Menopause and hormone replacement therapy (HRT)

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What is it about ?

Menopause

Menopause is the time in a woman’s life when her period stops. Most often, this time is between the ages of 45 and 55. The average age of menopause is 51 years old. Some women experience symptoms associated with menopause, which usually appear between the ages of 45 and 65.

During menopause, the ovaries produce less and less of the female hormones (estradiol, a type of estrogen), which causes end of the rules and causes other changes in the body, which cause symptoms. Menopause is preceded by a period during which periods decrease and ultimately disappear. If you’re over 45 and haven’t had your period for a year, you’ve officially gone through menopause. You can then assume that your fertile window is definitely over.

Menopausal symptoms

General complaints, such as tired, depressed mood and muscle and joint pain, are sometimes attributed to menopause, but this association is not clearly established. The reduced production of estrogen (female hormones) during menopause also has an important influence on weakened bones or osteoporosis ; it accelerates the process of bone loss.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is hormone therapy that can be started when a postmenopausal woman reports that she is suffering from the following symptoms:

As the name suggests, hormone replacement therapy “substitutes” or replaces hormones that were present in greater quantities before menopause.

It is best not to start hormone replacement therapy (HRT) too early, but to wait until your period becomes rare, even until it stops completely and symptoms are noticeable.

How common are menopausal symptoms?

Between 55 and 60% of women experience hot flashes and sweating during menopause. These symptoms occur mostly during the first year after menopause. They also occur in about 15% of women two years before menopause.1.
Vaginal dryness affects approximately 15% of women during the period of transition to menopause (perimenopause) and 30% of women during the period following menopause (postmenopause)1.

How to recognize it?

Your menstrual cycle will begin to vary due to hormonal changes. Your periods become irregular, may last shorter or longer, and may be heavier or lighter than before. At first, the differences may almost go unnoticed, but they become more and more noticeable over time.

In the meantime, you can face all kinds of inconvenience, which usually lasts until menopause and then gradually subsides. The number and severity of these inconveniences vary from woman to woman.

The main symptoms are:

Some of the above symptoms can have other causes, sometimes more serious. Therefore always consult a doctor if you develop this type of complaint.

What can you do ?

It is possible to relieve the symptoms and slow down the process ofosteoporosis by adopting a healthy lifestyle :

  • Get enough exercise.
  • Favor a healthy and balanced diet.
  • Do not smoke.
  • Limit your alcohol intake.
  • Aim for a healthy weight.

It is more effective to walk for an hour, three times a week, than taking calcium supplements or hormones.

We know that overweight women suffer more from sweats related to menopause. Smoking also worsens symptoms. In addition, menopause usually starts earlier in smokers. It may also help to limit coffee and spicy foods.

If you are suffering from urinary leaks, you can do perineal rehabilitation exercises with a physiotherapist.

As to pain during sex and at the vaginal dryness, you can relieve them by using a lubricant.

When can your doctor consider treatment?

The main reason for starting hormone replacement therapy (HRT) in a woman is to treat menopausal symptoms that interfere with daily functioning. In some cases, this treatment may be considered to preventosteoporosis.

We will not establish no hormone replacement therapy (HRT) :

  • in women who have a breast cancer or who have had one (there is some evidence that HRT increases the risk of recurrence);
  • in women who have severe heart or liver disease;
  • in case of’hypertension insufficiently controlled under treatment;
  • in case of endometrial cancer (the lining that covers the uterus);
  • in the presence of bleeding problems (e.g. in women who have suffered from deep vein thrombosis or a pulmonary embolism or who have an increased risk of bleeding disorders);
  • in the presence of vaginal bleeding with no known cause.
Advantages and disadvantages of hormone replacement therapy (HRT)

The doctor will weigh, for each patient, the advantages of HRT against its possible disadvantages and risks. In any case, the final decision rests with the woman, duly informed of the potential advantages and disadvantages of HRT.

Others benefits of HRT are, among others:

  • a possible protective effect against heart problems (although opinions differ);
  • a possible positive effect on mood disorders;
  • decreased risk of Type 2 diabetes.

This should not, however, be a reason for initiating treatment. Besides the benefits, there are a number of risks related to(prolonged) use of HRT :

  • Some studies show an increased cardiovascular risk because estrogen, whether taken alone or in combination with other agents, increases the risk of blood clots forming (embolism Where thrombosis). Therefore, you should always take your predisposition or other risk factors for blood clots into account.
  • HRT is associated with an increased risk ofstroke.
  • The hormonal action of HRT slightly increases the risk of breast cancer.
  • HRT increases the risk of gallstones and inflammation of the gallbladder.
  • In case of prolonged use (more than 10 years), the risk of ovarian cancer is slightly increased.

What can your doctor do?

Clinical examination and questioning
  • Your doctor will first do a gynecological examination and, possibly, a breast palpation. He will also perform a smear and may possibly send you back for a mammography (breast x-ray). Finally, it will measure your blood pressure and your weight.
  • At the same time, he will submit you to a full interrogation to determine if treatment should be considered. This interview also includes questions about your family history of certain illnesses.
  • At a woman under 45, the doctor will try to exclude a menstrual disorder other than menopause. A blood test for this purpose will measure the amount of a number of hormones (serum prolactin, thyroid stimulating hormone or TSH, follicle stimulating hormone or FSH). The results help the doctor learn more about your hormonal balance and determine if you are going through menopause. A woman over the age of 45 who hasn’t had a period for a year has officially gone through menopause. It is therefore not necessary to take a blood test to diagnose menopause.
The different forms of hormone replacement therapy (HRT)

If the doctor decides to start HRT, he will try to limit it to the lowest possible dose and for the shortest possible time. Depending on the symptoms and the woman, HRT can be started with estrogen alone or in combination with progestins.

Estrogenic HRT

  • Estrogen-only HRT is only used in women who no longer have a uterus (unless it is applied topically). Estradiol is the most commonly used estrogen and is prescribed in various forms. Thereby, skin patch or gel is often a better choice for women who suffer from migraine, of diabetes orepilepsy or who are at increased risk of clots.
  • For women with vaginal dryness or pain during intercourse, local treatment with estrogen cream or vaginal ring is the best choice. This local treatment should not be combined with a progestogen.

Estrogen-progestogen HRT

  • Progestins such as progesterone, dydrogesterone, and norethisterone have a different profile and effect on breast or uterine tissue. They are therefore chosen based on complaints and side effects. Progestins are also available as tablet, patch or IUD.
  • During the first year of menopause, a combined preparation taken cyclically is privileged. This means that estrogen is given continuously, while progestin is only added during the first 12-14 days of the month. The idea is to induce menstruation during the week without treatment or after the end of the progestogen phase in the case of cyclical treatment. The volume and duration of bleeding should be normal. After a few years of treatment, if it is needed all the time, many women will see their periods become less heavy or even go away altogether.
  • To avoid vaginal bleeding, women can opt for:
    • a combined treatment (estrogen + progestin)
      • Both preparations are taken daily.
      • This treatment is generally not started until one year after menopause.
    • the tibolone, a substance with hormonal properties of both estrogen and progestogen
      • Again, treatment is usually not applied until one year after menopause.

Non-hormonal treatments

It is also possible to opt for non-hormonal treatments. Women who suffer from hot flashes and who are not allowed to take estrogen, may consider an antidepressant such as venlafaxine, paroxetine, citalopram, …

How does the doctor monitor hormone replacement therapy (HRT)?

Your doctor will ask you to return for a consultation within a year of starting HRT. On this occasion, he will mainly check if the complaints have improved, if you are suffering from side effects, if the dose can possibly be reduced or if the treatment can be stopped. There is no point in taking a blood test to measure estrogen levels in the blood.

Want to know more?

http://www.mongeneraliste.be/veiller-a-sa-sante/divers/menopause-un-cap-pas-une-montagne

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