Early Menopause Treatment

Every year thousands of women between the ages of 15 and 44 experience an "Estrogen Crash", a sudden drop in estrogen levels that leaves women in the clutches of early menopause. Although menopause is traditionally seen as a problem in older women, the many younger women who experience early menopause find themselves unprepared for the unexpected changes that occur.

Estrogen Crash occurs when both of a woman's ovaries are removed or suddenly stop functioning. When this happens the body stops producing estrogen.

"Naturally, menopausal women have a gradual decline in estrogen levels over a two to ten year period. In contrast, estrogen output of younger women who have undergone surgical menopause or ovarian failure is cut abruptly," said Dr. Lila Nachtigall, MD, Director of the Woman's Wellness Division at New York University Medical School. "The result is the sudden and immediate arrival of vasomotor symptoms: hot flashes, night sweats, associated sleep disturbances, and vaginal dryness."

Over half a million women undergo hysterectomies annually in the United States and slightly more than half of the hysterectomies include bilateral oophorectomy—the removal of both ovaries. More than 20% of women who undergo bilateral oophorectomy are under 40. About one in 100 women will develop ovarian failure before age 40.

Woman sitting in front of fan suffering from menopause symptoms
Sean De Burca / Getty Images

Menopause vs. Estrogen Crash

Women who experience premature menopause often experience menopause considerably different from women who experience natural menopause at an older age. In natural menopause, estrogen levels decline gradually over a period of from 2 to 10 years, while surgically menopausal women encounter a sudden drop in estrogen.

"In general, a woman going through natural menopause will not experience vasomotor symptoms as consistently," said Dr. Lila Nachtigall. "It's more progressive. A patient may have one bad month here or there. But in the case of bilateral oophorectomy, the effects are much more drastic and young patients, in particular, can experience severe reactions."

In Dr. Nachtigall's practice, 100% of surgically menopausal women had vasomotor symptoms and 90% of these women experienced severe symptoms that lasted an average of 8.5 years. In contrast, while as many as 85% of naturally menopausal women experience hot flashes, only about15% experience severe symptoms. By the time women reach natural menopause, about 43% report moderate to severe symptoms which subside after approximately 2 years.

Women who experience sudden menopause after bilateral oophorectomy are often too ill immediately after surgery to swallow pills. Many times doctors prescribe an estrogen patch which is worn on the skin and delivers estrogen through the skin into the bloodstream over a period of days. The benefit of the estrogen patch is its time-released delivery.

The smallest of these patches is Vivelle-Dot. The .05 mg/day dose is the size of a postage stamp and about 75% smaller than average estrogen patches. It is worn on the lower abdomen where it delivers estradiol through a transdermal skin patch into the bloodstream. Estradiol is the primary estrogen produced by the ovaries. Vivelle-Dot is changed twice weekly and lasts through showers, swimming, and other daily activities without coming off. The patch provides relief from hot flashes, night sweats, and other symptoms of Estrogen Crash or natural menopause.

Vivelle-Dot is available in three other dosage strengths; .0375, .075, and .1 mg/day. The most commonly reported side effects were mild headaches and slight skin irritation.Systemic adverse events with Vivelle(R)* (estradiol transdermal system) and placebo, respectively, include headache (36% vs. 30%),breast tenderness (4.9% vs. 1.1%), and fluid retention (3.8% vs.2.2%). Some patients taking Vivelle-Dot(TM) 0.0375 mg/day may experience a delayed onset of efficacy.

Certain women should not use estrogens. This includes women with known or suspected pregnancy, undiagnosed abnormal genital bleeding, breast cancer, estrogen-dependent neoplasia, active thrombophlebitis or thromboembolic disorders, or a documented history of these conditions. Estrogens have been reported to increase the risk of endometrial carcinoma in postmenopausal women.

W. Neil Jones, Executive Director Marketing and Sales of Noven Pharmaceuticals, Inc. says the media and healthcare community should help younger women understand the possible consequences of Estrogen Crash so that they will be able to make the proper decision should they find themselves faced with early menopause.

Vivelle-Dot(TM) is marketed by Novogyne Pharmaceuticals, a joint venture between Novartis Pharmaceuticals Corporation of East Hanover, New Jersey, and Noven Pharmaceuticals, Inc. of Miami, Florida.

*The original formulation (Vivelle)(R) that was tested in clinical trials has been revised to reduce the patch sizes and the revised formulation (Vivelle-Dot)(TM) was shown to be bioequivalent to the original formulation.

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