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The term “menopause” is used to describe the last period in a woman’s life. The phenomenon is caused by the physiological cessation of ovarian functions, i.e. hormone production. It’s just the next stage in every woman’s life. What is worth knowing about it? Is hormone replacement therapy effective in relieving menopausal symptoms? Dr. Marcin Mika, MD, a gynecologist at the Superior Medical Center in Krakow, talks about it.
In Poland, the average age of the onset of menopause is around 50 years. Of course, it doesn’t always happen exactly at this age, but usually during the period medically known as perimenopause, which includes premenopause, menopause, and postmenopause. This is the time when major menopausal symptoms begin to appear, which fade away over time.
He is a graduate of Collegium Medicum of the Jagiellonian University. In the Clinical Department of the Gynecology and Oncology Clinic of the University Hospital of the Jagiellonian University Medical College in Krakow, he worked in a team dealing with the surgical treatment of benign and neoplastic breast diseases and developed skills in minimally invasive gynecology surgery. On a daily basis, he sees patients at the Superior Medical Center in Krakow.
Common symptoms of menopause
Typical symptoms of menopause may begin to appear already before menopause, just before the end of menstruation (this applies to about 40% of women), and after menopause – about 80%. he suffers from them. What symptoms are we talking about? They look a bit different in different women – says Marcin Mika, MD, PhD. By unifying, however, it can be said that the typical symptoms include: hot flushes (night sweats), sleep disturbances, heartbeat (palpitations), pressure throws, headaches and dizziness, mood swings (greater tendency to depression, difficulty in concentration and memory impairment). Sometimes it is also bone and muscle pains and a generally unfavorable well-being in women – adds the specialist.
Additionally, after the menopause, symptoms such as disorders of the genitourinary system, pain during intercourse, more frequent infections of the genitourinary tract (very often associated with stress urinary incontinence), vaginal dryness and conditions associated with estrogen deficiency in this area, such as loss of skin firmness, the appearance of wrinkles, etc.
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Every woman, entering the menopausal age, should implement certain dogmas that should accompany her from now on. First of all, when you reach menopausal age, you should start taking more care of yourself, not only by examining your doctor, using hormone replacement therapy if necessary, but also through proper diet and physical activity. It is also good to quit smoking which speeds up the menopause process. This is the entire envelope of taking HRT, which should also be introduced, especially then.
Unpopular therapy
Unfortunately, according to the available data, hormone replacement therapy is not very popular in Poland. It is used by only about 4 percent. menopausal women, so very little. Many women use various preventive measures, the so-called parapharmacists – says the gynecologist. However, these are not drugs, but various types of supplements and medical devices designed to reduce the symptoms of this ailment. Meanwhile, nothing can replace hormone replacement therapy based on two-component therapy: estrogens and progesterone – explains Marcin Mika, MD, PhD.
What does hormone replacement therapy do? First of all, it slows down and soothes the aging process. This is based on important elements of hormone replacement therapy, ie it slows down osteoporosis, and thus – reduces the risk of pathological fractures of the femoral neck, spine, back pain, etc. HRT also slows down the process of atherosclerotic plaque formation (cardioprotective effect).
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Regarding its other beneficial effects, HRT reduces the risk of insulin resistance-related diabetes, metabolic syndrome, Alzheimer’s, Parkinson’s and other diseases that progress with aging.
The risk of HRT?
Approx. 20 years ago, the global WHI (Women’s Health Initiative) study introduced a lot of confusion in the HRT paradigms. As it turned out later, this was due to the poorly selected group of women for the study, which resulted in alarming and disturbing information about the adverse effects of HRT.
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Many years had to pass to finally systematize these rules, fortunately it was finally done. Thanks to this, we now know that hormone replacement therapy does not harm women. Yes, there are some contraindications that you need to pay attention to, so HRT must always be started by a doctor, and it should be carried out under medical supervision – explains the gynecologist.
Contraindications
The absolute contraindications include pregnancy, abnormal uterine bleeding or a high risk of thromboembolism. Often in the history of such a patient it turns out that, for example, in the family history there have been strokes or heart attacks. Another contraindication is also high arterial hypertension, previous heart attacks, strokes, unstable coronary artery disease, liver diseases, or a history of breast cancer or endometrial cancer. These are all absolute contraindications to the use of hormone therapy for menopause.
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There is also a risk, often raised by opponents of HRT, of increasing the occurrence of breast cancer. Although it is a fact, the risk of breast cancer associated with taking HRT increases by about 1,2-1,4%. It is therefore worth noting that this is an increase in risk comparable to a woman’s weight gain of 5 kg or regular use of HRT. alcoholic beverages.
HRT – in what form?
The forms of HRT administration vary in Poland. It can be in the form of tablets, transdermal (transdermal – in the form of patches or gels) or intramuscular injections. In the West, there are also subcutaneous implants and vaginal discs with estradiol, but in Poland these solutions are rarely used.
Of course, the route of administration matters. It is known from research that transdermal administration puts less strain on the liver and is associated with a negligible risk of thromboembolism, which is significantly correlated with oral administration. Thus, the route of administration is important, as is the dose and the time at which the therapy is started.
When to start therapy and when is it too late?
HRT should be started in good time. In women with symptoms or before their onset (when they begin to enter perimenopause), it is worth considering the use of HRT. Why should it be done this way? Because more than ten years after the last menstruation, the action of hormones has an adverse effect on cardiovascular complications – explains the specialist.
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The inhibition of the development of the various diseases mentioned earlier depends on the time of starting HRT. It used to be believed that the therapy should end with the disappearance of symptoms. Today it is already known that it is important both to start therapy at the right time and to use the lowest possible effective doses. The doctor who prescribes HRT should choose the dose so that the dose is sufficient to relieve your symptoms, but not too high at the same time. Then HRT can be used for years, not necessarily only 10 years, from the start.
It is also worth knowing that starting therapy after the age of 60 is associated with a high risk of side effects that may accompany hormone replacement therapy.
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