Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
The end of your menstrual cycle is a natural time of transition, and may bring on side effects like hot flashes, insomnia, or mood changes. In addition to finding solutions to these side effects, midlife is an important time to focus on total health, an active lifestyle, and regular health screenings.
The average woman goes through menopause at 51 years of age. You may be one of the lucky women who sail through menopause without much difficulty, but most women experience some symptoms.
In fact, you may begin experiencing symptoms of menopause as early as your 40s, and the symptoms may last well into your 50s and beyond.
Recent studies, like the Womens Health Initiative, have led to the recommendation that hormones be individualized and be taken only by women with severe menopausal symptoms that seriously affect their quality of life, and then only for the shortest time necessary to treat their symptoms.
If your symptoms are severe and self-care strategies don't work, you may wish to try hormone therapy. If so, your prescription will usually include estrogen for symptom management and progesterone to balance the estrogen and prevent precancerous and cancerous changes in your uterine lining. If you have had a hysterectomy, you will only need to take estrogen.
If your primary concern is vaginal dryness and pain during love making, then a vaginal estrogen cream or ring will likely take care of the problem. These methods have few or no side effects. Check with us before ordering bioidentical hormones or before seeking medical advice from someone who prescribes these drugs.
It is important to weigh the benefits and risks when deciding whether or not to begin hormone therapy. Although the risks of hormone therapy are not high, they are significant and must be carefully considered. The decision to take hormones is an important one so we will review the pros and cons throughout this article.
Although there are no studies of the best way to stop taking hormone therapy, most medical professionals recommend tapering off hormone doses slowly over a period of 2 to 3 months or longer. This may give your body a chance to adjust to the changes.
Hormone therapy relieves most of the common symptoms of menopause: hot flashes, vaginal dryness, mood changes, irregular bleeding, and insomnia.
In addition to menopause symptom relief, positive effects noted by some women on hormone therapy include:
There are increased risks for a variety of medical conditions, especially for women over 60 who take hormones for 5 or more years. They include an increased risk of:
If you choose to take hormones, you should take them in the lowest possible dose and for the shortest time needed to relieve menopause symptoms, ideally less than 5 years.
Once you stop, many of the benefits disappear quickly, but so do the risks. In light of information from recent studies, we no longer recommend hormones to prevent heart disease or osteoporosis.
Women on hormone therapy (estrogen and progesterone) may experience minor side effects, including:
These side effects of hormone therapy do not harm your overall health but may cause discomfort. We can work together to find a hormone level with the least possible side effects.
If you choose to use hormones to treat your symptoms, we can come up with a plan that is right for you. Unless you have had a hysterectomy, your prescription will likely include both:
In addition, research has shown that a hormone called testosterone may help relieve menopause symptoms.
Some books, TV shows, and magazine articles have touted bioidentical hormones, suggesting that these alternatives are better, safer, and more natural for your body than regular hormones. However, so far no studies have proven that one type of hormone is safer or more effective than another.
Estrogen is a hormone made by your ovaries. It circulates in your bloodstream and turns on cell activity in many parts of the body, including the breasts, uterus, vagina, skin, bones, liver, arteries, and brain. Although estrogen levels drop with the beginning of menopause, your body will still produce some of the hormone.
When taken alone, estrogen may increase the risk of uterine cancer. Be sure to also take progesterone if you have not had your uterus removed.
There are many ways you can take estrogen. We will discuss which form of estrogen is best for you. If you are using estrogen only to treat vaginal problems like dryness or pain during sex, it is best to use a form of estrogen that is applied directly to your vagina. Uncomfortable side effects can sometimes be relieved by lowering your dose or changing from one form of estrogen to another (from the patch to a pill, for example).
Before menopause, progesterone plays a role in regulating other hormones at ovulation and is linked in some literature to a rise in libido and an increase in fertility. Beyond reproductive functions, progesterone may have additional benefits:
Progesterone added to estrogen protects the lining of the uterus (endometrium) from estrogen stimulation that can lead to hyperplasia (a precancerous condition). If you take progesterone in the recommended dose, along with estrogen, you have the same risk of uterine cancer as a woman who is not using hormones for menopause symptoms.
If you choose to take estrogen to manage your menopause symptoms, you also need to take progesterone. However, if your uterus has been removed you do not need to use progesterone.
Progesterone comes in a variety of forms. We will ensure that you take enough progesterone to balance the estrogen you are taking.
Although you may think of testosterone as a male hormone, women also produce testosterone in their ovaries and other organs.
Women whose ovaries have been removed produce less circulating testosterone and may have a decrease in sexual desire or sexual energy. If you went through a normal menopause, you may also feel less sexual desire.
Testosterone may help improve sexual health in women whose ovaries have been removed, as well as in menopausal women who still have their ovaries.
Side effects may include facial hair, increased acne, and increased irritability. Lowering the dose often eliminates these side effects. Rare side effects may also include hoarseness, enlargement of the clitoris, deepening of the voice, and hair loss.
Some studies have shown that testosterone reduces the good kind of cholesterol (HDL), and that it can increase blood pressure. Consequently, there are concerns that adding it to estrogen may have a negative effect on the heart. The other important issue in considering testosterone is that it has not yet been thoroughly tested in women.
The term "bioidentical" describes hormones that are chemically identical to those we make naturally in our bodies. These hormones are made from animal and plant chemicals including soy and yams. They come as pills, patches, creams, and sprays and act like regular hormones in the body.
No studies so far have proven that one type of hormone is safer or more effective than another.
In addition, there are compounds called tri-est or bi-est that combine different types of estrogen with emphasis on a weak estrogen called estriol. These forms of hormones are not approved by the Food and Drug Administration (FDA). However, the hormones estradiol and progesterone are available in their natural form and are approved by the FDA.
No studies so far have proven that one type of hormone is safer or more effective than another.
Concerns regarding the risks of breast cancer, stroke, and heart disease apply to all forms and types of hormones.
Several businesses offer hormone salivary or hair strand testing (cost varies but may be up to several hundred dollars). No laboratory standards exist for this type of testing. Methods of testing may vary across laboratories, and results should be interpreted with caution.
We do not endorse or recommend routine saliva or blood monitoring of hormone levels, as hormone levels fluctuate daily, even during menopause. Doses of hormone therapy are easily adjusted based on a patients symptoms.
If we’ve tried to relieve your symptoms without the use of hormones and were unsuccessful, I may recommend a limited course of hormone replacement therapy to manage severe symptoms of menopause.
If you think hormone therapy might be right for you, please contact me to discuss your symptoms and review the advantages and disadvantages of hormone therapy and other available treatment options.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.
As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.