Hormone Therapy (»HT«), often still called Hormone Replacement Therapy (»HRT«), is a valid option for some, but certainly not for all women who undergo menopause. Synthetic hormones can reduce heat flashes, nightly sweats and vaginal dryness very effectively, and also have a beneficial effect on sleep, mood and concentration deficits. They also maintain bone density and thus protect from fractures. However, HRT is also associated with a number of unfavourable, potentially even hazardous side effects: Especially the combination of estrogens and progestins have been shown to increase the risk of developing breast cancer. Women who have developed breast cancer previously should therefore refrain from HRT. Furthermore, the risk to experience cerebral insults, thromboembolic disease or a myocardial infarction, all increase with the prolonged use of HRTs.
When is Hormone Therapy helpful?
Not all women »experience« climacteric symptoms. While one third does not experience symptoms at all, and another third only occasionally complains, the remaining women suffer from severe heat flushes and night sweats. In extreme cases these complaints can be so debilitating that affected women are unable to live a social life and some have troubles in their professional life. Hormones can particularly alleviate heat flushes and night sweats, in some cases they even make them disappear completely. The same is often true for sleep disorders, palpitations, or joint pain, if caused by the decline of female sex steroids. Since estrogens support fluid retention in many tissues, their lack results in a thinning and dehydration of vaginal mucosa. This can result in painful intercourse and in a tendency to develop vaginal infections. Locally applied estrogen-containing crèmes and uvula are effective, yet are safe, since their hormonal effects are limited to the vagina. Disturbances of the menstrual cycle during the years before and during menopause are a common cause of dwindling concentration and phases of depressive moods and hormones can be particularly helpful. Estrogens are now available in a number of dosage forms: they can be applied in the form of tablets, hormone patches, gel, or as nasal spray, and can be prescribed alone or in combination with progestins.
What are the Risks of Hormone Therapy?
Older scientific work has suggested a preventive role for hormone therapy in women with cardio-vascular diseases. Unfortunately, we now know that hormone therapy has no such effect. Growing evidence indicates that hormone therapy does in fact slightly increase the risk of developing cardio-vascular diseases and stroke. In addition, the use of hormones results in an increased risk of deep vein thrombosis (»DVT«) and arterial clogging (»embolisms«). The risk for developing breast cancer increases with the length of intake. This is particularly true for estrogen / progestin combinations. The World Health Organization (WHO) has therefore classified the combined estrogen / progestin therapy as potentially carcinogenic. Finally, a pure estrogen therapy has been demonstrated to increase endometrial cancer risk in women with an intact uterus. Women who use this particular hormone replacement therapy should therefore undergo regular vaginal ultrasound exams.
Is Hormone Therapy an Option for me?
If you are uncertain whether hormone therapy is the right treatment for you, you should ask yourself the following three questions. They can assist you and your gynaecologist in making an informed decision for or against hormone therapy:
Do you suffer from heat flushes and night sweats that are severe enough to affect your night sleep the daily quality of living?
Profound heat flushes and night sweats are the only complaints which justify the use of hormone therapy on medical grounds. If vaginal dryness is your only symptom, you should rather apply estrogen creams locally.
Do you have a health state in which the advantages of hormone treatment outweigh the disadvantages?
The risk-benefit ratio for hormone treatment is most favourable in women who have experienced their last menstrual bleeding less than 5 years ago and who are not at an increased risk for cardio-vascular disease, DVT, or stroke. In all other women the risks associated with HT most probably outweigh its preventive benefits.
What is your general opinion regarding the use of hormone replacement therapy during menopause?
If you are rather reserved about the use of hormone therapy for the alleviation of menopausal symptoms, you should never allow your physician to push you towards such a treatment. There are other options that are available. Hormone treatment should never be used to »prevent« signs and symptoms of ageing
How to use Hormone Therapy safely
If you and your physician have decided that hormone treatment is indicated, you should consider the following advice:
· Always start with the lowest dosage that alleviates your complaints. Try using half of the prescribed dose and observe your symptoms for one to three months. If symptoms remain, consult your physician regarding an increase in dosage
· If you still possess an intact uterus, you should also use progestins in order to minimize the risk for developing endometrial cancer. Pre-formulated estrogen-progestin combinations the basis of many HT regimen
· Use hormone treatment for 1-2 years and never use it for more than 5 years. Try to phase out the treatment at least once a year. Often enough the heat flushes have ceased in the meantime and hormonal treatment is no longer necessary