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Menopause And Hormone Replacement Therapy (HRT)

Menopause, or “menopause,” refers to when a woman stops menstruating. It happens between 45 and 55 of the ages. The average age at which a woman reaches menopause is 51 years. Some of these women experience menopausal symptoms that usually occur between the ages of 45 and 65. Hormonal imbalance will also affect men in either ways. Know more about that <a href=”hrtresources.com/mens-health/testosterone/” rel=”dofollow”>here</a>.

During the menopause, the ovaries produce fewer and fewer female hormones (estradiol, a type of estrogen), as a result of which menstruation stops and other changes in the body also give rise to complaints. Menopause is preceded by a period in which menstruation decreases and eventually stops. If you are over 45 years old and have had no bleeding for a year, you are officially in menopause. You can then assume that your fertile period is over.

Menopausal complaints

General complaints such as fatigue, depressed mood, and muscle and joint pains are sometimes attributed to menopause, but this connection is less clear. The reduced production of estrogens (female hormones) during menopause also has an important influence on bone loss or osteoporosis; it speeds up the process of bone loss.

Hormonal replacement therapy (HRT)

Hormonal replacement therapy (HRT) is a hormone treatment that can be started if a menopausal woman reports the following symptoms:

  • hot flashes (short violent heart attacks);
  • to sweat;
  • poor sleep ;
  • vaginal dryness;
  • pain when having sex.

As the name says, the therapy substitutes or replaces the hormones that were present in larger amounts before the menopause.

Hormonal replacement therapy (HRT) is best not started too early, but preferably only if the menstrual periods are rare or preferably stopped and there are clear complaints.

How often do menopausal complaints occur?

Of all women, 55% to 60% suffer from hot flashes and sweats during menopause. These complaints mainly occur in the first year after the transition. Two years before the menopause, these complaints occur in about 15% of women.

About 15% of postmenopausal women (perimenopausal) and 30% of postmenopausal women (postmenopausal) experience vaginal dryness.

How can you recognize it?

Due to hormonal changes, your menstrual cycle will begin to change. Bleeding becomes irregular and may last shorter or longer, with more or less blood loss. The differences may be barely noticeable at first, but over time they become increasingly apparent.

In the meantime, you may experience all kinds of discomfort, which usually lasts until the transition and then gradually subside. The amount and severity of these discomforts differ for each woman.

These are the main symptoms:

  • hot flashes and flushing ;
  • (nightly) sweating;
  • difficulty sleeping ;
  • fatigue ;
  • irritability;
  • mood swings;
  • decreased sexual interest;
  • pain when having sex;
  • urinary tract infections ;
  • accidental leakage of urine ;
  • aching joints and muscle pain.

Some of the above complaints can also have other, sometimes more serious, causes. Therefore, always consult a doctor if you experience such complaints.

What can you do yourself?

A healthy lifestyle can relieve the symptoms of menopause and counter bone loss (osteoporosis) :

  • Exercise sufficiently.
  • Eat a healthy and balanced diet.
  • Don’t smoke.
  • Limit alcohol.
  • Strive for a healthy weight.

An hour of walking three times a week has more effect than the intake of extra lime or hormones.

Overweight women are known to suffer from menopausal sweating more. Smoking also worsens the symptoms. Also, menopause in smokers generally starts earlier. It also helps to limit coffee and spicy foods.

If you suffer from urine leakage, you can exercise your pelvic floor muscles together with a physiotherapist. Pain during sex and vaginal dryness can be remedied by using a lubricant.

When can your doctor consider treatment?

The main reason for initiating hormone replacement therapy (HRT) in women is to treat menopausal discomforts that hinder daily functioning. In some cases, this treatment may be considered to prevent  osteoporosis.

It is best not to start hormone replacement therapy (HRT) :

  • in women with breast cancer or a history of breast cancer (there are indications that HRT increases the risk of relapse);
  • in women with severe heart or liver disease;
  • in case of high blood pressure that does not drop sufficiently with medicines;
  • in case of cancer of the endometrium ;
  • for blood clotting problems (e.g. women who have had a deep vein thrombosis or pulmonary embolism or are at an increased risk of clotting disorders);
  • with vaginal bleeding without a known cause.

Advantages and disadvantages of hormone replacement therapy (HRT)

The doctor will consider per patient whether the benefits of HRT outweigh the disadvantages and possible risks. In any case, the final decision to start HRT lies with the woman herself, after she has been informed about the possible advantages and disadvantages of the treatment.

Additional benefits of HRT include:

  • a possible protective effect against heart problems (but there is debate about this);
  • a possibly beneficial effect on mood disorders;
  • a decrease in the risk of type 2 diabetes.

However, this should not be a reason to start treatment. In addition to the benefits, there are also several risks associated with the (long-term) use of HRT :

  • Some studies show an increased risk of cardiovascular disease, because estrogens, alone or in combination therapy, increase the risk of clots in the veins ( embolism or thrombosis ). That is why you should always take into account your predisposition or other risk factors for clot formation.
  • The hormonal effect of HRT slightly increases the risk of breast cancer.
  • HRT increases the risk of gallstones and gallbladder inflammation.
  • With long-term use (longer than 10 years), there is a slightly increased risk of ovarian cancer.

What can your doctor do?

Physical examination and questioning

Your doctor will first perform a gynecological examination and possibly a breast examination. He will also take a pap smear and possibly refer you for a mammography (chest X-ray). Finally, he will measure your blood pressure and weight food.

Also, your doctor will conduct a thorough survey to determine whether you are eligible for treatment. This also includes questions about the family appearance of certain disorders.

In women under 45, the doctor will try to rule out a menstrual disorder other than menopause. For this, he can take a blood sample, in which several hormones are determined (serum prolactin, thyroid-stimulating hormone or TSH, follicle-stimulating hormone, or FSH).

The results provide the doctor with insight into your hormonal balance and help him determine whether or not you are in menopause. Women over the age of 45 who have had no bleeding for a year are officially in transition. So for these women, a blood draw is not helpful or necessary to diagnose menopause.

Different forms of hormone replacement therapy (HRT)

If the doctor decides to initiate HRT, he will try to limit it to the lowest dose and to the shortest time possible. Depending on the complaints and the woman, HRT can be started with only estrogens, or in combination with progestins.

HRT with estrogens

Estrogen-only HRT (unless local) is only used in women who no longer have a uterus. Estradiol is the most commonly used estrogen and is prescribed in various forms. For example, a patch or skin gel is often a better choice for women with migraines, diabetes, epilepsy, or an increased risk of clots.

For women who suffer from vaginal dryness or pain during sex, topical treatment with estrogen cream or a vaginal ring is the best choice. This topical treatment should not be combined with a progestogen.

HRT with progestins

  • Progestogens such as progesterone, dydrogesterone, and norethisterone have a different profile and effect on the breast or uterine tissue. They are therefore chosen in function of the complaints and side effects. Progestogens are also available in pill, patch, or IUD form.
  • During the first year of menopause, preference is given to a cyclically combined preparation. This means that the estrogen is given continuously while the progestogen is only added in the first 12 to 14 days of the calendar month. The intention is to cause bleeding during the treatment-free week or after the end of the progestin phase in cyclic treatment. The volume and duration of bleeding should be normal. After several years of treatment, if needed for so long, the volume of bleeding in many women will decrease or even stop altogether.

To avoid vaginal bleeding, women can opt for:

  • a combined treatment (estrogen + progestin)
  • Both preparations are taken daily.
  • This treatment is usually only applied from 1 year after menopause.
  • tibolone, a substance with hormonal properties of both estrogens and progestins
  • This treatment is also usually only applied from 1 year after menopause.

Non-hormonal treatments

<a href=”womanlab.org/menopause-can-be-complicated-non-hormonal-treatments-shouldnt-be/” rel=”dofollow”>Non-hormonal treatments</a> are also possible. Women who suffer from hot flashes and are not allowed to take estrogens can consider an antidepressant such as venlafaxine, paroxetine, citalopram,….

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

Your doctor will ask you to come for consultation within one year of starting the HRT. Then he will mainly check whether the complaints have improved, whether there are side effects, whether the dose can be reduced or if the treatment is stopped. There is no point in having blood estrogen levels determined via a blood draw.