Menopausal Hormone Therapy

by Michael_Koger

There are many issues to consider for the use of hormones to manage menopause.

Over the decades there has been much controversy with regard to menopausal hormone therapy. Physicians have debated this issue, and patients seem to have a variety of ideas as to whether or not it is beneficial. Nevertheless, there is evidence that it provides significant relief from hot flashes, night sweats, as well as dryness and atrophy of the vagina in these clients [1, 2].

In fact, clinical studies have shown that it is the most effective tool for the control of vasomotor symptoms such as hot flashes [2].

The vaginal mucosa becomes thin in these women, and there may be painful sex. The current term for this is genitourinary syndrome of menopause, and this replaces the older name which many medical doctors remember as vulvovaginal atrophy [2].

Menopausal hormone therapy is beneficial for the prevention and treatment of osteoporosis, and women who receive it will have a lower risk of fractures than those who do not take it.
[1, 2].

Hormone Preparations

The use of hormones such as estrogen and progesterone--whether in combination or as a single agent--may be either topical or systemic.  For example, topical treatment with estrogen is useful when the patient applies it to her vaginal mucosa.  Systemic therapy, on the other hand, may include estrogen and progestin via oral tablets, skin patch, injection, or vaginal ring [1].

Medroxyprogesterone acetate is a progestin which clinicians may prescribe in conjunction with estrogen [1].

Since topical preparations do not lead to absorption of the medication into the bloodstream, they are not beneficial for relief of hot flashes, night sweats, or osteoporosis.  The administration of systemic agents, however, does provide very good results for control of these symptoms because the medication circulates through most of the human body [1, 2].

The use of estrogen as the only agent to treat these women may increase the risk for development of uterine cancer.  It is feasible to reduce that possibility with the addition of progestin to the regimen.  However, women who do not have a uterus will obviously not present a problem in this regard, and it is reasonable to give them single drug therapy with estrogen [1].

Clinical Management

As with any medical condition, the management of this clinical situation may vary with the patient.  Hence, the physician must consider the client’s desires and quality of life.  He or she also has to take into consideration the woman’s age, specific clinical signs and symptoms, length of time since the onset of menopause, and whether she has had a hysterectomy [2].

Her personal risk of breast cancer, osteoporosis, cardiovascular disease, stroke, and venous thromboembolism are also important variables.  In any event, the doctor must reevaluate the client’s health at least once a year to determine whether any changes to the treatment plan are necessary [2].

The recommendation of the North American Menopause Society is that the clinician prescribe the lowest dose and for the shortest time such that the regimen will control the patient’s symptoms.  Of those women who discontinue menopausal hormone therapy, half will likely suffer recurrence of hot flashes and night sweats [2].

Women who begin treatment before the age of 60 or within 10 years of menopause will probably have a more favorable course of the illness than those who do not take that approach [2].

Conclusion

There has been much progress in the management of menopause as a result of research, clinical experience, and development of pharmaceutical products.  Early medical intervention and long-term follow up will help to ensure a good outcome for these women.

References

  1. American Cancer Society.  (2015).  Menopausal hormone therapy and cancer risk.  Retrieved September 2, 2016.
  2. Lipold, L., Batur, P. and Kagan, R.  (2016).  Is there a time limit for systemic menopausal hormone therapy?  Cleveland Clinic Journal of Medicine, 83, 605-612.
  3. The photo is that of a library at the Centers for Disease Control and is reprinted with permission from that organization.

Disclaimer

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 09/09/2016, Michael_Koger
 
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