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Patient Education - MAKING MENOPAUSE EASY - HORMONE REPLACEMENT THERAPY

MAKING MENOPAUSE EASY - HORMONE REPLACEMENT THERAPY

  • Dr. Smriti Uppal, GYNECOLOGIST
MAKING MENOPAUSE  EASY - HORMONE REPLACEMENT THERAPY

HORMONE REPLACEMENT THERAPY

Hormone replacement therapy (HRT) is a treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as you approach the menopause.

Menopause is not an illness ,but a natural transition from the years in which a female can reproduce to the next phase of life. Many women go through menopause without requiring any treatment. However, if the transition causes troubling or distracting symptoms, a variety of treatment approaches are available.

SYMPTOMS

  • Hot flushes
  • Night sweats
  • Vaginal dryness
  • Loss of sex drive
  • Stress incontinence (leaking urine when you cough or sneeze)
  • Bone thinning (which can lead to osteoporosis and fractures)
  • sleep problems
  • mood changes
  • irregular periods
  • difficulties with concentration and memory

 It is safe to take hormone therapy:

  • for moderate-to-severe hot flashes and vaginal dryness
  • up to the age of 59 years
  • within 10 years of menopause
  • at the lowest possible dosage, for the shortest possible length of time

 HRT may not be suitable for people with a history of:

  • uncontrolled hypertension, or high blood pressure
  • thrombosis or blood clots
  • high levels of triglycerides in the blood
  • stroke
  • heart disease
  • breast cancer
  • gallbladder disease

Types of HRT available

  • Cyclical HRT mimics the normal menstrual cycle. Oestrogen is taken every day and progestogen for 12 to 14 days. At the end of each course of progestogen there is some bleeding as the body “withdraws” from the hormone and the endometrium is shed. Progestogen regulates bleeding and protects the endometrium from harmful pre-cancerous changes
  • Continuous combined therapy HRT (CCT) combinations of an oestrogen and progestogen are prescribed continuously to achieve period-free HRT. Usually, women start on cyclical HRT and change to CCT later
  • Long cycle HRT uses a formulation which causes withdrawal bleeds every three months instead of every month, and is most suited to women who suffer side effects when taking a progestogen. Its safety in long-term use with regard to the lining of the womb is questionable.
  • Tibolone is a synthetic form of period-free HRT which may have similar benefits to CCT. It is taken continuously in tablet form
  • Estrogen Therapy: Doctors generally suggest a low dose of estrogen for women who have had a hysterectomy , the surgery to remove the uterus, and for women who've had a bilateral oophorectomy (the surgical removal of the uterus and ovaries). Estrogen comes in different forms.
  • Estrogen pill — Pills are the most common treatment for menopausal symptoms. Among the many forms of pills available are conjugated estrogens (Cenestin, Estrace, Estratab, Femtrace, Ogen, and Premarin) or estrogens-bazedoxifene (Duavee). Most estrogen pills are taken once a day without food.
  • Estrogen patch — the patch is worn on the skin of your abdomen. Depending on the dose, some patches are replaced every few days, while others can be worn for a week. Examples are Alora, Climara, Estraderm, and Vivelle-Dot. Combination estrogen and progestin patches -- like Climara Pro and Combipatch -- are also available. Menostar has a lower dose of estrogen than other patches, and it's only used for reducing the risk of osteoporosis.
  • Topical Estrogen – Creams, gels and sprays offer other ways of getting estrogen into your system. Examples include gels (like Estroge and Divigell), creams (like Estrasorb), and sprays (like Evamist). As with patches, this type of estrogen treatment is absorbed through the skin directly into the bloodstream. They're usually used once a day. Estrogel is applied on one arm, from the wrist to the shoulder. Estrasorb is applied to the legs. Evamist is applied to the arm.
  • Vaginal estrogen — Vaginal estrogen comes in a cream, vaginal ring, or vaginal estrogen tablets. In general, these treatments are for women who are troubled specifically by vaginal dryness, itchiness, and burning or pain during intercourse. Examples are vaginal tablets (Vagifem), creams (Estrace or Premarin), and insertable rings (Estring or Femring).Most vaginal rings need to be replaced every three months. Vaginal tablets are often used daily for a couple of weeks; after that, you only need to use them twice a week ,while creams might be used daily.

As with any medicine, HRT can cause side effects, but these will usually pass within 3 months of starting treatment.

  • breast tenderness or swelling
  • headaches
  • indigestion
  • abdominal pain
  • fluid retention.
  • bloating.
  • depression.
  • vaginal bleeding

Alternatives to HRT

Not every woman chooses HRT or can have HRT to help their symptoms of the menopause. This may be because:

  • Your GP has advised you not to take HRT because of your own or your family’s medical history, e.g. breast cancer or deep vein thrombosis (DVT - a blood clot in a deep vein)
  • You want an alternative treatment that works especially well for one particular symptom
  • You have concerns about the safety and side effects of HRT
  • You would prefer alternative treatments to help alleviate symptoms of the menopause

 The alternatives to HRT can be broadly classified as:

  • Herbal medicine - a practice based on the use of plants or plant extracts to relieve symptoms, e.g. evening primrose oil or St John’s Wort
  • Alternative medicine - a range of therapies used instead of conventional medicine, such as acupressure, acupuncture and homeopathy
  • Complementary therapy - interventions that tend to be used alongside conventional medicine, e.g. aromatherapy with HRT
  • Lifestyle measures- such as exercising regularly, eating a healthy diet, cutting down on coffee, alcohol and spicy foods, and stopping smoking ,wearing loose clothing ,maintaining regular sleeping habits, using a fan or cooling gel pad to help prevent night sweats, practicing stress reduction techniques, such as mindfulness, meditation, or yoga and talking to friends and family members about their experience
  • Non-hormonal medical treatments - treatments prescribed by your doctor, such as:
  • antidepressants – some antidepressants can help with hot flushes and night sweats, although they can also cause unpleasant side effects such as agitation and dizziness
  • clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small

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 Women on HRT should be re-assessed by their doctor at least annually.

 

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