Hormone Therapy for Symptoms of Menopause

Introduction

Hormone therapy (HT) is a treatment for the relief of menopausal symptoms. These symptoms, caused by lower levels of estrogen at menopause, may include hot flashes, vaginal dryness, and sleep disturbances.

Hormone Therapy is also approved for the prevention of osteoporosis.

What is Menopause?

Menopause is referred to as a natural decline in reproductive hormones and can happen when a woman reaches her 40s or 50s.

Menopause is a time period that marks the end of menstrual cycles. It is a natural biological process. However, physical symptoms; such as night sweats and hot flashes, and emotional symptoms of menopause may disrupt sleep,  reduce physical strength, and sometimes affect emotional health.

Menopause is diagnosed after a woman has gone 12 months without a menstrual period. 

Menopause Treatments

There are several effective treatments available for menopause; ranging from home remedies to hormone therapy.

The three stages of natural menopause:

• Perimenopause (or the menopause transition) is the time span between the start of symptoms (such as erratic periods) and 1 year after the final menstrual period.
• Menopause is confirmed 1 year (12 months) after the last menstrual period.
• Postmenopause ( all the years beyond menopause).

Menopause Symptoms

• Genitourinary syndrome of menopause; refers to the vaginal and urinary symptoms that arrive with menopause.
• Vaginal symptoms; symptoms may include abnormal vaginal bleeding, vaginal dryness, itching, or irritation and/or pain with sexual intercourse (dyspareunia). Symptoms occur because the tissues lining the vagina become thinner, less elastic and drier as estrogen levels decrease.
• Urinary symptoms;  similar to the tissues of the vagina, the lining of the urethra and become drier, less elastic and thinner with declining estrogen levels. This can lead to dysuria, recurrent urinary tract infections, feeling the need to urinate more frequently, or leakage of urine (urinary incontinence)
• Vasomotor symptoms of menopause treatment guidelines – There will be Physical Changes Like night sweats and weight gain. Changes in skin texture and wrinkles may develop along with worsening of acne. The distribution of body fat may also change. Body fat is deposited more in the abdominal and waist area than in the hips and thighs.
• Hot flashes; A hot flash is a warm feeling that spreads over the body and is most often observed in the chest and head. A hot flash is occasionally followed by perspiration and is sometimes associated with flushing. Hot flashes can last for 30 seconds and sometimes for several minutes. They are possibly due to a combination of biochemical and hormonal fluctuations that occur as a result of declining estrogen levels.
• Menstrual abnormalities; It is possible to have irregular periods years prior to menopause. However, it is important to be evaluated by a doctor to confirm that the irregular menses are due to perimenopause and not as a sign of another medical condition.
• Emotional and cognitive symptoms; Perimenopause often leads to a variety of (cognitive) and/or emotional symptoms, like memory problems, fatigue, irritability, and rapid mood changes.

Effects of Menopause

• The function of the ovaries (the source of female hormones, that controls the development of female body characteristics such as body shape, breasts, and body hair) ceases.
• A woman in her menopause can no longer become pregnant.
• Women in their menopause can develop complications such as heart disease and osteoporosis (thinning of bone).

Time Period

Menopause is a gradual process. The average age of menopause is 51 years old. However, menopause may occur as early as the 30s or as late as the 60s.

Test

There are no lab tests conducted to predict when a woman will experience menopause.

The only way to diagnose menopause is to observe the lack of menstrual periods for 12 months in the woman, during the expected age range.

Menopause Treatments

Treatments for menopause are customized for each woman and are applied when symptoms become distressing or uncomfortable.

Treatments range from Hormone therapy, Oral contraceptives and vaginal treatments, Antidepressants and other medications, the Use of vaginal lubricants, and Home remedies, to Plant-based remedies.

Menopausal Hormone Therapy

Hormone therapy (HT) involves the administration of synthetic estrogen and progestogen to relieve menopausal symptoms by replacing a woman’s depleting hormone levels.

Types of Hormone Replacement Therapy 

There are two types of HT:

• Estrogen-only therapy: The Estrogen hormone provides the most relieving menopausal symptom relief. This therapy is prescribed for women without a uterus due to a hysterectomy.

• Combined estrogen plus progestogen therapy: Progestogen is added to the Estrogen-only therapy to protect women with a uterus against uterine (endometrial) cancer from estrogen alone.

Dose and mode  of administration

There are two major methods of application of HT:

• Systemic products are available as an oral tablet, patch, injection emulsion, gel or spray, and can be used for hot flashes and night sweats, vaginal symptoms, and osteoporosis. They circulate throughout the bloodstream and to all parts of the body.
•  Local (nonsystemic) products affect only a specific or localized area of the body. They are available as a cream, ring, or tablet and can be used for vaginal symptoms.

What Are the Benefits of Hormone Replacement Therapy?

• Relieve for hot flashes and night sweats.
• Ease vaginal dryness and itching.
• Help prevent fractures caused by osteoporosis (thinning bones).
• Improve sleep pattern.
• Reduce prospects of having a heart disease.
• Lower chances of dementia.
• Make sex less painful.

Hormone Replacement Therapy Risks

Hormonal Therapy may lead to increased chances of having;

• Endometrial cancer, for does who take estrogen without progestin and you still have your uterus.
• Stroke.
• Breast cancer.
• Blood clots.

Factors that may pronounce risks

• Health history; a family history with a risk of cancer, stroke, blood clots, heart disease, liver disease, and/or osteoporosis are important factors in determining whether hormone replacement therapy would be a reliable treatment method.

• Type of hormone therapy; risks of hormone therapy may  vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen.

• Age;  Women who begin hormone therapy more than 10 years from the onset of menopause or at age 60 or older face a greater risk after using the treatment. However, starting hormone therapy before the age of 60 or within 10 years of menopause allows the benefits to likely outweigh the risks.

How to reduce risks

• Use the lowest, most effective dose for the shortest amount of time necessary to treat symptoms.
• Take progesterone or progestin if you still have your uterus.
• Ask about other forms of HRT besides gels, pills, like patches, vaginal creams, vaginal suppositories, vaginal rings or mists.
• HRT should start within 10 years of menopause or before age 60.
• Regular mammograms and pelvic examinations.
• Find and choose the best product and delivery method.
• Minimize the amount of medication you take.
• Women younger than age 45, need enough estrogen to provide protection against the long-term health effects of estrogen deficiency.
• Regular check-ups and updates with the doctor. To ensure that the benefits of HT are higher than risks or side effects.
• Healthy lifestyle choices. Like physical activity, healthy diet, and a healthy weight.

Stopping HRT

Hormonal Replacement Therapy may be kept on hold after a few years, once menopausal symptoms pass.

Taking HRT for more than one year may increase the chances of breast cancer as compared to those who never used HRT.

This risk is linked to all types of HRT except vaginal estrogen.