Examinations Required Prior To Receiving Mht
Points to consider prior to initiating MHT include checking the indications and contraindications of MHT, which requires history recording, physical examinations, and other tests. Because the symptoms of menopause are varied, customized tests should be conducted for each risk factor based on the basic examination conducted according to the life cycle necessary for women .
Does It Cause Weight Gain
Some people worry that hormone treatment might lead to weight gain, but there is no evidence to support this.
Eating a healthful diet and getting plenty of exercise can help manage the weight gain that commonly affects both females and males in midlife.
There are various ways of delivering hormone therapy, and the different types provide different combinations and amounts of hormones.Common types include:
Estrogen-only HRT: A doctor may recommend this if a person has had their uterus and ovaries removed, in which case progesterone is not necessary.
Cyclical, or sequential, HRT: This may be a good option if symptoms occur before menopause the dosage can align with the menstrual cycle.
Continuous HRT: After menopause, a doctor may prescribe a continuous combination of estrogen and progesterone.
Local estrogen: Vaginal tablets, creams, or rings can help with urogenital symptoms, including vaginal dryness and irritation.
The doctor will prescribe the lowest possible dosage that addresses the persons symptoms, and arriving at this dosage may take some trial and error.
Ways of delivering HRT include:
When a person no longer needs the treatment, the doctor will describe how to stop it gradually.
Various lifestyle adjustments can help manage the symptoms of menopause.
They include:
Also, it is a good idea to ask the doctor about nonhormonal treatment options.
Always speak to a doctor before using any supplements.
A Note From Cleveland Clinic
The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.
Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.
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Menopausal Hormone Therapy After Breast Cancer
Taking post-menopausal hormone therapy , also called hormone replacement therapy , to help with menopause symptoms may not be safe for women who have had breast cancer. If you are bothered by menopause symptoms, talk to your doctor about ways to get relief.
Many women have menopause symptoms such as hot flashes after treatment for breast cancer. This can happen naturally as women get older, but it can also be caused by some breast cancer treatments. Some pre-menopausal women have menopause symptoms as a result of chemotherapy or from hormone therapy drugs used to treat breast cancer . Women who are past menopause might also get symptoms if they had to stop taking PHT when they were diagnosed with breast cancer.
Who Shouldnt Take Hormone Therapy
Hormone therapy is not usually recommended if you:
- Have or had breast cancer or endometrial cancer.
- Have abnormal vaginal bleeding.
Less common side effects of hormone therapy include:
- Fluid retention.
- Increased breast density making mammogram interpretation more difficult.
- Skin irritation under estrogen patch.
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Description Of The Intervention
Hormone therapy consists of oestrogen alone or oestrogen combined with a progestogen . It is available in a variety of formulations and doses that can be taken orally, vaginally or intranasally, or as an implant, skin patch, cream or gel. Clinical effects vary according to the type of HT and its duration of use.
The addition of a progestogen reduces the risk of endometrial hyperplasia associated with the use of oestrogen alone in women with a uterus , but the issue is problematic because progestogens have adverse effects on blood lipids and may have the potential to cause symptoms such as headache, bloating and breast tenderness . Progestogens used for HT include synthetic derivatives of progesterone, synthetic derivatives of testosterone and natural progesterones derived from plants. These differ in their metabolic action and potential for adverse effects, and it is currently unclear which type of progestogen has the best riskbenefit profile for use in HT. In combined HT, progestogen can be taken continuously , sequentially or less frequently.
Hormone therapy has been utilised for over 50 years for the treatment of women with hot flushes and other menopausal symptoms, and its efficacy is well established, as evidenced by a Cochrane systematic review of 24 randomised controlled studies of HT for hot flushes that was published between 1971 and 2000 .
Key Points: Sexual Dysfunction
- 1. Increase in age and decreased serum estrogen levels lead to harmful effects on sexual function and cause dyspareunia and reduction of sexual desire and sexual response.
- 2. Measuring the serum level of a sex hormone does not provide much help in diagnosing and treating sexual dysfunction, and conducting a blood test for testosterone to diagnose androgen deficiency in healthy women is not advised.
- 3. When considering sexual dysfunction, the role of vaginal atrophy should always be considered.
- 4. Systemic MHT and low-dose vaginal ET are effective for treating urogenital atrophy and improve sexual function by increasing vaginal lubrication, blood flow, and sensory function as well as improve dyspareunia in particular.
- 5. Regarding female MHT for women with HSDD, percutaneous therapy is preferred over oral therapy and tibolone is effective for treating female sexual dysfunction by increasing women’s sexual desire and arousal.
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Menopause Symptoms: The Role Of Estrogen And Progesterone
Estrogen and progesterone are hormones that play key roles in a womans reproductive system.
Estrogen is a sex hormone that regulates the menstrual cycle and has a direct impact on reproductive and urinary tracts, blood vessels, breasts, skin, hair, pelvic muscles, heart and the brain, explains Anna Cabeca, D.O., an OB-GYN and business owner of The Girlfriend Doctor, a womens health website.
Progesterone is a reproductive hormone that helps prepare a womans body for a potential pregnancy, and when pregnancy doesnt occur and the hormone levels fall, it triggers menstrual bleeding, says Dr. Cabeca. Progesterone is also known as the mother hormone because it is the precursor to DHEA, testosterone and estrogen, she explains.
Both estrogen and progesterone are mainly produced in the ovaries, adds Bruce Dorr, M.D., a board-certified physician in obstetrics and gynecology. When production stops at menopause, hormone levels go to virtually zero, explains Dr. Dorr. The drop off in production is what causes common menopause symptoms such as night sweats, hot flashes, sleep disturbances, fatigue and weight gain.
What Is Bioidentical Hormone Therapy
Companies that make bioidentical hormone therapy use the term bioidentical to suggest that their products are exactly the same as natural hormones. Many of these companies also claim that their products are safer than menopausal hormone therapy. However, the FDA does not recognize this term or regulate these products. No studies have been done to evaluate how safe or effective these products are.
Talk to your doctor or nurse before trying any bioidentical hormone therapy.
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Perimenopausal Women May Experience A Variety Of Problems
Perimenopause is one of the most difficult times in a womans life. Your body is constantly adjusting to the changing hormone levels over a period of years. Eventually, these hormonal changes begin to reduce the frequency of your periods and at some point, stop them altogether. Once they stop, you enter a full menopausal phase for several months.
Not every woman experiences the same symptoms, but perimenopausal women commonly experience some or all of the following:
- Hot flashes and heart palpitations
- Night sweats, migraines and headaches
- Insomnia and poor-quality sleep
- Weight gains related to a slowing metabolism
- Vaginal dryness and pain
Mht For Women In Menopausal Transition
Menopausal transition refers to the period from the moment of increased variation in menstrual cycle until the moment immediately prior to the last day of menstruation. It varies among individuals and is a period that often includes vasomotor symptoms such as hot flushes alongside frequent or excessive menstruation. Hot flushes vary among individuals but may appear from 1 year to 3 years prior to the last day of menstruation and are especially severe around the last day of menstruation. They may even last for several years. Approximately 75% of women aged between 45 years and 55 years suffer from symptoms of menopause, which may lead to low self-esteem, sleep disorder, and feelings of decreased energy. To evaluate the ovarian reserve during menopausal transition, measuring the serum level of anti-mullerian hormone , day 3 follicle-stimulating hormone , estradiol , and ovarian antral follicle count using pelvic ultrasonography is possible, but they are not used as indicators for predicting menopause. Additionally, because the function of the ovaries changes during this period, it is advised not to conduct a hormone test for menopause diagnosis .
Hormone therapies for treating the symptoms of menopause during menopausal transition are combination therapy of levonorgestrel releasing-intrauterine system with oral or percutaneous estrogen, low-dose combined oral contraceptives , and estrogenâprogestogen therapy .
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Bioidentical Hormone Replacement Therapy Helps Improve Skin
As we age, our skin tends to dry out and become more fragile, leading to more skin infections, wrinkles, and lines. Studies have shown that using bioidentical hormone replacement therapy can increase skin hydration, thickness, and elasticity.
This result is a more hydrated appearance with reduced fine lines and wrinkles! Reports have also shown that collagen production increases as estrogen levels increase. This is a great way to combat signs of aging on the skin, giving you a younger appearance.
Hormone Replacement Therapy And Breast Cancer Risk
Hormone replacement therapy also called estrogen replacement therapy, menopausal hormone therapy, or post-menopausal hormone therapy can be an effective treatment for menopausal symptoms, but its important to know that some types of HRT can increase your risk of breast cancer.
HRT also can increase your risk of the cancer coming back if youve been diagnosed with breast cancer in the past. Because of this risk, doctors usually recommend that women with a history of breast cancer should not take types of HRT that affect the entire body .
HRT has also been linked to cardiovascular risks, such as heart disease, stroke, and blood clots.
However, all of these risks vary and depend on many factors, including:
-
how long you use it
Years ago, before the link between HRT use and breast cancer risk was known, many women took HRT for years to ease menopausal symptoms and prevent bone loss. After 2002, when research linked HRT and breast cancer risk, the number of women taking HRT dropped dramatically.
Newer research that has followed women for a longer amount of time suggests the link between HRT and breast cancer risk is more complex than first thought, and using HRT remains a controversial topic.
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How Do The Hormones Used In Mht Differ From The Hormones Produced By A Womans Body
The hormones used in MHT come from a variety of plants and animals, or they can be made in a laboratory. The chemical structure of these hormones is similar, although usually not identical, to those of hormones produced by womens bodies.
Non-FDA-approved hormone products, sometimes referred to as bio-identical hormones, are widely promoted and sold without a prescription on the Internet. Claims that these products are safer or more natural than FDA-approved hormonal products are not supported by credible scientific evidence. The FDA provides more information about these products on its Menopause page.
Selective Estrogen Receptor Modulators
The clinically oldest selective estrogen receptor modulator , tamoxifen, acts in breast tissue as an estrogen antagonist and therefore it is used in treatment and chemoprevention of breast carcinoma while its agonistic effect causes endometrial hyperplasia.39
Bazedoxifene is a new SERM that verifiably reduces bone mass loss in postmenopausal women and reduces the risk of vertebral and nonvertebral fractures without stimulating breast tissue or endometrium.40
It can be used for treatment or prevention of osteoporosis in postmenopausal women. It does not stimulate the mammary gland or the endometrium. When used at a dose of 20 or 40 mg per day, it protects the endometrium during systematic estrogen treatment .41
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Will Hormone Replacement Therapy Make Me Gain Weight
No this is a myth. HRT does not cause weight loss . In a large review of almost 30,000 women, there was no significant difference in weight between the people who used HRT and people who did not use HRT. In some people, HRT can cause bloating, which can be mistaken for weight gain. This is a side effect that usually goes away with time.
The truth is: Weight gain during and after menopause has more to do with hormonal changes, aging, and diet and lifestyle than HRT. After menopause, many people gain an average of 5 lb. You may find that you gain weight more easily, or in different areas of your body. If weight is a concern, consider adding more physical movement into your daily life or reducing your calorie intake.
Who Can Benefit From Hormone Therapy
The benefits of hormone therapy may outweigh the risks if you’re healthy and you:
- The need to avoid fractures or bone loss. Systemic estrogen helps protect against the osteoporosis-called bone-thinning condition. However, to treat osteoporosis, physicians typically prescribe drugs called bisphosphonates. But estrogen therapy can help if you can not tolerate other treatments or do not benefit from them.
- Experience early menopause, or lack in estrogen. Your body has been subjected to less estrogen than the bodies of women who undergo traditional menopause if you have your ovaries surgically removed before age 45, started getting cycles before age 45 or lost normal ovary function before age 40 . Estrogen therapy, including osteoporosis, heart disease, stroke, dementia, and mood changes, may help reduce the risk of many health conditions.
- Getting hot flashes that are mild to extreme. The most effective medication for the relief of problematic menopausal hot flashes and evening sweats remains systemic estrogen therapy.
- You may have other menopausal signs. Estrogen can ease menopausal vaginal symptoms, such as dryness, itching, burning, and intercourse discomfort.
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Key Points: Cognitive Function And Alzheimer’s
- 1. If MHT is started in early menopausal women, a prevention effect against the reduction of cognitive function could be expected although the evidence from randomized controlled studies is lacking.
- 2. Executing MHT with the sole purpose of preventing worsening or treatment of current cognitive function is not advised.
Key Points: Instructions For Tissue
- 1. CE/BZA is effective in alleviating VMS such as hot flush and GSM including urogenital atrophy.
- 2. CE/BZA significantly increases the bone density of the lumbar spine and hip joint.
- 3. CE/BZA is associated with a low incidence of vaginal bleeding and breast pain and increased breast density.
- 4. The safety of CE/BZA for the endometrium has been proven.
- 5. No RCTs have been conducted with breast cancer, fracture, and cardiovascular disorder as the primary endpoints.
- 6. In South Korea, no studies on VMS, increased breast density, breast tenderness, endometrial proliferation, vaginal bleeding, and osteoporosis have been conducted yet, but CE/BZA is being selected as one of the MHT options.
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When To Stop Taking Hrt
Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start .
Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may find that your menopausal symptoms come back after you stop HRT, but these should pass within a few months.
The Current Thinking On Hormone Therapy
The reason these individuals and others are making efforts to raise awareness regarding the current thinking on hormone therapy is that the current thinking is dramatically different than it was twenty years ago. Over twenty years ago, the Womens Health Initiative study, which randomized women to receive either hormone therapy or a placebo, set out to assess the benefits and risks of hormone therapy. In 2002, the WHI study was abruptly halted because the researchers found that women taking a combination of estrogen and progestin had an increased risk of breast cancer, heart attacks, stroke, and blood clots. Headlines blasted the news that hormone therapy was unsafe, and the use of hormone therapy in the United States plummeted by about 80%.
Later analysis of the WHI study data focused on the age of the participants. This analysis found that primarily older women were at high risk from the use of these hormones, and that the benefits of hormone therapy generally outweighed the risks for healthy women who are under 60 years old and within ten years of the onset of menopause. Despite the good news, many women and doctors are still relying on the original warnings to guide their decisions regarding hormones.
In fact, a pooled statistical analysis of thirty clinical trials found that women who began hormone therapy before age 60 had a 39% lower risk of death than women who didnt take hormones.
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Shortage Of Some Hrt Products
There are ongoing supply problems with some HRT products. For some products this is because of irregular supply while for others it’s a longer-term shortage. There are lots of different reasons why medicines can be in short supply. Work is happening with the pharmaceutical manufacturers who make the medicines to help the situation.
If your pharmacy cant supply the specific HRT product you’ve been prescribed, they may supply an alternative product. This will usually have the same ingredient, but may be made by a different manufacturer. Your pharmacy might also reduce the amount they provide you with to help ensure that as many woman as possible can get access to their required medication.
Disruptions in the availability of HRT will be worrying if it has been prescribed for you. However, there are always alternative options. If you are concerned about this contact your GP, pharmacist or specialist doctor to discuss the best treatment options for you.