Vms Menopause:
It is better to start MHT immediately once symptoms appear before or after menopause. If premature hypoestrogenism or early menopause (menopause under 45 years of age) is diagnosed, it is recommended to start MHT regardless of whether symptoms of menopause are present [182]. In the WHI study, the risk of facture significantly decreased by 33% at the lumbar spine and 35% at the femur using EPT and by 38% at the lumbar spine and 39% at the femur using ET. This protective effect rapidly disappeared after stopping over here MHT, and the long-term follow-up study of WHI reported that the ET group showed a continued reduction effect of all fractures after stopping therapy, whereas the EPT group showed no reduction in all fractures [81]. Addition of progestogen could negatively affect mood in women with a past history of depression, premenstrual syndrome, or premenstrual dysphoric disorder [159]. The effect of progestogen on the central nervous system could differ depending on the ratio of estrogen and progestogen [160].
When taking tibolone, high-density lipoprotein (HDL) cholesterol is reduced by 20%, total cholesterol by 10%, and triglycerides by 20%, and low-density lipoprotein (LDL) cholesterol is also reduced. Moreover, tibolone is effective considering the fact that it reduces anthogenesis and the acidity of LDL [195]. In the Long-Term Intervention on Fractures with Tibolone (LIFT) study, tibolone (1.25 mg) reduced vertebral fracture by 45% and the risk of non-vertebral fracture by 26% [194]. The optimal daily dose of tibolone for treating VMS is 2.5 mg, and it shows a significant effect within 4 weeks of administration and shows a maximum effect after 12 weeks of administration [183].
Blood tests include tests for liver function, kidney function, anemia, and fasting blood sugar as well as lipid examination, followed by mammography, bone mineral density (BMD) test, and Pap smear screening [3]. Furthermore, it is reasonable to regard pelvic ultrasonography as part of the basic examination in Korea considering its cost-effectiveness. Elective examinations such as thyroid function test, breast ultrasonography, and endometrial biopsy are customized to fit individuals’ risk factors. Depending on clinical manifestations and individual risk factors, the basic examinations and elective examinations are conducted at an interval of 1’2 years. MHT is used to prevent and treat symptoms and physical changes caused by estrogen deficiency, vasomotor symptoms, atrophy symptoms of the urogenital system, postmenopausal osteopenia, and osteoporosis. In the case of premature ovarian insufficiency (POI), MHT can be used at least until the mean age of menopause regardless of symptoms [1,2].
However, as most studies are small with different age, health condition, and exercise program, the interpretation of results could be affected. On the other hand, although there is a lack of studies, plant hormones such as isoflavone are considered to have no effect on sarcopenia [178]. In contrast to the over here consistent effect being reported regarding muscle strength, the effect of MHT on muscle mass remains controversial. In the WHI study, a preservation effect of body mass except fat was observed during the first 3 years of MHT, but this effect was reduced and disappeared during the 3 years afterward.
According to the results of a research on blood lipids, tibolone reduces neutral fats while reducing HDL cholesterol compared with MHT [200]. Tibolone generally showed a positive effect on bone density, and after comparing the effects of therapy for 1 year, an increased bone density of the lumbar, which is similar to that with MHT, was reported 42. Furthermore, tibolone users who had undergone surgical treatment for epithelial ovarian cancer and 33 tibolone non-users were retrospectively examined [201]. There was no evidence that tibolone negatively affects the overall survival rate as well as the survival-free rate of patients with epithelial ovarian cancer. Furthermore, in a study that compared 68 tibolone users who had received surgical treatment for endometrial cancer and the same number of nonusers, tibolone did not show any harmful effects in the prognosis of the patients with endometrial cancer [202]. Women going through menopause frequently experience vasomotor symptoms such as hot flashes, night sweats, and sleep disturbances, significantly influencing their quality of life.
However, when the administration stops, the prevention effect of colorectal cancer disappears. Individual estrogen therapy does not have any effect on invasive colorectal cancer or on the mortality rate due to invasive colorectal cancer [123,124]. The absolute risk of VTE was significantly increased in women initiating hormone therapy more than 10 years from menopause onset [75]. In the WHI study, based on the analysis my sources according to age, use of ET in women aged 50’59 years showed no significant increase in the risk. Because oral estrogen increases the activity of thrombin while reducing the activity of plasmin and has a higher thrombus tendency than that of transdermal estrogen, the use of transdermal estrogen could be better in case of women having a medical history or risk factors of venous thromboembolism [1,22,90].
They will also recommend hormone replacement only as long as it is helping your symptoms and not increasing your risk of heart disease, stroke, or blood clots. In terms of duration of symptoms, most people get hot flashes for about 4 years. You may only have them for a while during perimenopause, or you may continue to have them after your period stops.
Nevertheless, tissue-selective estrogen complexes have the possibility of providing comparable efficacy to hormone replacement therapy with an improved safety and tolerability profile. In contrast, the International Menopause Society (IMS) (2016) claimed that hormone therapy has shown to reduce the incidence of new-onset diabetes mellitus and has a beneficial effect on vascular function, lipid levels and glucose metabolism, which are risk factors for cardiovascular disorders [22]. There is strong evidence showing that the mortality rate and the incidence of coronary artery disease are reduced if started around the time of menopause or under the age of 60 or within 10 years of menopause. Accordingly, hormone therapy does not increase the risk of coronary artery disease in young and healthy menopausal women, but it is not effective in case they already have the disease. In the Danish Osteoporosis Prevention Study, when hormone therapy was conducted for 10 years with 1,000 young menopausal women with the average age of 50 years, there was a 52% reduction of the indicator, which is a combination of mortality, heart failure, or myocardial infarction [77].
According to the North American Menopause Society, up to 75% of people assigned female at birth in the United States experience hot flashes around menopause. Hot flashes usually occur over a period lasting from 6 months to 2 years, but you can experience them for up to 10 years. VMS have traditionally been conceptualized as an important quality of life issue during the menopausal transition, and they have generally not been assumed to have specific implications for physical health. However, emerging research from SWAN and other studies has begun to call this assumption into question. The C301 study assessing the therapeutic value of estetrol (E4) in post-menopause is a crucial component for the company’s submissions in both the United States and the European Union. The positive progress and timely completion of this phase reinforce the company’s commitment to meeting its final Clinical Study Report (CSR) timeline.
Hot flashes may occur in early pregnancy or as a response to cancer treatment or other medications. The mean duration that women experience hot flashes and night sweats is seven to nine years; one-third of women will continue to have VMS for a decade or more. For example, a 2021 study found that people assigned female at birth who ate a low fat, vegan diet containing whole soybeans reduced their hot flashes by 79%, compared with 49% in the control group.
Women over 40 years old who have reached the midlife and postmenopausal stages of life are most prone to hot flashes. You’ve probably heard about classic menopause symptoms, such as hot flashes and mood changes. Despite limited scientific evidence, soy-based foods can be part of a healthy diet for menopausal women. Women report having them from 10 times per day to several times per week, according to a meta-analysis published in the Journal of General Internal Medicine. Some find them mildly annoying, while others feel that their lives are seriously disrupted.
For women who started the therapy within 10 years of reaching menopause, there was a trend toward reduced risk, whereas for women who started the therapy more than 20 years after reaching menopause, the risk significantly increased [73]. Systemic MHT and low-dose vaginal ET are effective in treating urogenital atrophy and improve sexual function by increasing vaginal lubrication, blood flow, and sensory function. Although ET is effective for the treatment of menopausal symptoms, it does not increase sexual desire, arousal, and orgasm. In the case of women who are in need of systemic MHT expressing decreased sexual desire, percutaneous therapy is preferred to oral therapy because oral intake of estrogen reduces free testosterone by increasing sex hormone-binding globulin (SHBG). An injection of testosterone for women suffering from sexual dysfunction due to decreased sexual desire improves sexual satisfaction, desire, arousal, and orgasm; thus, it is effective for both natural menopausal or surgical menopausal women and is effective regardless of whether the woman is receiving MHT. Testosterone is also effective for the treatment of sexual desire disorder and sexual arousal disorder, which are related to antidepressants [59,60,61].
It can result in periods that are lighter or heavier, last longer, or come closer together. Dr. Kling reports personal fees from Proctor and Gamble and Triangle Insights Group outside the submitted work. Dr. Kapoor reports personal fees from Astellas Pharmaceuticals and Womaness and grants and personal fees from Mithra Pharmaceuticals outside the submitted work. As you approach menopause (at least a year without menstruating), hormonal shifts can cause symptoms including skin changes. Studies are ongoing; some research, per the National Center for Complementary and Integrative Health, suggests that practices such as hypnotherapy and mindfulness meditation could help with symptom management.
According to clinical results, the effects of CE/BZA for improving sexual function and treating symptoms related to moderate-to-severe genital atrophy as well as for alleviating dyspareunia have been proven [208]. Breast cancer was found to recur in 15.2% of patients in the tibolone treatment groups (237 of 1,556 patients) and in 10.7% of patients (165 out of 1,542 people) in the placebo group, and a 1.4-fold increase in the incidence of breast cancer was observed when taking tibolone. In the LIBERATE study, the risk of breast cancer recurrence was assessed in a clinical double-blind study of tibolone that compared the placebo group and patients who had undergone breast cancer surgery and had VMS [196]. The standard dose of MHT increases bone density by inhibiting bone resorption and reducing bone remodeling process.