of gamma-aminobutyric acid (GABA) receptors in the brain, leading to its sedative and anxiolytic effects. These effects contribute to feelings of relaxation and help induce sleep.

Q: Why do some people not experience the sedative effects of allopregnanolone (progesterone)?

A: Individual responses to allopregnanolone can vary due to factors such as genetic differences, variations in hormone levels, and differences in GABA receptor sensitivity.

Q: What factors might influence the lack of benefit from allopregnanolone (progesterone)?

A: Factors such as genetic variations in GABA receptor subtypes, differences in allopregnanolone metabolism, and individual differences in baseline levels of anxiety or arousal may contribute to some individuals not experiencing the sedative effects of allopregnanolone. Additionally, other medications or substances that affect GABA receptors or overall neurochemistry may interfere with the effects of allopregnanolone.

Q: Do individuals who initially don't feel the calming effects of allopregnanolone (progesterone) eventually start to feel them?

A: Some individuals might not immediately experience the calming effects of allopregnanolone, but over time, they may begin to feel its benefits.

Q: How long does it usually take for this change to happen?

A: The time it takes for individuals to start feeling the calming effects of allopregnanolone (progesterone) can vary. For some, it may take weeks or even months of consistent use before noticing a difference. However, not everyone may eventually feel the effects, as individual responses can differ.

Q: Is it possible for individuals to initially respond to the calming effects of allopregnanolone (progesterone) but then stop responding over time?

A: Yes, some individuals may initially respond to the calming effects of allopregnanolone but may later experience a diminished response, where the effectiveness of the treatment decreases over time.

Q: What can be done if someone stops responding to allopregnanolone (progesterone)?

A: If someone stops responding to allopregnanolone, it's important to consult with a healthcare provider. Adjusting the dosage, switching to a different formulation, or taking breaks from its use may help mitigate the diminished response. Additionally, exploring alternative treatment options or addressing underlying factors contributing to the change in response may be necessary.

Q: Why is the progesterone blood test not always reliable?

A: The progesterone blood test may not always be reliable due to various factors that can affect its accuracy and interpretation.

Q: What factors contribute to its unreliability?

A: Factors such as the timing of the test within the menstrual cycle, individual variations in progesterone levels, and differences in testing methods can all contribute to inconsistencies in results. Additionally, factors like medications, underlying health conditions, and lab errors can further impact the reliability of progesterone blood tests. As a result, it's essential to consider these factors and interpret the results in the context of the individual's clinical presentation.

Q: Do men produce progesterone?

A: Yes, men produce progesterone, primarily in the adrenal glands and testes, although in smaller amounts compared to women.

Q: Can men experience sedation from progesterone?

A: While progesterone is not typically associated with sedation in men as it is in women, low levels of progesterone in men could potentially contribute to symptoms such as fatigue and changes in mood, which might indirectly lead to feelings of sedation or lethargy. However, the specific effects of progesterone on mood and energy levels in men are not as well-understood as they are in women.

Q: Where in the adrenal glands is progesterone produced?

A: Progesterone is primarily produced in the zona reticularis layer of the adrenal glands, which is one of the three layers of the adrenal cortex.

Q: How does the production of progesterone in men compare to that in women?

A: In men, the production of progesterone is approximately 10 times less than in women. While men do produce progesterone in the adrenal glands and testes, the amount is relatively smaller compared to what is produced in women's ovaries.

Q: What is the meaning of micronized progesterone (Prometrium)?

A: Micronized progesterone refers to progesterone that has been processed into tiny particles, or microparticles, to improve its absorption and bioavailability in the body. This form of progesterone is often used in hormone replacement therapy and other medical treatments.

Q: How is micronized progesterone (Prometrium) produced?

A: Micronized progesterone is typically produced through a process called micronization. In this process, progesterone crystals are mechanically ground or crushed into very small particles, usually less than 10 micrometers in size. These tiny particles have a larger surface area, which allows for improved absorption when taken orally or through other routes of administration. The micronized progesterone can then be formulated into various pharmaceutical products such as capsules, tablets, or creams for use in hormone therapy.

Q: Why is micronized progesterone referred to as "body identical"?

A: Micronized progesterone is often called "body identical" because its molecular structure is identical to the progesterone produced naturally in the human body. This means that when micronized progesterone is administered, it behaves in the body in the same way as endogenous progesterone, leading to more natural and physiological effects.

Q: What is the process of extracting micronized progesterone from yams and turning it into a pharmaceutical product?

A: The process begins with harvesting yams, which contain diosgenin, a precursor to progesterone. The diosgenin is extracted from the yams and chemically converted into progesterone. Once progesterone is obtained, it undergoes a micronization process, where it is ground into very small particles to improve its absorption and bioavailability. The micronized progesterone is then formulated into pharmaceutical products such as capsules, tablets, or creams for use in hormone therapy. Throughout the process, strict quality control measures are implemented to ensure the purity and potency of the final product.

Q: How is diosgenin extracted from yams and chemically converted into progesterone?

A: The process begins by extracting diosgenin from yams, which are rich in this compound. Once extracted, diosgenin undergoes several chemical steps to convert it into progesterone. This conversion process typically involves multiple chemical reactions, including oxidation, reduction, and rearrangement of molecular bonds, to transform diosgenin into progesterone. Specific chemical reagents and catalysts are used to facilitate these reactions, and the process is carefully controlled to ensure high yields and purity of the final progesterone product.

Q: Do yams contain estrogen and testosterone?

A: Yams contain compounds called phytosterols, including diosgenin, which is a precursor to progesterone. While diosgenin can be chemically converted into progesterone, yams do not naturally contain estrogen or testosterone.

Q: How is body identical estrogen and testosterone produced?

A: Body identical estrogen and testosterone are typically derived from plant-based precursors, such as soy or yam extracts. Through a series of chemical reactions, these precursors are transformed into forms of estrogen (e.g., estradiol) and testosterone (e.g., testosterone cypionate) that closely mimic the molecular structure of the hormones naturally produced in the human body. This process allows for the creation of hormones that are virtually indistinguishable from those produced endogenously.

Q: Does HRT cause bloatng and flatulence?

A: Gassiness or bloating with hormone replacement therapy (HRT) can occur due to hormonal changes affecting gastrointestinal motility and function. Estrogen and progesterone, the hormones commonly used in HRT, can influence smooth muscle tone in the gastrointestinal tract, potentially slowing digestion and leading to gas buildup. Additionally, changes in estrogen and progesterone levels may cause water retention, contributing to abdominal discomfort. Dietary adjustments and individual sensitivity to hormonal changes can also play a role. Consulting with a healthcare provider is important to address these symptoms, as they can evaluate whether adjustments to the HRT regimen, dietary modifications, or other interventions are necessary to alleviate gassiness or bloating.

By Dr Purity Carr

Founder Purity Health Menopause Clinic

Gp & Menopause Doctor



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1 Comment

Unknown member
Apr 23

Hi, in regards to all synthetic progestogens veing the culprit fir breast cancer.

What about dydrogesterone in femoston, i was told thst that is on par with prometrium in regards to breast cancer safety.

The only problem with femoston is the estrogen part is oral and that supposedly comes slong with blood clot risk especially of 60, so what do u do if dont get on with prometrium 🙂

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