Hormone replacement therapy for menopausal women. What is it for, and what are the options?
Throughout a woman’s lifetime, her body goes through many changes. Menopause is a significant transformation, marking the end of a woman’s reproductive life. This transition isn’t necessarily an easy one. It can go on for many years, and many women experience symptoms that disrupt their lives. Hormone replacement therapy is one way to reduce the impact of the most challenging symptoms. In this article, we will discuss the benefits and risks of hormone replacement therapy.
Menopause is defined as a woman’s final menstrual period. This usually occurs between the ages of 40 and 58, the average age being 51. However, before this happens, she will experience several years of perimenopause or the menopausal transition. During these years, most women experience some combination of period irregularities, hot flashes and night sweats, mood swings, insomnia, lower libido, and vaginal dryness. In addition, perimenopausal women have a higher risk of osteoporosis, heart disease, and some types of cancer.
What is menopause, and why does it happen?
The menopausal transition has three stages. Perimenopause, which usually lasts four to eight years and sometimes even longer. Menopause—a woman’s final menstruation, confirmed when she has gone a full calendar year without a period. Twelve months after a woman’s final period, perimenopause ends, and the Postmenopause period begins. The first two to five years post-menopause, some women still experience occasional symptoms but in decreasing intensity and frequency.
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When a woman reaches the end of her reproductive life, the amount of the female sex hormones oestrogen and progesterone produced by the ovaries greatly diminishes, although testosterone continues to be produced for some time. These hormones are important not only for fertility and reproduction, but also influence the endocrine system as a whole. The body must adapt to these changes and this process can be uncomfortable and challenging. However, many women find they are relieved to no longer have to endure painful menstruation and other hormone-related conditions.
Menopause is categorized into three types:
- Natural menopause, which occurs gradually, often between the ages of 45 and 55.
- Premature menopause can be brought by certain endocrine disorders and lifestyle habits. Women who smoke commonly experience menopause two years earlier than women who don’t smoke.
- Induced menopause, which can occur at any age before natural menopause if the ovaries or uterus are surgically removed or affected by certain medications. Hysterectomy, or removal of the uterus, and cancer treatments are the most common causes for premature, induced menopause.
What are the symptoms of menopause?
There is a good deal of variation in the way different women experience the menopausal transition, but the most common symptoms are:
- Irregular periods—As a woman enters the menopausal transition, her periods become irregular; they may become heavier at first, but later can become very short and skip a month.
- Hot flashes—A sudden feeling of heat, sometimes accompanied by flushing of the skin and/or perspiration, is a common symptom of perimenopause. The feeling can last anywhere from about thirty seconds to several minutes and can reoccur multiple times during the day or night (night sweats). Some women find that hot flashes are debilitating and severely interrupt their lives.
- Trouble sleeping—Lack of oestrogen is linked to insomnia and fragmented sleep.
- Vaginal atrophy—As a woman ages, her vagina produces less natural lubrication, and the delicate skin of the vagina becomes even thinner and more fragile. This means intercourse may become painful, and small tears in the skin make the vagina more susceptible to infections.
- Mood swings—Changing hormones affect the nervous system and can cause irritability, anxiety, panic, and depression; many women also report experiencing feelings of rage that may be due not only to hormonal changes but also to the continued pressures and demands of life at this time.
- Incontinence—Muscle mass tends to decrease while fat tissue increases during perimenopause; these changes can contribute to incontinence.
- Hair and skin health is also affected as we age. As collagen production naturally declines, the skin loses its elasticity, forms wrinkles, and begins to look duller. Hair also becomes drier and more brittle; many women experience some hair loss at this time.
Read more about anti-ageing treatments for your skin.
What is hormone replacement therapy?
Hormone Replacement Therapy (HRT) is designed to reduce the symptoms of menopause by replacing the hormones a woman’s body is no longer producing naturally. HRT comes in many forms—as pills, patches, creams, sprays, or implants.
HRT must be prescribed by a doctor. Most HRT products contain a combination of oestrogen and progesterone (or progestin, a synthetic version) to minimize the risk of oestrogen dominance. HRT can be used as long as necessary to treat the symptoms of perimenopause, but more than five years is not generally recommended.
What are the HRT options?
There are multiple HRT options to suit many different needs. Before you start HRT, it’s crucial to consider the benefits and the risks. Your doctor will be able to help you decide what is most suitable for you.
Options for HRT:
- Pills—usually taken once a day
- Skin patches that gradually release hormones into the bloodstream
- Topical gels that are applied to the skin daily
- Implants that are usually inserted in the tummy area to excrete small amounts of oestrogen
- Testosterone gels, although not always recommended, can help with low sex drive
- Vaginal oestrogen gel to combat vaginal dryness; this is used topically and doesn’t help with other symptoms of menopause
HRT can be used continuously or cyclically/sequentially. Cyclical HRT involves taking oestrogen daily and progesterone alongside it for the last 14 days of the month; this can be prescribed as monthly HRT—usually for women who are still menstruating regularly—or as 3-monthly HRT resulting in a period once every three months. Continuous combined HRT involves taking oestrogen and progesterone every day without a break; this is usually prescribed for postmenopausal women.
What are the benefits of hormone replacement therapy?
Many women choose HRT during their menopausal transition to mitigate the symptoms. Hot flashes can be so unpleasant as to wake you up at night in a pool of sweat or make you feel dizzy. Vaginal dryness is also uncomfortable and can cause pain and tearing during intercourse. Other symptoms, such as mood swings and insomnia, can also improve with HRT.
HRT has other benefits like:
- A lower risk of diabetes
- A lower risk of osteoporosis, especially if begun before the onset of menopause
- A lower risk of bowel cancer
The risks of HRT
Hormone replacement therapy can be a salvation for women who suffer greatly from the symptoms of perimenopause. However, the prolonged use of hormones has been linked to a number of health conditions that can outweigh the benefits.
Some of the risks:
Breast cancer
Breast cancer tends to be sensitive to oestrogen, and oestrogen dominance can increase a woman’s risk of breast cancer. Studies have shown that HRT may increase a woman’s risk of breast cancer if she uses it for more than five years. Women who use HRT for fewer than five years and those who never use HRT have a similar risk.
Cardiovascular disease and stroke
Studies have shown that HRT can increase a person’s risk of heart disease and stroke, but results varied depending on the timing of the treatment. The lowest risk of stroke and cardiovascular disease was found among women who used HRT before they reached their 60s but not more than 10 years after the beginning of menopause.
Venous thrombosis
Oestrogen-based HRT heightens a woman’s chances of developing blood clots that lead to venous thrombosis. However, one study found that thrombosis was much less prevalent in women who used oestradiol-based HRT.
Ovarian cancer
Studies comparing the instance of ovarian cancer in women using HRT and those who never taken supplemental hormones found that the former group had a 1.28 higher chance of developing ovarian cancer.
Cholecystitis
Cholecystitis is inflammation of the gallbladder, usually due to gallstones trapping the bile this tiny organ produces. The condition causes bloating and severe pain in the upper right belly but can be treated easily if properly diagnosed. Cholecystitis is more common among menopausal and postmenopausal women than the general population, but studies indicate that women who take HRT are at even greater risk.
Who shouldn’t take HRT?
Due to the known risks of hormone replacement therapy, women who have a history of breast cancer, ovarian cancer, blood clots, fibroids, and other oestrogen-related conditions are encouraged to seek other options.
There are alternatives for women who can’t take HRT. A healthy diet and an active lifestyle are good for all of us, not least for women going through “the change”. But there are many natural remedies and targeted treatments, as well as some pharmaceutical alternatives for alleviating the symptoms of menopause, including hot flashes, insomnia, and vaginal dryness.
Conclusion
Menopause can be a challenging transition to a new stage of life. There are many ways to manage the symptoms and make the journey as easy as possible. Hormone replacement therapy can be very helpful in mitigating the most taxing symptoms of menopause, but the treatment is not without risk. If you are interested in HRT, consult with your doctor to find the best course of action for you.
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