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Menopause Therapy Research

Part 1
Resource #1 Age at menopause: Do chemical exposures play a role?
Experts are looking at a potential influence between environmental
exposures and age of menopause. This is something that is still in the early stages
but there is research suggesting that there could be a link between endocrine-
disrupting compounds and early menopause. The long-term implications of early
menopause can be severe. There is still a lot of research to be done especially
because isolating effects of chemicals can be difficult among many other influences
that can impact the beginning of menopause. In the 1970s, the first evidence came
about that exposures could cause early menopause, through exposure with tobacco
smoke. Since then, other chemicals such as dioxins, polychlorinated biphenyls, and
phthalates have been associated as well. The natural start of menopause can depend
on several different factors such as genetics, body weight, activity, smoking, and
contraceptive use. One exposure associated with early menopause is smoking.
Studies had shown that woman who smoke on average begin menopause 1 to 2
years earlier. It may seem as not much, but the potential consequences overall can
be large. Recently, scientists also discovered that secondhand smoke could
accelerate menopause as well. The Womens Health Initiative observational study
estimated that nonsmokers exposed to secondhand smoke started menopause 13
months before those not expose to smoke. Hydrocarbons in tobacco smoke reduce
the number of developing follicles, inhibit estrogen synthesis, and enhance
metabolism of estrogen in the live. Several chemicals such as mono-(2-ethyl-5-
hydroxyhexyl)phthalate are speculated to slowly damage the follicular pool or
impede the production of oocytes in utero. It is hard to tell what is being targeted
because of feedback loops. It is important to use humans and not animals because
the animals do not have the same fundamental features of the reproductive cycle.
Ongoing research is attempting to focus on environmental health research and
chemicals in human life (Schmidt, 2017). This is a new perspective on menopause,
because it looks at whether there are other causes rather than the natural ones
within the body, that cause menopause. Smoking and even drug use is a large
problem in todays times. For instance, if there is a link to secondhand smoke and
menopause, then that can be a large scale problem simply because so many people
are exposed to it these days. By smoking, they are harming themselves but also
dozens of others that are around them, breathing in their smoke. It could be that
there are chemicals within the environment that are causing menopause to begin
earlier, which could in turn cause earlier death ages due to earlier instances of
cardiovascular disease, cancer, etc.

Resource #4 Comparative Assessment of the Effects of Hatha Yoga and Physical


Exercise on Biochemical Functions in Perimenopausal Women
Yoga therapy can relieve stress, enhance health, improve fitness, and manage
symptoms of a variety of disorders. Hath yoga is one of many alternative therapies
and is a good approach to life style disorders, that is not pharmacological. Controlled
breathing, posture, and meditation help improve strength and wellbeing. With
physical exercise, it is beneficial in toning muscles, strengthening the heart and
lungs, and blood pressure. The study was done with 216 women that were between
the ages 40 and 60. One group participated in yoga and the second group
participated in physical exercise, this was the control group. This study is the only
study in which only yoga and exercise are studied with premenopausal women.
Because perimenopause is stressful, exercise and yoga can be helpful in decreasing
stress. The nature of yoga is relaxing and calming and this can be as beneficial or
maybe better than exercise. Yoga helps with a general feeling of wellness and the
perception of the quality of life (Chaturvedi, Nayak, Nayak, & Rao, 2016). This study
brought a very different perspective. The perspective is not pharmaceutical and it is
not saying you should take something, but rather it is suggesting to lessen stress you
could participate in yoga. By participating it yoga, it helps to reduce stress and
increase flexibility. One thing that is supposed to help in not only menopausal years
but all other years with health, is physical activity. Yoga is a form of physical activity.
It is a different approach and perspective to many things we have been learning
about.

Resource #11 Menopause and Hormones: Common Questions


This resource has many commons questions for people regarding menopause. It
begins with answers the most common question, what is menopause? and then
answers many more common questions. Menopause is the change in a womans life
in which her period stops. This website also mentions that this a normal change.
During this time, the body produces less estrogen and progesterone, often between
45 and 55 years of age. Menopause has been reached when a period has not been
had in 12 months in a row. Symptoms of nearing menopause include changes in
period, hot flashes, night sweats, vaginal changes, and thinning of bones. Some
women do not undergo treatment while some women chose a treatment such as
hormone therapy. Hormone therapy is the addition of estrogen or estrogen and
progestin. If choosing this therapy, they should be used at the lowest dose and
shortest time that helps. People that should not take hormone therapy include
women who: are potentially pregnant, have problems with vaginal bleeding, have
had cancer, have had a stroke or blood clots, or have liver disease. Benefits of
hormones could include helping to relieve hot flashes, night sweats, or vaginal
dryness. They also could reduce osteoporosis chances. Risks of hormones include
increase in chance of blood clots, heart attack, stroke, breast cancer, and
endometrial cancer. All forms of hormones, for example pill, patch, or cream, all
have the same benefits and risks. There is no evidence that the hormone estriol is
safe and effective to be used, as well as herbs and natural products. There are FDA
approved treatments that are non-hormonal such as a treatment for hot flashes.
Hormones could be used for osteoporosis but there are other ways to help bones.
Hormones should not be used to protect the heart, prevent memory loss, or aging
(U.S. Food and Drug Administration, 2017). I think this website specifically, could be
very helpful for women who do not know as many medical or science terms. It had a
lot of simple information that I think most people would be able to understand. It
was also set up in a way that did not include a lot of words or reading. It gives a
simpler perspective rather than a more scientific perspective. The information is
true and correct and the website is credible.
Resource #12 Obesity in Menopause
Obesity is three times more often to be found in menopausal women than
any other period of their lives. The question regarding this is, is the obesity from
menopause or is it from negligence in diet and activity during this time? Overweight
and obesity is defined as abnormal or excessive fat accumulation that may impair
health. Obesity is one of the most important things associated with menopause
because it is a medical, social, and economic problem. In the United States, 65% of
women between 40 and 65 years are obese. In women over 65, the rate is about
74%. Estrogen is responsible for the accumulation of fat in the subcutaneous tissue
in the gluteal and femoral regions. Androgens are responsible for fat accumulation
in the abdominal region. Therefore, the lack of estrogen could be responsible for the
redistribution of fat. It also could be said that estrogen is involved with energy
balance and reduce appetite so the decline could contribute to increased appetite.
Although hormone changes can contribute to weigh gain, there are also other
factors to look at, such as genetic and environmental factors, lifestyle changes, and
medications. Because there is a growing overweight and obesity population, this
problem is socioecomic as well and not simply individualistic in nature. It can be
effectively counteracted against by implementing healthy choices for a healthy
lifestyle and if appropriate, using hormonal therapy (Kozakowski, Gietka-Czernel,
Leszczyska, & Majos, 2017). The perspective that this study brings about is weight
gain potentially due to menopause. I thought it was really shocking to see the
statistics of the amount of obese or overweight women. This study brings up the
point that is could be due to lack of hormones, but it also could include other factors.
I think it should have mentioned the limitations of the environmental factors.
Obesity is rising in the United Stated but not just in menopausal women. I think the
perspective brought about some bias. Rather than implying that there are other
causes as well, it implied menopause has a big part in obesity.

Resource #22 Womens Health Initiative


The Womens Health Initiative (WHI) began in 1991 by the National Institutes of
Health (NIH) in order to address issues in postmenopausal women that were
causing morbidity and mortality. There were three clinical trials and an
observational study done. It was one of the largest prevention studies in the United
States with a budget of $625 million and 160,000 women aged between 50 and 79.
In 2014 there was an economic return calculated at $37.1 billion for one portion of
the trial. Some of the motivation behind the study was because in the past the
research focused on white men. The NIH then created the Office of Research on
Womens Health, in 1990, because they wanted to promote the study of women. In
order to obtain funding, the BIH required including women, rather than just
recommending it. Some leading causes of morbidity in postmenopausal women are
cardiovascular disease, cancer, and osteoporosis. In all of the age groups of woman,
cancer and cardiovascular disease are leading, but women over 50 are leading.
People were generally accepting that estrogen deficiency could play a role in this
and there were concerns to if women would sufficiently adhere to the hormone
treatment regimens. In 1987 there was the Postmenopausal Estrogen/Progestin
Intervention (PEPI) done. In this trial, treatment of estrogen, estrogen and
progestin, or a placebo were given to 875 women. It was successful in terms of
adherence and a lot of the procedures from this trial were then used in the WHI
clinical trial. In 1991, the first female director of the NIH, Dr. Bernadine Healy,
announced the plan for the WHI. The Clincal Coordinating Center went to the Fred
Hutchinson Cancer Research Center. This center was to coordinate the study clinics
nationwide. The WHI had a careful organizational structure because of the large
scale. This was during the time of early Internet, so e-mail was helpful in
information exchange. The age range of women participating was so wide so the
effect of the therapy could be examine on the younger women in additions to
looking at the outcomes in the older women. In order to accurately represent
minorities as well, one-fourth of the clinical centers were used as minority
recruitment centers. The women then joined hormone therapy, dietary
modification, or both. After a year in the trial the women were asked to just a trail
for calcium and vitamin D. If the women did not want to participate in the clinical
trial or could not, then there was the option to enroll in an observational study. For
the hormone therapy component, the hypothesis was that there would be a
decrease in coronary heart disease and osteoporosis due to estrogen therapy and an
increased risk in breast cancer was the potential adverse outcome. The pills were
stopped in 2002 because there was an indicated risk of coronary heart disease,
stroke, and breast cancer to name a few. The authors recommended after the study
that hormone therapy not be used to prevent disease. In the years following, there
appeared to be a decrease in breast cancer rates in postmenopausal women, which
studies linked to less use of hormone therapy. In regards to the dietary study there
was no significant results in reduction of heart disease, breast cancer, or stroke.
With the calcium and vitamin D study, there was a significant improvement in the
density of the hip bone, but no other effects were observed. There was an adverse
effect though, the increase of kidney stone. Afterwards, there were three extensions
of the WHI. Presently, the third extension is active, until 2020 (Wikipedia, n.d.). The
perspective that this source gives is information on a specific large-scale study
dealing with menopause. The page gave a lot of good information regarding this
study. It was interesting because it is something that I have never heard of before. I
did not realize that there was something this large-scale regarding menopause. It
gives a more scientific approach because it details a specific study with their
findings. I found it interesting that this study is still in progress today, as one of the
three extensions.

Part 2
Pros/Benefits:
Most effective treatment for hot flashes and night sweats
Can ease vaginal symptoms (Mayo Clinic, n.d. a)
Role in preventing osteoporosis (Womens Health Concern, 2017)
Cons/Risks:
Increased risk of heart disease, stroke, blood clots, breast cancer (Mayo
Clinic, n.d. a)
Can have serious health risks if taken in high doses for a long time
Risks are higher in older women, such as over 60 years old (North American
Menopause Society, n.d.)

I am in between what I would recommend to my female patients regarding


hormone therapy. Through this class I have learned so many things regarding
therapy that makes it sound bad, but on the other hand there are things that make it
sound good. I think that I would first tell my patients to wait it and manage
symptoms as best as they can before they turn to HRT. If I were in that position I
would try other things before turning to this. My mom is currently going through it
and I see it all the time. She is not taking anything extra, rather just managing it the
best she can on her own. I see first hand that she is doing okay managing it and not
using HRT. So, it is manageable without HRT or other medications because I see that
with my mom. Research says that if you are going to use HRT then use the lowest
dose and the shortest amount of time. So, I would recommend that if they do decide
to do that then that is what they should do. I would also give them credible websites
to do their own research before they decide. They should know all the risks as well
and make their own decision on if it is worth it. If a patient decides that the benefits
outweigh the risks on their own then I will not be against that. It is their quality of
life and their decision. From other knowledge through this course, women are
already at a risk for some of the diseases mentioned in the risks, so that makes me
think well is that really a risk if they are already at an increased advantage? If taken
at a low dosage and short term, then the benefits can outweigh the risks and I could
stand behind recommending HRT to them.

Part 3
Diet
Vegetables and fruits high in vitamin C and antioxidants to help with aging
Soy and flaxseeds contain dietary phytoestrogens
Fiber-rich whole grains (oatmeal, quinoa, brown rice) help to fill you up so
you don't eat as much
Unsaturated fats such as nuts, seeds, avocados, fatty fish, and olive oil
Calcium to protect bones, approx. 1,200 milligrams daily, can get it from
low-fat dairy, sardines, salmon, broccoli, and kale
Vitamin D (& oily fish) help to absorb calcium

Avoid foods full of added sugar and salt sugar promotes weight gain and
salt can lead to high blood pressure and cardiovascular problems
Cut back on empty calories in sugary treats and drinks
Eat a diet of 1,200 calories daily and stick to it
It is important to not just cut calories and cut them too low, this can cause
other problems and not lead to weight loss
Drink a lot of water (Martinac, 2017)

Exercise
Dont be sedentary being physically active helps to either drop to a healthy
weight or stay at a healthy weight, get up and move, even just walking helps
Aerobic exercise burns fat & improves cardiovascular health
Strength training enhances lean body mass & counteracts loss of bone
density
Stretching maintains range of motion
Do a combination of the 3 types of exercise, aerobic, strength training, and
stretching
Exercise for at least 30-60 minutes at least 3 times a week (Hill, 2017)

The most effective way to maintain a healthy weight with diet, is eating high-
quality foods such as fruits and vegetables, whole grains, and the healthy fats and
proteins. A person will get more from these foods rather than eating high calorie
foods with no or little nutritional value. It is important to find a diet that works for
each person and their individual body based on their likes and dislikes. Another
effective way is cutting sugars, sugary drinks, and all the calories with no nutrition.
This can cause great changes in a persons weight just by doing this and switching to
water. While cutting sugars and eating better can help a person lose weight, the
most beneficial will be better eating with a combination of physical activity. Physical
activity can be beneficial in promoting better health through a healthier heart and
lungs. This helps a person lose weight but also lower their risk of cardiovascular
disease, heart attack, etc. Exercising will burn more calories in your body than just
the normal that are used every day. Anything that keeps you moving and your heart
rate elevated is beneficial (Kendall, 2017).

Part 4
Osteoporosis is a condition characterized by porous bones that are weakened
and brittle. As people age, bone breakdown occurs more than bone buildup, so there
is a loss of bone mass. The holes in the bone grow larger and more numeroud with
weakens the insides of the bones. Womens bones to begin with, are lighter and
thinner than mens bones generally. Also, the decrease of estrogen can cause bone
density loss because normally it helps to protect bones. There is a direct
relationship between the loss of estrogen and the development of osteoporosis.
Women are four times more likely than men to develop osteoporosis. As much as
half of the total bone loss can occur within the first ten years post-menopause. In
some women, the bone loss can occur rapidly and severely. The longer that a female
is without estrogen, the greater the bone density loss will be (International
Osteoporosis Foundation, n.d.).
Prevention:
Adequate calcium intake from childhood and beyond
Regular physical activity
Avoid under-nutrition
Avoid smoking and alcohol

Treatment:
Calcium and Vitamin D
Hormone replacement therapy
Raloxifene hormone like medication
Bisphosphonates
Denosumab if cannot take bisphosphonates
Teriparatide for men and postmenopausal women with very low bone
density
Abaloparatide new medication with potential to rebuild bone
Hormone replacement therapy is one of the best treatments, but there are
still issues between whether the risks are too great

(Mayo Clinic, n.d. b)

Part 5
Recommend:
Black cohosh is a plant from North American that was primarily used for
menstrual problems and childbirth by American Indians. This is one of the most
studied botanical to use in menopausal women. The mechanism is not understood
but some studies do suggest that there is an estrogenic activity, but it is not
estrogenic. With the 12 clinical trials using this for menopause, only one showed
negative results with vasomotor symptoms. The most common side effect is mild
gastric complaints. Ideally it is suggested for women with breast cancer since it is
not estrogenic. One negative thing is, long term conditions have not been studied
with this. Scientists found black cohosh is an equivalence of conjugated estrogens on
improving symptoms for menopause (Geller, 2005). I would recommend this to
patients because there are studies done that show there are positive results. Also,
the side effects seem minor and there are no documented cases of drug interactions.
Out of all the herbal remedies, this seems to be safe to use. I have even found a study
that explains why it could be of good use. When looking for recommendations this is
what I want to see, published evidence that it is something good for the body and
not harmful. I also want to know that it works, which this publication shows that it
does.

Soy foods and supplements are an interest in the reduction of symptoms of


menopause because they have a high concentration of phytoestrogens. They have
properties of estrogen but the mechanism is not understood completely. It appears
that they may be safe for breast tissue because they do not affect in vivo biological
indicators of estrogenicity. Soy is most studied fro menopause symptom alleviation
but there is still no clear role in how they reduce menopause. There is promise in
bone conserving or improvement in bone density. Studies have also show there is
no increased risk of endometrial cancer. Data is minimal but there are
cardiovascular benefits and potential effects with bone density (Geller, 2005). I
would recommend this because it appears to be a promising treatment, it is natural,
and does not appear to have any bad side effects associated with it. It also does not
seem to effect breast or endometrial important. I think that is really beneficial to a
patient because they are not having all the added estrogen to increase their risk of
developing breast cancer. Soy is also a material in many foods so it is something that
many people already consume in their diet. I would not be opposed to increasing the
soy in a persons diet to help combat menopause symptoms. There is also a potential
in helping with bone density with soy. That is big since osteoporosis is a great risk
for many women. If they can increase bone density with this rather than HRT, then
it could be safer for their health. I would recommend it based on the fact that it is a
safer alternative for women.

Valerian is a grass and the root can be used to treat disorders such as
dizziness, neural pains, anxiety, and menopause symptoms because of its
phytoestrogenic components. Phytoestrogens are complexes like estrogen that can
be found in plants and have estrogenic and antiestrogenic qualities. In a study I
found, valerian root was an effective treatment in reducing hot flash frequency is
some women. It is unsure how valerian root works although it could be through the
increase of gamma aminobutyric acid. It seems to work best after talking it regularly
for more than a few weeks (Mirabi & Mojab, 2013). The side effects appear to be
minimal, such as headaches, dizziness, and gastrointestinal disturbances, according
to the NIH (National Institutes of Health, 2013). I would recommend this root to a
patient to try because I believe it could be beneficial in helping them. If my patient
were looking for an herbal remedy, it seems to be a safe alternative than some
treatments. Although I would warn patients that it could make them drowsy
because it can also be used for insomnia. So, it would need to be taken at a lower
dosage. There are studies and credible sources that reference using this root. So,
since the information is credible, the side effects do not seem too severe, and it
appears to work to help hot flashes, I would recommend this to a patient.

Not Recommend:
Gotu kola is a plant that has been used for many years in India, China, and
Indonesia to treat many different conditions. It is used in the United States in
ointments to help with minor wounds or treat psoriasis. Side affects are rare but can
be things such as skin allergy and burning sensations, headache and extreme
drowsiness. There and also many interactions that can happen. One severe
interaction can cause liver damage if taken with other drugs that affect the liver as
well. It can act as a diuretic and rid the body of access fluid. This can be harmful and
cause the body to lose too much fluid. Gotu Kola acts as a sedative and could interact
with anxiety or insomnia medications and make the reaction stronger (Ehrlich,
2015). I would not recommend this herb because I think that the side effects and
reactions are too great. It can also affect women over 65 so I think that this would
not be beneficial to recommend since post-menopausal women could fall at this age
range. They would have to take a lesser dose and work their way up. I think there
could be better therapies out there that are safer with fewer side effects. I would not
want to recommend something that I do not feel is totally safe because I am
supposed to be looking out for their best interest. I would not want to make them
feel worse than they already do or give them more problems than they already have.

The menopause magnet is a small magnet that is fixed on the front of a


womans underwear. According to 71% of women that have tried it, they agree that
is works. It claims to reduce menopausal symptoms such as hot flashes, water
retention, and mood swings. The magnet supposedly works by balancing the
autonomic nervous system by reducing excessive activity of the sympathetic
nervous system and increasing activity of the parasympathetic nervous system. It
does this because hormonal changes can affect the equilibrium of the nervous
system. The makers of the magnet also claim that is works in a way to not activate
the fight or flight response that increases heart rate and body temperature. Users
also claims that there are few if any side effects. The magnet is supposed to work for
5 years (Simmonds, 2017). I would not recommend this product because to me it
seems crazy that a magnet would be able to do that. If it could, I also question if this
would be safe. In order to fully believe this I think I would need scientific proof,
which I did not find, showing that it does in fact work. Women claim that it works
but I cannot believe that that is not all in their head because they believe it will
work. I would not recommend something to patients that does not have any
scientific background available. I would never recommend something to a patient
that I do not believe in myself, and this is something I do not believe in.

Passion flower is a herb that come died, liquid, as a capsule, or as a tablet. It


could be used for anxiety, insomnia, pain, menopausal symptoms, and attention
deficit disorder (National Center for Complementary and Integrative Health, 2017). I
would not recommend passion flower to patients for several reasons. One reason is
that when researching I saw that there is not very much credible information on
studies available and most of the websites do not seem credible either. For example,
one website for a doctor has a blog type post without references, promoting
passion flower. He mentions a study that I am not sure if even is a credible study.
Also, the website has many popups for his book, to subscribe, to check out this or
that, etc. I did find one site, University of Maryland Medical Center, that gave
credible information about passion flower, but it mostly talked about insomnia and
anxiety and not about menopause. Conclusions are not very well known if this herb
works well or not because mostly it is used in combination with other herbs. Finally,
I found a website, the National Institutes of Health, that I know to be credible. The
website is National Center for Complementary and Integrative Health. The NCCIH
does not have much information on it about passion flower. It has a little bit of
background information, and then says that the effects of passion flower have not
been studied extensively. It also mentions that the studies have serious
complications do they do not support its use. I think that if the NCCIH does not
support the use of passion flower then I should not support it either. Overall, I
would not was to recommend this to a patient because if I was not knowledgeable
about a therapy then I would not want to just recommend it to them. I would rather
have a lot of knowledge that I know to be right, before I tell them to take something.
References

Chaturvedi, A., Nayak, G., Nayak, A. G., & Rao, A. (2016). Comparative Assessment of
the Effects of Hatha Yoga and Physical Exercise on Biochemical Functions in
Perimenopausal Women. Journal of Clinical and Diagnostic Research: JCDR,
10(8), KC01KC04. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028509/

Ehrlich, S.D. (2015). Gotu kola. University of Maryland Medical Center. Retrieved
from www.umm.edu/health/medical/altmed/herb/gotu-kola

Geller, S.E. (2005). Botanical and Dietary Supplements for Menopausal Symptoms:
What Works, What Doesnt. J Womens Health (Larchmt), 14(7). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764641/

Hill, C. (2017). Successful Weight Loss Plan for Menopausal Women. Livestrong.
Retrieved from https://www.livestrong.com/article/466276-successful-weight-
loss-plan-for-menopausal-women/

International Osteoporosis Foundation (n.d.) What is Osteoporosis? Retrieved from


https://www.iofbonehealth.org/what-is-osteoporosis

Kendall, K. (2017). How to Lose Weight. Body Building. Retrieved from


https://www.bodybuilding.com/fun/how-to-lose-weight.html

Kozakowski, J., Gietka-Czernel, M., Leszczyska, D., & Majos, A. (2017). Obesity in
menopause our negligence or an unfortunate inevitability? Przegla d
Menopauzalny = Menopause Review, 16(2), 6165. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509974/

Martinac, P. (2017). The Best Diet for Post-Menopausal Women. Livestrong.


Retrieved from https://www.livestrong.com/article/232549-the-best-diet-for-
post-menopausal-women/

Mayo Clinic (n.d. a). Hormone therapy: Is it right for you? Retrieved from
https://www.mayoclinic.org/diseases-conditions/menopause/in-
depth/hormone-therapy/art-20046372

Mayo Clinic (n.d. b). Osteoporosis treatment: Medications can help. Retrieved from
https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-
depth/osteoporosis-treatment/art-20046869

Mirabi, P., & Mojab, F. (2013). The Effects of Valerian Root on Hot Flashes in
Menopausal Women . Iranian Journal of Pharmaceutical Research: IJPR, 12(1), 217
222. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813196/
National Center for Complementary and Integrative Health (2017). Passionflower.
Retrieved from https://nccih.nih.gov/health/passionflower

National Institutes of Health (2013). Valerian. Retrieved from


https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/

North American Menopause Society, (n.d.). Hormone Therapy: Benefits and Risks.
Retrieved from https://www.menopause.org/for-
women/menopauseflashes/menopause-symptoms-and-treatments/hormone-
therapy-benefits-risks

Schmidt, C.W. (2017). Age at Menopause: Do Chemical Exposures Play a Role?


Environmental Health Perspectives, 125(6). Retrieved from
https://ehp.niehs.nih.gov/EHP2093/

Simmonds, S. (2017). The LadyCare Menopause Magnet: What is it and What Does it
do? Woman and Home. Retrieved from http://www.womanandhome.com/diet-
and-health/542462/ladycare-menopause-magnet

U.S. Food and Drug Administration (2017). Menopause and Hormones: Common
Questions. Retrieved from
https://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118624.htm

Wikipedia (n.d.). Womens Health Initiative. Retrieved from


https://en.wikipedia.org/wiki/Women%27s_Health_Initiative

Womens Health Concern (2017). HRT: Benefits and Risks. Retrieved from
https://www.womens-health-concern.org/help-and-advice/factsheets/hrt-
know-benefits-risks/

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