Dr Derran M Govender treats menopause and perimenopause with injectable hormone replacement therapy at his practice in Durban North. Every treatment plan starts with blood tests. It restores estrogen, progesterone, and testosterone, so that women feel like themselves again.
Menopause symptoms
Falling hormone levels can cause:
- hot flushes and night sweats
- poor sleep
- mood changes, anxiety and irritability
- brain fog and poor concentration
- low energy
- low libido
- vaginal dryness
- joint aches
- weight gain, especially around the middle
These symptoms can start in perimenopause, years before your periods stop.
Blood tests first
Dr Govender checks your hormone levels with blood tests before starting treatment, so that your therapy is based on your actual levels rather than guesswork. These include:
- estradiol
- progesterone
- testosterone
- FSH and LH
- SHBG
- thyroid function
Injectable hormone therapy
Dr Govender uses injectable hormone therapy, which gives steady hormone levels without a daily pill or patch. Your blood results decide which hormone you need:
- estradiol for hot flushes, night sweats, poor sleep and vaginal dryness
- progesterone for sleep, mood and cycle-related symptoms
- testosterone for energy, libido, mood and muscle strength
Every woman needs estrogen
The vagina, vulva and bladder all depend on estrogen. When it falls, these tissues become thin, dry and fragile. That leads to discomfort, painful sex, recurrent urine infections and leaking. These changes keep getting worse without treatment. They are not something women simply have to live with.
Does HRT cause cancer?
Much of the fear about HRT comes from the Women’s Health Initiative (WHI), a 2002 study that used older synthetic hormones (horse-derived estrogen and a synthetic progestin) in women who were, on average, 63 and more than a decade past menopause. The headlines overstated the risk, and newer research tells a different story. Over 18 years of follow-up, women in the WHI trials were no more likely to die from cancer, or from any cause, than women on placebo. Women who took estrogen alone had fewer breast cancers and fewer breast cancer deaths. A French study of more than 80,000 women found that estrogen combined with natural progesterone did not raise breast cancer risk, unlike estrogen combined with synthetic progestins. A Danish trial that started HRT in women around 50 found fewer heart attacks and heart failure admissions, with no rise in cancer. For most women who start HRT around the time of menopause, the benefits outweigh the risks.
Monitoring and follow-up
Dr Govender repeats your blood tests after you start treatment and adjusts the dose until your levels and symptoms are where they should be. After that, you have regular reviews to keep your treatment on track.
What to bring
Please bring:
- your ID
- your medical aid card, if applicable
- a list of your current medicines and supplements
- any previous hormone blood test results
Fees and medical aid
The practice accepts all major medical aids. For fees, contact the practice.
Appointments
The practice is open Monday to Friday, 09:00 to 17:00, and walk-ins are welcome. Book an online or in-person appointment.
Frequently asked questions
What are the first signs of menopause?
The first signs are often changes to your periods. They may become irregular, heavier or lighter. Many women also notice poor sleep, night sweats, mood changes or anxiety, brain fog and low libido. These usually start in perimenopause, often in your 40s.
Can menopause start at 40?
Yes. Perimenopause often starts in your early to mid-40s, and some women notice symptoms from their late 30s. If menopause happens before 40, it’s called premature menopause. Blood tests confirm your hormone levels so that treatment can start early.
How do I know if I need hormone replacement therapy?
You may benefit from HRT if menopause symptoms such as hot flushes, poor sleep, low mood, brain fog, low libido or vaginal dryness are affecting your quality of life. Blood tests show which hormones are low, and that tells Dr Govender which treatment is right for you.
References
- Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials. JAMA. 2020;324(4):369–380. Read source
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. Read source
- The NAMS 2020 GSM Position Statement Editorial Panel. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020;27(9):976–992. Read source
- Davis SR, Baber R, Panay N, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666. Read source
- Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA. 2017;318(10):927–938. Read source
- Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008;107(1):103–111. Read source
- Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012;345:e6409. Read source