Hormone Therapy For Premature Menopause

Protection For Your Bones And Colon

After menopause, many people experience bone loss. This can lead to osteoporosis, a condition where your bones become weak and brittle. People with osteoporosis are more likely to have bone fractures, which can lead to other problems.

Body-wide estrogen can help protect you against osteoporosis. Though there are other types of medications that can also help to protect your bones, HRT can be a good option if your osteoporosis medication isnt working or if theres a reason that you cant take this type of medication. Its also a great choice for bone protection if you have other symptoms of menopause, like hot flashes, night sweats, or mood changes.

Theres also some evidence that combination HRT may reduce your risk for colon cancer.

Safety Of Hormone Replacement Therapy

The group of POI patients is under-researched. The results of studies assessing HRT safety in the population of postmenopausal women cannot be simply applied to young women with premature ovarian function depletion.

There is no evidence for increased risk of breast cancer associated with oestrogen therapy used by women with POI, compared to healthy women who do not receive such treatment. The necessity of earlier, preventive mammography or ultrasound scan has not been demonstrated . The review of current studies showed a lower impact of micronised progesterone on the development of breast cancer than that of synthetic progestogens .

Continuous oestrogen-progestogen HRT seems to be the most effective in the prevention of endometrial hyperplasia and cancer . However, in young women with POI, regular withdrawal bleeding during sequential therapy gives a sense of normalcy with their peers.

If I Do Take Hrt How Can I Reduce My Risks

If you do decide to use HRT, there are ways to limit your risks. One approach is to keep your hormone use as low as possible. For example:

• Use the lowest dose of estrogen that will provide you with relief.

• If you only have vaginal symptoms, consider using a vaginal estrogen . Vaginal estrogen usually circulates throughout your body at a lower level.

• Use HRT mindfully. Consider checking in with your healthcare provider every 3 to 6 months or at least annually to talk about your medication, and to re-evaluate your overall health. In some cases, your provider may recommend you taper off of HRT after 2 to 5 years to limit your risks, especially if you have been stable for years. They may also recommend lower doses of hormones as you get older.

If you are concerned about blood clots, you can also consider using a skin-based medication, like a:

These types of medication do not seem to have the same risks for serious blood clots that oral medications do. Skin-based and vaginal estrogen treatments may also have a lower risk for stroke than pills and tablets do.

When taking HRT, you should also check in regularly with your healthcare provider, to keep an eye on your overall health. Preventive care exams, including mammograms and pelvic exams, may be especially important while youre on HRT. Your provider can also support you in managing other chronic conditions that can increase your risk of HRT complications like diabetes, high cholesterol, and high blood pressure.

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Is Menopausal Hormone Therapy Safe

Menopausal hormone therapy, sometimes called hormone replacement therapy, is safe for some women, but it also has risks. That is why the FDA advises women who want to try menopausal hormone therapy to use the lowest dose that works for the shortest time needed.

Research shows that:1

• Menopausal hormone therapy may be an option for women up to age 59, but usually only within 10 years of menopause. Younger women and those closer to their final menstrual period are less likely to have the harmful side effects from menopausal hormone therapy.
• Menopausal hormone therapy reduces menopause symptoms, such as hot flashes, sleep problems, mood changes, and vaginal dryness.
• Hot flashes usually require higher doses of estrogen therapy that affect the whole body.
• Women with vaginal dryness or discomfort during sex may find relief with low doses of topical vaginal estrogen.
• Estrogen alone and estrogen plus progesterone raise the risk of stroke and blood clots in the legs and lungs. The risks are rare in women between 50 and 59.

Managing Health Risks Associated With Premature Ovarian Insufficiency

Adopting healthy lifestyle changes can reduce the risk of some of the health impacts associated with POI. Long-term health risks include:

• osteoporosis or bone loss
• learning and memory disturbances
• emotional disturbances.

It is widely known that regular physical activity, a healthy diet and healthy sleep patterns can improve these problems, no matter what the cause. In addition, regular check-ups with your doctor can help you to manage your health.

Osteoporosis

Osteoporosis in women with POI can be caused by:

• low levels of oestrogen
• low levels of calcium in the diet
• low levels of physical and weight-bearing activity
• some types of chemotherapy and medications.

In addition to lifestyle changes women should have regular bone density scans every one or two years. Use of HRT can help to maintain bone health.

Cardiovascular or heart disease

POI can result in an earlier increase in the risk of heart disease in women.

Taking HRT early and continuing treatment until the age of a natural menopause can reduce the risk of heart disease. Regular check-ups for high blood pressure, diabetes and fats in the blood will help you manage your heart health.

Learning and memory problems

There is only limited evidence that low levels of oestrogen affect memory. Taking HRT early and continuing treatment until the age of a natural menopause might reduce the risk of any potential learning and memory problems.

Emotional issues

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Causes Of Premature Ovarian Failure

In some cases, the cause of this condition cannot be identified. However, sometimes premature ovarian failure may be due to a genetic condition such as Turner syndrome. Premature ovarian failure may also result as a side effect of chemotherapy, an autoimmune disease, infection or enzyme deficiency.

A Higher Risk Of Certain Cancers

A 2020 study found that past use of HRT was linked to a higher risk of breast cancer. This elevated risk was associated with both estrogen-only and combined therapies.

There is some debate about the risk of ovarian cancer. Some studies suggest that both estrogen-only and combined therapies raise your risk of ovarian cancer. Other say ovarian cancer is only a risk with estrogen-only therapy, but not with combination therapies.

Estrogen-only HRT may also increase the risk of endometrial cancer . A of 28 studies concluded that the following HRT regimens may all increase the risk of endometrial cancer:

• estrogen-only, sequential combination therapy
• micronized progesterone

Because of the risk, these therapies are generally recommended for women who no longer have a uterus.

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How Long Do You Take Mht

Current guidelines recommend women who take MHT for menopausal symptoms take the lowest effective dose to alleviate symptoms for as long as is needed. For the treatment of symptoms, women can stay on MHT for as long as is required to relieve their symptoms. Current thinking is that the benefits of MHT far outweigh the risks in healthy women within 10 years of the menopause or between 50 and 60 years of age. MHT does not need to be discontinued after five years because:

• the mean duration of menopausal symptoms is approximately eight years
• 20â25% of women will have bothersome symptoms in their 60s and 70s
• 10% of women will have bothersome symptoms for 10 years or more.

Every year, it is important to have a discussion with your doctor about management of your menopausal symptoms. Some women can take MHT safely for many years, but this must be assessed on an individual basis and be supported with annual reviews by your doctor.

In women with premature menopause, MHT is prescribed in high doses and recommended to continue until the age of expected menopause, about 50-52 years.

As a general rule when using MHT in midlife:

Bone Mineral Density And Fracture Risk

Multiple studies have shown that the lower BMD seen in women with POI or early menopause due to any etiology is associated with significantly increased risk for fracture . Several of these studies further demonstrated that fracture rates are reduced among women with POI or early menopause who are treated with HRT . Peak bone mass is attained by ~age 30 in women prolonged estrogen deficiency prior to this age results in decreased peak bone mass accrual, and estrogen deficiency after this age results in early bone loss. Early BMD loss or failure to attain peak bone mass results in increased fracture risk and is a primary health concern among young women with POI, particularly if appropriate treatment with HRT is not initiated soon after disease onset . Compared to regularly-menstruating, similarly-aged women, a cohort of young women with 46,XX sPOI had significantly lower BMD z-scores. Importantly, 21% of women with sPOI in this cohort had BMD z-scores < â2.0, indicative of low BMD for age and a fracture risk factor . Fully 67% of these women with sPOI had femoral neck BMD scores of < â1.0, and among women with sPOI who were within 1.5 years of diagnosis, almost half had femoral neck z-scores < â1.0. Progressive decreases in ovarian hormone production occurring well before the diagnosis of sPOI may perhaps contribute to the high rates of low BMD in women who were recently diagnosed.

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How Is Premature Menopause Diagnosed

To diagnose premature menopause, your doctor will most likely perform a physical exam and draw blood to rule out other conditions, such as pregnancy and thyroid disease. They may also order a test to measure your estradiol levels. Low levels of estradiol, a form of estrogen, can indicate that your ovaries are starting to fail. When estradiol levels are below 30, it may signal that you are in menopause.

However, the most important test used to diagnose premature menopause is a blood test that measures follicle stimulating hormone . FSH causes your ovaries to produce estrogen. When your ovaries slow down their production of estrogen, your levels of FSH increase. When your FSH levels rise above 40 mIU/mL, it usually indicates that you are in menopause.

Important Questions To Ask About Menopause Hormone Medicines

• Are hormones right for me? Why?
• What are the benefits?
• What are the serious risks and common side effects?
• How long should I use hormone therapy?
• What is the lowest dose that will work for me?
• Are there any non-hormone medicines that I can take?

Want more information about menopause? Check the FDA website at: www.fda.gov/menopause

The drug and risk information in this booklet may change. Check for the latest facts on each product listed in this booklet.

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How Can I Reduce My Risk Of Early Menopause

Most causes of early menopause are beyond your control. Smoking cigarettes is the only lifestyle factor that may cause early menopause. You can reduce your risk of menopause by quitting smoking. The other causes of menopause like health conditions, surgeries or treatment for cancer are unpreventable in most cases.

Patient Population Under Consideration

This recommendation statement applies to asymptomatic, postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women who have had premature menopause or surgical menopause.

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What Are The Risks Of Premature Or Early Menopause

People who go through menopause early tend to have more severe symptoms of menopause. These symptoms can lead to sexual dysfunction or loss of intimacy.

Additionally, people who experience premature or early menopause spend more years without the benefits of estrogen. Without typical amounts of estrogen, youre at greater risk for certain health conditions like:

• Various neurological diseases like dementia and Parkinsons disease.

Symptoms And Effects Of Menopause

Menopause is the time in a womans life when menstruation ceases, signaling the end of her reproductive ability. The timing of menopause varies widely, but this event often occurs naturally in women in the fourth or fifth decades of life, at a mean age of 51 years. Certain medical or surgical conditions may induce the cessation of menses before this age. If menopause occurs before the age of 40 years, it is considered premature.

The STRAW classification proposed by the American Society for Reproductive Medicine depicts the natural transition in a female’s life from the reproductive years to the time of menopause.

The reproductive years are divided into early, peak, and late and are characterized by regular menstrual cycles . This is followed by the stage of menopausal transition, which earlier on is characterized by a variable cycle length that is more than 7 days different from normal. During the latter stages of this transition phase, women experience intervals of amenorrhea of more than 60 days. When this duration of amenorrhea lasts for up to 12 months, it is classified as postmenopause. The stage of perimenopause spans from the beginning of the stage of menopause transition up until the completion of 1 year following the final menstrual period.

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Can Increase The Risk Of Blood Clots

Studies have shown that HRT may raise your risk of blood clots and stroke. This risk may be highest for people over 60 or who started menopause over a decade ago. The longer you take HRT, the greater the increase in your risk.

Because of this risk, health experts recommend the lowest possible HRT dose for the shortest period of time for people over 60 or who are 10 years past the onset of menopause.

Protection For People Who Experience Early Menopause

Some people go through early menopause . This may be caused by genetics, an illness, or surgery, or it may not have a clear cause. But no matter what the reason, early menopause means that you wont naturally be exposed to as much estrogen throughout your lifetime. This can increase your risk for some health conditions, like:

For people who experience early menopause, HRT is recommended to reduce the risk of these complications.

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Where Can You Find Information About Other Treatment Options

If your symptoms are bothering you, your doctor can help. Your doctor can tell you about the changes in your body and offer options for managing your symptoms. Other fact sheets about treatment options include:

• POI and Osteoporosis infographic

The Healthtalk Australia Early Menopause online resource contains womens stories, information, question prompt list and links to services:

If you have any concerns or questions about options to manage your menopausal symptoms, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to an individuals personal circumstances and should always be discussed with their own healthcare provider. This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members, other health professionals and their patients for clinical practice is permissible. Any other use of this information must be agreed to and approved by the Australasian Menopause Society.

Content updated October 2020

New Treatment For Premature Ovarian Failure

There have been some studies which may be able to reverse the effects of premature ovarian failure. More research is needed, but the procedure does hold promise for the future. Women with premature ovarian failure can find out more about all treatment options by consulting a fertility specialist.

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What Do The Guidelines Say

The ESHRE Guideline recommends cyclic combined HRT. An estrogen preparation of 17ß-estradiol with micronized natural progesterone is to be preferred. According to the ESHRE Guideline, combined cyclic HRT provides the highest endometrial protection 4, although other authors suggest greater endometrial safety by using a continuous combined regimen 43.

The current IMS white paper recommends a higher dose of estrogen than is intended for natural menopausal therapy. The goal of therapy should be to achieve physiologic estradiol levels of between 200 and 400 pmol/l 3. In any case, a progesterone preparation should be used for endometrial protection. The progesterone used can be either 200 mg of micronized progesterone for 12 days of the cycle or noretheristerone acetate or MPA. A bleeding-free continuous hormone regimen may be chosen if women have already been experiencing amenorrhea for more than 1 year at the start of therapy, or after several years of sequential therapy 3. Alternatively, the IMS recommends the use of a levonorgestrel-containing IUD for additional contraception, although studies assessing endometrial protection in women with POI are lacking. COCs containing ethinyl estradiol are inferior to HRT in terms of metabolic profile and osteoporosis protection, according to the IMS, and are recommended by the IMS only for initial therapy of POI in the first two years after diagnosis, when there is no desire to have children and safe contraception is desired.

Menopause Hormone Therapy Providers: 986

IMPORTANT DISCLAIMER: This article is provided as general information only and is not intended to be used as medical advice. While the benefits of hormone replacement are well documented through clinical research, we are not representing that hormone therapy is a cure for any disease. Only your treating physician can determine if hormone replacement may be a beneficial part of your healthcare regimen, based on your age, overall health, risk factors, and lifestyle.

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