Introduction:
Hormone therapy is one of the government-approved therapy for the relief of menopausal symptoms. The symptoms caused by the low estrogen level during menopause are hot flashes, sleep disturbances, and vaginal dryness. Hormone therapy has also been approved for the prevention of osteoporosis. The ovaries no longer produce estrogen and progesterone as one transitions into menopause. Changes in the hormone can cause uncomfortable symptoms. Menopausal hormonal therapy involves treatment with only estrogen or estrogen along with progestin.
There are three stages of natural menopause, they are:
- Premenopause: It is also called menopause transition. It is the period between the start of symptoms and one year after the final menstrual period.
- Menopause: Menopause is confirmed 12 months after the final menstrual period.
- Postmenopause: Postmenopause is all the years beyond menopause.
What Are the Functions of Estrogen and Progesterone?
Ovaries produce estrogen and progesterone hormones.
The functions of estrogen are:
- It helps to maintain healthy blood cholesterol levels.
- It is an important bone-building material.
- Helps in preventing osteoporosis.
- Helps to keep the vagina healthy.
- Helps in thickening the lining of the uterus.
The functions of progesterone are:
- Helps to improve mood and sleep.
- Helps in regulating blood pressure.
- Helps in maintaining pregnancy.
- Prepares the uterus for the implantation of a fertilized egg.
What Are the General Ways to Take Hormone Therapy?
- Local: The local products used during hormone therapy only affect a specific body area. There are creams, rings, and tablets available which can be used for vaginal symptoms.
- Systemic: The systemic products used during hormone therapy circulate throughout the bloodstream and to all parts of the body. They are available as an oral tablet, gel, patch, injection, spray, and emulsion that can be used for hot flashes, night sweats, vaginal symptoms, and osteoporosis (bones become brittle and weak).
What Are the Types of Hormone Therapy?
There are two main types of hormone therapy:
- Estrogen Therapy - It includes estrogen only. Doctors usually prescribe a low dose of estrogen to be taken as a patch or pill daily. It can also be prescribed as an ointment, gel, vaginal ring, or spray. The lowest dose of estrogen is needed to relieve menopause symptoms.
- Estrogen Progesterone Hormone Therapy - It includes estrogen plus progesterone therapy. Combination therapy combines doses of progesterone as well as estrogen. This therapy is often called combination therapy.
What Are Some Commonly Used Postmenopausal Hormones?
There are some commonly used postmenopausal hormones:
Estrogen
- Pills - Pills are considered to be the most common treatment for menopausal symptoms. The estrogen pills are taken once a day without food.
- Vaginal Ring.
- Vaginal Tablet.
- Creams - Creams and gels are other ways to get estrogen into the system. These are absorbed directly into the bloodstream.
- Patch - The patch is worn on the skin of the abdomen. Some patches are replaced after every few weeks.
- Spray.
Vaginal Dehydroepiandrosterone
- Vaginal Insert.
Combination EPT (Estrogen Progesterone Therapy)
- Pills.
- Patches.
What Are the Benefits of Hormone Therapy?
Hormone therapy is beneficial in relieving menopausal symptoms:
- It helps to relieve vaginal dryness that results in painful intercourse.
- Hot flashes.
- Relieves symptoms of menopause such as night sweats and dry, itchy skin.
- Reduces the risk of developing osteoporosis.
- Decreases risk of colon cancer.
- Improvement in joint pain.
- Lower death rate for women taking hormone therapy.
- Improved overall mental health.
- Makes sex less painful.
- Helps to sleep better.
What Are the Risks of Taking Hormone Therapy?
Hormone therapy helps many women to help through menopause. The treatment is not risk-free, and it includes other health risks like:
- It increases the risk of gallstones (calcified stone formation in the gallbladder).
- It increases the risk of dementia (memory issues).
- It increases the risk of endometrial cancer and breast cancer.
- It increases the risk of stroke (brain damage due to compromised blood supply) and blood clotting.
Who Should Not Take Hormone Therapy?
Hormone therapy is usually not recommended for:
- Pregnant women.
- Patients with liver disease.
- History of stroke, heart attack, or increased risk of vascular disease.
- Women with abnormal vaginal bleeding.
- Women having breast cancer or endometrial cancer.
What Are the Side Effects of Hormone Therapy?
Every medicine has some or other side effects. The most common side effects of hormone therapy are:
- Mood swings.
- Irregular periods and spotting.
- Nausea.
- Hip and vertebra fracture.
- Urinary incontinence.
- Tenderness of breast.
The less common side effects of hormone therapy are:
- Skin irritation under estrogen patch.
- Mammogram interpretation becomes difficult because of increased breast density.
- Fluid retention.
- Skin discoloration, like brown or black spots.
- Headaches.
How Long Should Hormone Therapy Be Continued?
There is no time limit to how long one can take hormone therapy. One should take the lowest dose of hormone and analyze which dose of hormone therapy works best for them and continue routine monitoring with their healthcare provider. One can reevaluate their treatment plan each year.
How to Reduce the Risk of Side Effects While on Hormone Therapy?
Risk is the possibility or chance of harm. Consultation with the healthcare provider about different methods and strategies will be beneficial:
- Minimize the medication and try to take the lowest dose for the shortest time.
- Make a healthy lifestyle choice that will include exercising, eating healthy, maintaining a healthy weight, not smoking, limiting alcohol, and managing stress and chronic health conditions like blood pressure and high cholesterol.
Conclusion:
The healthcare provider should discuss the risks and benefits of hormone therapy. Hormone therapy is not for everyone, so the treatment needs to be personalized.
