In recent decades, doctors have routinely prescribed hormone replacement therapy and drugs to treat menopause and menopausal symptoms and reduce the risk of osteoporosis and cancer.
But the results of recent studies, which have raised serious questions about the benefits and risks of such treatment, have forced most women to stop using hormones.
So what to do? Should I be treated this way or not?
Read on to find out the answers to the most common questions about this popular but controversial menopause remedy and see if it might be right for you.
This treatment is used to reset the body's natural hormonal levels, either as estrogen for women who have had a hysterectomy, or as estrogen with progesterone for most menopausal women.
Why hormones are replaced and to whom it isneed?
Many women of childbearing age have hormonal problems that lead to infertility and inability to bear a child. Then, in order to prepare the uterine lining for egg implantation, women take estrogen in combination with progesterone, which, in addition to this, perform many other functions.
They help the body retain calcium (important for strong bones), help maintain he althy cholesterol levels, and support a he althy vaginal flora.
With the onset of menopause, the amount of natural estrogen and progesterone produced by the ovaries plummets, which in turn can lead to symptoms such as hot flashes, night sweats, vaginal dryness, painful intercourse, mood swings, and problems with sleep.
Menopause can also increase the risk of osteoporosis. By replenishing the body's supply of estrogen, hormone replacement therapy for menopause can help relieve menopausal symptoms and prevent osteoporosis.
Estrogen alone is commonly given to women who have had hysterectomy or adnexectomy. But the combination of estrogen and progesterone is suitable for those who have a preserved uterus, but who need hormone replacement therapy during menopause. For these women, estrogen-only use may increase the risk of endometrial cancer (the lining of the uterus).
This is because during reproductive years, endometrial cells are shed during menstruation, and if menstruation stops and the endometrium is no longer shed, the addition of estrogen can cause overgrowthuterine cells, which in turn leads to cancer.
Progesterone supplementation reduces the risk of endometrial cancer by causing menstruation every month.
Who can take treatment and who can't?
Women with menopausal symptoms and those with osteoporosis as a hereditary disease are candidates for hormone replacement therapy.
Women who have had breast cancer, who have a history of cardiovascular disease, liver disease or blood clots, and women without menopausal symptoms, this treatment is contraindicated.
When should a woman start hormone replacement therapy for menopause and how long does the treatment last?
Although the average age of menopause is believed to be 50 years old, and in many cases the most severe symptoms often last for two to three years, there is no exact age limit when menopause can begin.
According to doctors, taking low-dose drugs is the most effective way to get the benefits of hormone replacement therapy after the age of 50. These drugs reduce the possible risks of heart disease and breast cancer. Doctors limit such treatment for women to four to five years. During this time, the most severe symptoms disappear, and you can continue to live without medication.
What types of drugs are there?
Both estrogen and estrogen-progesterone products are available as tablets, gel, patch andvaginal cream or ring (the latter two are most often recommended for vaginal symptoms only).
According to some doctors, low doses in a patch are the best treatment, because it delivers hormones directly into the bloodstream, bypassing the liver, and therefore reduces the possible effects of taking. For hormone replacement therapy, drugs should be chosen especially carefully and only as directed by a doctor.
What is menopause?
Menopause is the time when the menstrual cycle stops. This diagnosis is made after 12 months have passed without menstruation. Menopause can occur between the ages of 40 and 50.
Menopause is a natural biological process. But physical symptoms, such as hot flashes, emotional instability, can disrupt sleep, lower vitality, and affect he alth. There are many effective treatments, from lifestyle changes to hormone therapy.
There are three stages of natural menopause:
- premenopause (or transitional menopause) is the time between the onset of symptoms and 1 year after the last menstrual period;
- menopause - one year after the last menstruation;
- postmenopause is all the years after menopause.
Symptoms
In the months or years before menopause (perimenopause), you may experience the following signs and symptoms:
- irregular periods;
- vaginal dryness;
- tides;
- chill;
- night sweats;
- sleep problems;
- mood change;
- weight gain and slow metabolism;
- thinning hair and dry skin;
- breast loss of firmness.
Symptoms, including changes in menstruation, are different for every woman.
The disappearance of periods during perimenopause is common and expected. Often the menstrual cycle disappears for a month and returns or disappears for several months, and then goes on as usual for a while. Bleeding can last less time, therefore, the cycle itself decreases. Despite irregular periods, pregnancy is still possible. If you feel a delay, but are not sure that the menopausal transition has begun, take a pregnancy test.
When should I see a doctor?
Every woman should see a doctor regularly for disease prevention and he alth, and continue to receive appointments during and after menopause.
Prophylactic treatment may include recommended he alth screening tests such as colposcopy, mammography, and ultrasound of the uterus and ovaries. Your doctor may recommend other tests, including a thyroid exam, if you have inherited conditions. With hormone replacement therapy after age 50, the frequency of visits to the doctor should be increased.
Always see a doctor if there is vaginal bleeding after menopause.
Menopause or thyroid problems?
The thyroid gland is a small organ located in the front of the neck above the collarbone. Its main task is to produce hormones that regulate metabolism. These powerful hormones affect nearly every cell, tissue, and organ in the body. When the hormones it produces become imbalanced, the problem of hypothyroidism or hyperthyroidism occurs.
Hypothyroidism (underactive thyroid) occurs when the thyroid gland does not produce enough hormones for the body to function properly. If left untreated, it can lead to high cholesterol, osteoporosis, heart disease, and depression. Some of the symptoms of hypothyroidism are similar to those during the menopause transition. These are fatigue, forgetfulness, mood swings, weight gain, irregular menstruation and cold intolerance.
Hyperthyroidism (hyperfunction) occurs when the thyroid gland produces too many hormones. Some symptoms of hyperthyroidism can also mimic the onset of menopause, including hot flashes, heat intolerance, palpitations (sometimes rapid heartbeat), tachycardia (persistent rapid heartbeat), and insomnia. The most common symptoms of thyrotoxicosis are unplanned weight loss, goiter (an enlarged thyroid gland) and exophthalmos (bulging eyes).
Hypothyroidism is usually treated with oral thyroid hormone supplements to replenish the supply. Treatment options for thyrotoxicosis are antithyroid drugs, radioactivethyroid therapy or thyroid surgery.
A little about hormones
Before you go for your annual checkup, try to learn more about menopause and the hormones (estrogens, progesterone, and androgens) and the various hormone therapies available to help relieve menopause-related symptoms and reduce long-term risk of conditions like osteoporosis. This test can help determine which hormones may be right for you.
Estrogen is a “female hormone” that promotes the development and maintenance of female sexual characteristics and the ability to bear and give birth to offspring. The three main types of estrogen - estrone, estradiol (the most biologically active), and estriol (increased during pregnancy) - decrease during menopause, and this decrease can lead to menopausal symptoms such as hot flashes and vaginal dryness.
Progesterone is often referred to as the “caring hormone”. It signals the uterus to prepare tissues to receive a fertilized egg. It is also aimed at maintaining pregnancy and the development of the mammary glands (breasts). In menstruating women, progesterone is produced in the ovary only after ovulation (or the release of an egg from the ovary). If the egg is not fertilized, progesterone levels will drop and menstruation will begin. The end of ovulation in menopause means the end of progesterone production.
Androgens are also produced in the female body, like testosterone and dehydroepiandrosterone, but in much smaller quantities than in men. Insufficient androgen levels at any age contribute to fatigue, mood swings, and reduced sex drive. There is nothing wrong with changing the level of androgens in menopause.
Hormone replacement therapy: pros and cons
First used in the 1940s, but more widely used in the 1960s, revolutionizing the management of menopausal symptoms. This therapy was commonly given to menopausal women to relieve symptoms such as hot flashes, night sweats, sleep disturbances, psychological and genitourinary problems such as frequent urination and vaginal dryness, and to prevent osteoporosis.
In the 1990s, two of the largest studies were conducted among women using hormone replacement therapy after the age of 50. The published results of these two studies raised concerns about safety. These issues revolved around two main issues:
- long-term use of hormones may increase risk of breast cancer,
- their use may increase the risk of heart disease.
The results of the research received a wide public outcry, which caused panic among women.
After the results were published, regulatory authorities took urgent safety measures, suggesting that physicians prescribe the lowest effective dose to relieve symptoms, use it only as a second line treatment for preventing osteoporosis, and not use it in the absence of menopausal symptoms.
Manydoctors stopped prescribing hormone replacement therapy after 50 (drugs), and women immediately abandoned it, after which all menopausal symptoms returned. The number of women taking hormones has declined, and nearly a generation of women have been denied the opportunity to improve their quality of life during menopause.
The subsequent publication of the full results of the study showed a clear increase in the risk of breast cancer, which was found only in those who took HRT prior to enrollment in the study. In addition, because the authors initially stated that age had no effect on drug exposure, further analyzes showed no increased risk of heart disease in women who started treatment within 10 years of menopause.
Treatment Today: Key Points
The balance of benefits and harms must always be weighed, but it seems that the positive impact on he alth is still higher. Patients can be assured of this under the following conditions:
- Hormone replacement therapy for women is taken to relieve menopausal symptoms. It plays an important role in the prevention of osteoporosis, but long-term use is not required.
- Therapy is taken in the required amount at the lowest effective dose.
- Patients on treatment undergo a medical examination at least once a year.
If women start taking hormones during menopause, the risk of side effects is very low.
Many women are looking for information about the effects on sexual activity andthe desire for hormone replacement therapy after 50 years and what drugs have such an effect. There is no definitive answer yet, but research suggests that estrogen may help maintain or restore sex drive. But it certainly gets in the way of other menopausal symptoms, such as vaginal dryness and pain during intercourse. If vaginal symptoms are the only concern, then the use of topical treatment in the form of vaginal estrogen suppositories may be preferable.
Only for menopause?
There are more than 50 types of hormonal drugs. They can be taken:
- inside (in tablets),
- transdermal (through the skin),
- subcutaneous (long-term implantation),
- vaginally.
Cycling regimen mimics the normal menstrual cycle. This hormone replacement therapy is usually prescribed after 40 for women whose periods have stopped too early. Estrogen and progestogen are taken every day for 21 days. At the end of each course, bleeding occurs, as the body “refuses” hormones and rejects the lining of the uterus. Progesterone regulates bleeding and protects the endometrium from harmful precancerous changes. These drugs have a contraceptive effect, which helps women with unstable or early menopause protect themselves from unwanted pregnancies. Also, the drug is prescribed for the treatment of secondary infertility. The appointment in such cases often gives a positive result: after several cycles of use, women manage to get pregnant.
Estrogen alone is usually given to women who have had their uterus removed (hysterectomy).
"Tibolone" is an estrogen-progestin drug prescribed for patients whose menstrual cycle ended no earlier than a year ago. If you start taking the drug earlier, it can cause bleeding. The indication for use is the onset of menopause and osteoporosis.
Tips
With long-term use of hormonal drugs, you should take a blood test every three months, as there is a risk of blood clots.
Topical estrogen (such as vaginal tablets, creams, or rings) is used to treat local urogenital problems such as vaginal dryness, irritation, problems with frequent urination, or infections.
Women wishing to begin treatment should carefully discuss the benefits and risks with their physician, taking into account age, medical history, risk factors and personal preferences. When choosing hormone replacement therapy, reviews should not be relied upon - drugs should be prescribed by a doctor.
For most patients using drugs as a short-term treatment for menopausal symptoms, the benefits of treatment outweigh the risks.
Women on HRT should see a doctor at least annually. For some women, long-term medication may be needed to further relieve symptoms and quality of life.
