MENOPAUSE, a natural decline in reproductive hormones when a woman reaches her 40s or50s is signalled by 12 months since last menstruation in the absence of any surgery or medical condition that may stop bleeding. It is also caused naturally by estrogen deficiency at this stage of life. Menopause primarily occurs in 3 stages:
- Perimenopause (it precedes menopause and usually begins in the 40s or earlier. It is
characterized by hormonal fluctuations manifested as mood swings and irritability) - Menopause (This is the ceasing of menopause and common symptoms include hot flashes,
vaginal dryness and sleep disturbances that can cause anxiety or depression) - Postmenopause (this is the time after menopause and it lasts for the rest of your life. During
this stage, menopausal symptoms, such as hot flashes, get milder or go away)
These happens as a result of decline in estrogen or progesterone.
WHAT IS HORMONE REPLACEMENT THERAPY (HRT)?
HRT is a possible treatment for menopause symptoms. It can also be refered to as MHT
(menopausal hormone therapy), hormone therapy and estrogen replacement therapy. It is
basically the replacement of hormones (primarily estrogen and/or progesterone) that your
ovaries stop producing during menopause.
While not all women might need HRT, it has been a sorce of relief from uncomfortable
symptoms of menopause like:
- Hot flashes (hot flushes)
- Night sweats
- Vaginal dryness and discomfort.
It is important you speak to your doctor whether you have considered the benefits and risks of
HRT or not as this will help you make an informed decision whether it is the right fit for you
especially if you are feeling any of these menopause symptoms: - Vaginal and Urinary Symptoms (Genitourinary Syndrome of Menopause – GSM)
- Painful intercourse (dyspareunia)
- Recurrent UTIs
Other Symptoms: - Mood swings, irritability, anxiety, depression
- Sleep disturbances/insomnia
- Brain fog, memory issues
- Joint pain
- Decreased libido
- Hair loss
BENEFITS OF HRT
The benefits of HRT for the improvement of menopausal symptoms are constantly being
discussed and emphasized. it includes but is not limited to: - Effective relief from menopausal symptoms (as listed above).
- Bone health: Prevention of osteoporosis and reduction of fracture risk.
- Cardiovascular health: Potential reduced risk of heart disease when started early in
menopause (within 10 years or before age 60). - Reduced risk of colorectal cancer (for combined therapy).
- Potential for improved mood and overall well-being.
- Reduced risk of Type 2 Diabetes.
Depending on your needs and preferences, there are several ways HRT can be administered. - Estrogen-only therapy: For women who have had a hysterectomy.
- Combined therapy (Estrogen + Progestogen): For women with an intact uterus to protect the
uterine lining from estrogen’s effects.
It could be delivered as - oral pills
- transdermal (patches, gels, sprays) – often preferred due to lower risk of blood clots.
- Vaginal (creams, tablets, rings) – for localized vaginal/urinary symptoms.
- Implants
The lowest effective dose of is usually recommended to start with. Also, Bioidentical Hormone
Therapy (BHRT) treatment for menopause uses hormones that are chemically similar to those
produced by the body, often derived from plants. The FDA approves some bioidentical
hormones for menopausal treatment, like estradiol and micronized progesterone, which are
regulated for safety and efficacy but compounded bioidentical hormone preparations, which are
custom-blended, are not FDA-approved and may contain untested combinations and dosages.
While HRT is praised to be a solution to uncomfortable menopause symptoms. It just might not
be right for you because of risks like: - Increased risk of blood clots (especially with oral estrogen).
- Slightly increased risk of stroke.
- Slightly increased risk of breast cancer (primarily with combined therapy, usually after 5+ years
of use). - Increased risk of gallbladder disease.
Like all drugs, HRT has side effects. Though they are temporary, they commonly include: - Headaches
- Breast tenderness
- Bloating
- Irregular bleeding/spotting (especially initially).
If you are wondering who should not take HRT, women with a history of breast, ovarian or
uterine cancer, blood clots, liver, heart or gallbladder disease, unexplained vaginal bleeding,
stroke, heart attack and known or suspected pregnancy may want to avoid HRT. If you smoke,
your doctor may encourage you to stop before prescribing HRT.
Making an informed decision about HRT is essential. This is why it is advised to discuss HRT
with a healthcare provider (GP, gynecologist) because your individual health history, symptom
severity, and preferences needs to be taken into consideration. This will help you weigh the
benefits vs. risks for you as an individual to make sure it is done right at your “window of
opportunity”. Also, regular monitoring and re-evaluation will be done when treatment starts to
make sure it is progressing positively.
If HRT is not an option for you or you just don’t want to take HRT for your menopause
symptoms, here are alternatives you can explore: - Lifestyle changes to your diet, exercise, stress management like calcium and vitamin D to help
with bone health. - Non-hormonal medications like SSRIs, Gabapentinor antidepressants for hot flashes.
- Vaginal moisturizers and lubricants to relieve dryness during intimacy.
- Take note of when your hot flashes happen so you can know and understand what triggers
them. - Herbal remedies but make sure it is taken under professional advice).
