Menopause is a completely normal and natural part of biological ageing for women that usually occurs between the ages of 45 and 55 as estrogen levels decrease, marking the end of menstruation and fertility. Unfortunately, the hormonal changes associated with menopause also cause a host of troublesome physical and emotional symptoms, such as lack of energy and fatigue, mood changes, hot flashes and night sweats, vaginal dryness, or insomnia. 

Hormone Replacement

Hormone Replacement

While menopausal changes vary from person to person, and some women only experience mild issues, for others the symptoms can be long-lasting and debilitating, having a major impact on their daily activities and quality of life. So, if you’re approaching menopause or are already experiencing some of the symptoms listed above, a better understanding of these issues and the potential treatments can make the transition to menopause a lot smoother. 

A lot of women monitor their hormone levels regularly to predict or confirm the onset of menopause and get ready for what’s about to come. Although it's not possible to reverse the ageing process and stop menopause in its tracks, there are various treatments that can help women manage the symptoms and limit the discomfort they’re experiencing, and hormone replacement therapy has proved to be one of the most effective options so far. 

Understanding hormone replacement therapy

Understanding what hormone replacement therapy is, how it works and how it can benefit women will help you decide if this could be a good option for you or not. As the name suggests, hormone replacement therapy (HRT), also known as menopausal hormone therapy or estrogen replacement therapy, is a type of treatment that is used to boost women’s hormone levels and thus provide relief for common menopausal symptoms.    

As women transition into menopause, the levels of estrogen and progesterone produced by their ovaries start to decline, leading to a long list of symptoms, some of which we have already mentioned. Estrogen and progesterone are the main reproductive hormones in the female body and play a key role in regulating a series of essential processes and functions. 

Estrogen is responsible for the development of the reproductive system and contributes to bone health, cognitive health and cardiovascular health. Similarly, progesterone has several important functions, including regulating the menstrual cycle, preparing the uterus for a potential pregnancy, supporting pregnancy and lactation, regulating blood pressure and improving mood and sleep. 

HRT aims to replace the hormones that the body no longer produces naturally after menopause and restore normal levels via medication that mimics female hormones estrogen and progesterone. Doctors often prescribe HRT to women who enter menopause naturally as well as women who undergo a surgical menopause. HRT has proven its efficiency in reducing the most common menopausal symptoms such as hot flashes and vaginal dryness, but it can also be used to strengthen bones and reduce the risk of fractures in postmenopausal women. 

Women need to undergo a detailed medical evaluation to determine if they are good candidates for receiving HRT. The treatment is usually recommended to patients who meet one or more of the following criteria: 

  • They experience mild to severe hot flashes
  • They present other common menopausal symptoms such as vaginal thinning and dryness and a sensation of burning and itching that can cause discomfort during intercourse 
  • They want to prevent bone loss and reduce risks associated with osteoporosis 
  • They have entered menopause prematurely (before the age of 45) due to surgical interventions, or they suffer from ovarian insufficiency

Types of hormone replacement therapy 

There are two main types of HRT: estrogen therapy and estrogen/progesterone/progestin therapy, and both can benefit women who struggle with menopausal symptoms. 

Estrogen therapy is usually recommended for women who have had their uterus removed. In this case, a small dose of estrogen may be prescribed to the patient. The estrogen can be administered through various methods, as follows: 

  • Estrogen pill – pills and tablets are the most common form of HRT, and they are usually taken once a day, although dosage may vary. 
  • Estrogen patch – estrogen patches are applied to the lower part of the stomach and are mostly used for the treatment of hot flashes. Most patches need to be replaced after a few days, but some can be worn for a longer period of time. 
  • Topicals – estrogen treatments also come in the form of creams, gels and sprays that are applied directly onto the skin so they can be absorbed into the bloodstream. Dosage and applications vary depending on the product.  
  • Vaginal estrogen – women who want to treat vaginal dryness specifically often use estrogen in the form of vaginal creams, rings and tablets.   

Estrogen/progesterone/progestin therapy is also known as combined therapy as estrogen is used along with progestin to treat menopausal symptoms. Doctors usually prescribe this type of therapy to women who still have their uterus since taken alone estrogen can cause the lining of the uterus to thicken and thus increase the risk of endometrial (uterine) cancer. As with estrogen treatments, progestin can be administered orally, in pill form, or via intrauterine devices. 

Is it a safe option for everyone? 

As with any other treatment out there, HRT can also cause side effects. Research has revealed that HRT can increase the risk of heart disease, stroke, blood clots and breast cancer. However, it’s less likely to experience these side effects if you start HRT later (after the age of 60), use lower doses and get regular medical check-ups. The age of the patient, as well as their health history and the type of HRT they’re taking also play an important role in managing risks. For most women, the benefits provided by HRT far outweigh the potential risks. 

HRT is definitely not a one-size-fits-all treatment, so it’s important to be aware of the pros and cons. Therefore, women need to discuss the possibility of starting HRT with their doctor and take into consideration all the implications in order to make an informed decision.

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