Menopause Hormone Therapy:
HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) is the most effective treatment for menopause symptoms. A tablet containing conjugate equine oestrogen combined with the SERM bazedoxifene improves menopausal symptoms, bone density and reduces breast density. Bazedoxifene, like progestogen, reduces the risk of cancer of the lining of the uterus in women who have not had a hysterectomy. Tibolone is taken as a single tablet and has some oestrogen, progesterone and testosterone effects.
FDA advises women to use MHT for the shortest time and at the lowest dose possible to control menopausal symptoms. DOPS is the only randomized clinical event trial to closely replicate the populations of women in observational studies (22). Women in DOPS were on average 50 years of age and 7 months past menopause with an average BMI of 25.2 kg/m2 when randomized to HRT or no HRT.
The absolute risk was also very low as the increased mortality was 4 cases per 10,000 people and individual estrogen therapy did not have any effect on the mortality rate of lung cancer [125]. These systemic estrogen products are referred to as “hormone therapy” and contain either estrogen alone or estrogen plus progestogen. Estrogen alone is used only for postmenopausal women who have had a hysterectomy (surgery to remove the uterus) because taking estrogen by itself raises the risk of uterine cancer. Adding progestogen (a version of the hormone progesterone) protects against the risk of uterine cancer, so estrogen plus progestogen therapy is used for postmenopausal women who still have their uterus. On the other hand, lipid-lowering therapy is effective in reducing CHD, nonfatal MI and CHD mortality by 20’30% when used for secondary CVD prevention in women.
During the transition into menopause, which can last several years, many women experience some depression. Numerous studies have confirmed that when HRT is started early, within 10 years of menopause, it can help protect your heart and vascular system from disease. Although there’s still confusion about HRT, many researchers say the benefits outweigh the risks. But many people are still hesitant to use HRT because of concerns about the risks it could pose. Whether it’s right for you depends on your age, when you entered menopause, and other risk factors. Read copyright and permissions information.This information is designed as an educational aid for the public.
In general, a lower frequency of venous thromboembolism is observed in Asian women than in Western women [86]. Vaginal DHEA has received FDA approval as a medicine for the treatment of GSM because it reduces vaginal dryness and dyspareunia as well as vaginal acidity by recovering the thickness and safety of epithelial cells and increasing the quantity of vaginal discharge [36]. 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 [1,2,3].
Even the evidence we do have about the effectiveness of certain treatments, in particular hormones, is only limited to studies done on women with severe symptoms, which may not be as frequent a scenario, she said. Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. Compared with placebo, CE/BZA reduced the levels of total cholesterol and LDL cholesterol while increasing the level of HDL cholesterol. In contrast to placebo, for hemostasis variables, CE/BZA reduced the activation of fibrinogen, PAI-1, and antithrombin and increased the activation of plasminogen. CE/BZA was demonstrated to not cause a negative effect on the balance of lipid metabolism and hemostasis [212].
Cumulated data across RCTs show that when lipid-lowering therapy is used in women, all-cause mortality is neither reduced in primary CVD prevention (RR, 0.95; 95% CI, 0.62’1.46) nor secondary CVD prevention (RR, 1.00; 95% CI, 0.77’1.29) (33). In a small number of observational studies, MHT did not increase the risk of breast cancer in women with a family history of breast advice cancer or who received ovariotomy and have BRCA 1/2 [107,108,109,110]. Thus, because MHT could increase recurrence in breast cancer patients, it is not advised [111]. However, in case of low-dose vaginal ET, it could be considered as an effective therapy after trying non-hormonal therapy when suffering from urinogenital atrophy due to minimal systemic absorption [112].
Because there is no clinical data to guarantee the safety of the endometrium for a long-term application of more than 1 year, the duration of using low-dose vaginal estrogen should be limited to less than 1 year, and afterward, it must be used along with the evaluation of the endometrium. The use of oral or percutaneous estrogen therapy (ET) together with LNG-IUS is not only effective for alleviating the symptoms of menopause but also for preventing endometrial hyperplasia. Even in the case of a normal menstrual cycle, if the symptoms of menopause are severe, the use of a combination therapy of low-dose percutaneous estrogen and LNG-IUS could effectively control a hot flush [8]. In addition, some reports have shown that it could help improve symptoms that appear during menopausal transition such as depression, reduced quality of sleep, and increased anxiety [9,10]. NAMS reported that MHT prevents menopause-related bone loss and reduces osteoporotic fractures including those of the spine and femur in the low-risk group.
In another epidemiological study targeting the elderly in the Gangbuk district in Seoul, the prevalence rate of sarcopenia was 6.3% in men and 4.1% in women [169,170,171]. In addition, according to the cumulative data of more than 10 years from the Korean National Health and Nutrition Examination Study, 19.5% of women in their 50s, 16.6% of women in their 60s, 23.7% of women in their 70s, and 30.8% of women in their 80s were reported to have sarcopenia [172,173,174]. reference No difference was found between the continuous and cyclic use of progestogen, and no effect has been proven to reduce the risk of fractures using low- and ultralow-dose estrogen therapy. Most (82%) menopausal women with fractures in the NORA study were reported to have osteopenia with a T score above -2.5, but even though the frequency of femur fracture was the highest in the study, only 6.4% of the patients had a T score below -2.5 [166].
Most severe VMS appear within 1’2 years from the last day of menstruation and usually continue for about 4’5 years. However, there are cases in which the symptoms last for more than 12 years, which is reported to be 10% of the total cases; therefore, the symptom duration greatly varies [13,15]. Talking about article source menopause symptoms can be uncomfortable, especially when the symptoms feel personal. Creams and rings supply hormones to a localized area, which help to limit the amount in your system. According to a 2020 meta-analysis, estrogen-based HRT may have a protective effect against some neurological conditions.
Tibolone increased muscle mass and reduced the waist’hip ratio in menopausal women [188,189]. When taking more than 1.25 mg over a period of 12 weeks, 86% of participants experienced improvement of hot flush [183]. In addition, the frequency of abnormal vaginal bleeding was significantly low in the group treated with tibolone during the first 3 months of therapy. In addition, the frequency of breast pain was significantly low in the group treated with tibolone when compared with the E2/NETA group. Undergoing treatment for menopausal transition should be primarily decided according to the frequency and severity of the symptoms of menopause.