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Stress-free menopause: how hormone therapy helps women

With age, women experience a natural decrease in reproductive function, known as menopause. This process takes a long time and is accompanied by changes in the physical and emotional state, hormonal restructuring and complete cessation of menstruation. On average, menopause (the so-called last menstruation in a woman's life) occurs at the age of 45-55 years, but its precursors may appear earlier, and the process of "restructuring" the body can last for several years. A decrease in the level of female sex hormones leads to unpleasant symptoms that not only worsen the quality of life, but can also contribute to the development of serious diseases. Although menopause is not a disease and does not require treatment, there are methods to improve well-being and prevent complications. One of these methods is menopausal hormone therapy (MGT). The decision on the need and time of MGT is made by a gynecologist. To understand whether such therapy is necessary for all women, it is important to understand the nature and characteristics of menopause.

Published at

June 26, 2024

Stages of menopause

Menopausal syndrome is a natural process of age-related changes in the female body, in which the production of essential hormones such as estrogens and progesterone decreases. Usually this process occurs gradually and is not always accompanied by obvious clinical symptoms.
The process of menopausal transition can be divided into several stages, which smoothly merge into each other. The time of onset and duration of each stage are individual for each woman.

Menopause periods and their signs:

1. Premenopause. At this stage, disruptions in the menstrual cycle begin. Menstruation becomes irregular, and the intervals between them increase. The reproductive function is still preserved, so pregnancy is possible. Premenopause lasts about 4-5 years, during which time hormone levels decrease significantly.
2. Menopause. This is the last menstruation in a woman's life. It is considered such if 12 months have passed without menstruation. If at least one bleeding occurs during this period, the woman is still premenopausal. At this stage, conception is no longer possible. In the presence of "hot flashes" and delayed menstruation, confirm a blood test for FSH. During menopause, the level of this hormone will be significantly higher than normal.
3. Postmenopause. This stage begins a year after the last menstruation, that is, after the confirmed menopause. In the late stage of menopause, the ovaries are no longer functioning. Postmenopause can also be induced if the ovaries were removed at any age.

In a natural cycle, all these stages smoothly merge into each other, so the boundaries between them are often blurred. The process can cause discomfort or deterioration of health. With artificially induced menopause (for example, after surgical removal of the ovaries), hormonal changes occur abruptly, which is usually difficult to tolerate.
Menopause most often occurs at the age of 48-52 years. If menstruation stops before the age of 40, it is considered premature menopause; at the age of 40-45 years — early; after 55 years — late.

Indications for hormone replacement therapy in menopause

Menopausal hormone therapy (MGT) is an effective means to alleviate the symptoms of menopause and prevent age-related pathologies associated with hormonal changes. Taking female sex hormone substitutes helps to soften the transition to adulthood, preventing bone loss.

Hormone therapy is indicated if the symptoms of menopause cause severe discomfort or if there have been cases of osteoporosis in the woman's family history. As a rule, MGT begins in the period of early postmenopause, but sometimes pronounced symptoms also occur with a preserved menstrual cycle. 

The goals of menopausal hormone therapy include:

- Elimination of vasomotor symptoms: hot flashes, excessive sweating, changes in the psycho-emotional state, sexual dysfunction and decreased libido, insomnia, palpitations and pressure surges, frequent headaches.
- Treatment of genitourinary syndrome: dystrophic changes in the mucous membranes of the vulva and urethra, urinary incontinence.
- Prevention of the development or aggravation of osteoporosis.

It is important to remember that many symptoms of menopause may be signs of other serious diseases (endocrine, urinary nervous or cardiovascular systems). MGT should be prescribed only by a qualified doctor after a thorough assessment of the tests and the patient's medical history. It is also worth considering that many women unsuccessfully treat headaches, cystitis or nervous disorders, whereas the cause of these problems may be hormonal dysfunction against the background of menopause. Therefore, in each case, diagnosis and a comprehensive analysis of all factors are necessary to determine the optimal treatment regimen.

Contraindications to menopausal hormone therapy

Menopausal hormone therapy (MGT) is contraindicated in the following conditions in women:

- Oncological diseases in gynecology (for example, uterine tumors or breast cancer).
- Cardiovascular diseases (such as thrombosis, angina pectoris).
- Uterine bleeding.
- Liver diseases.


It is important to remember that hormonal drugs should not be taken without a doctor's appointment. Self-medication can worsen the condition and cause side effects.

Types of menopausal hormone therapy

 

Depending on the clinical situation, the doctor selects one of the following types of treatment:

- Monotherapy: involves taking drugs containing estrogens (mainly estradiol and its derivatives).
- Combined treatment: usually includes estrogen and progesterone.
- Androgen intake: it is rarely prescribed.

The duration of treatment can vary from several months to several years. Sometimes the duration of MGT exceeds even 10 years (with persistent symptoms).

Hormones are available in various forms:

- pills;
- vaginal candles or gels with estrogen (to eliminate local symptoms and discomfort in the genital area);
- creams with an active substance for skin application.

Some drugs are used daily, others several times a week or only a few days a month.

Vaginal forms of estrogen, such as cream and candles, are injected into the vagina to reduce local symptoms (dryness, burning or itching of the mucous membranes of the genitals). These drugs act locally and have practically no contraindications.


Rules for menopausal hormone therapy

Hormone replacement therapy requires a preliminary examination, on the basis of which the doctor makes the optimal treatment regimen.
The basic principles of treatment include:

- Integrated approach: Hormone therapy is only part of a comprehensive strategy that also includes a healthy lifestyle and the correction of concomitant diseases.
- Individualization of treatment: the doctor starts with a minimum dose of hormones to alleviate symptoms, then reviews the therapy plan and adjusts it as necessary.
- Selection of medicines according to indications: treatment is prescribed based on the symptoms and phase of menopause, as well as the age of the onset of menopause. For women with early menopause (up to 40 years old), therapy can continue until the average age (up to 50 years old) as a prevention of osteoporosis.
- Consideration of individual characteristics: the history of menstruation, gynecological operations, the presence or absence of the uterus and ovaries, as well as previous tumors are taken into account.
- Constant monitoring and correction: it is necessary to constantly monitor the patient's condition and test results, making adjustments to appointments if necessary.
- The choice of drugs depending on the presence of the uterus: in the presence of the uterus, combined estrogen-progesterone drugs are used, and in the absence of the uterus, drugs containing only estrogen.

The benefits of hormone replacement therapy for women

Medical intervention in the menopause process brings significant benefits that exceed its disadvantages:

- Mitigation of vasomotor symptoms: Manifestations such as headaches and hot flashes become less intense, which helps to stabilize the heart rate.
- Restoration of psycho-emotional balance: Psychological symptoms, including mood swings, depression and irritability, decrease, improving the overall emotional state.
- Improvement of urogenital health: Hormone therapy helps to restore the mucous membranes of the vagina and urinary tract, reducing the frequency of urination and vaginal dryness, as well as improving sexual function.
- Prevention of osteoporosis: MGT helps to make up for the lack of calcium, preventing the development of osteoporosis and strengthening bones.
- Reducing the risk of developing dangerous diseases: Hormone therapy can reduce the risk of diabetes, by eliminating the metabolic syndrome.
Disadvantages of the method: risks and possible complications

When using hormone replacement therapy, some undesirable effects may occur, such as increased menstrual discharge and swelling or tenderness of the mammary glands, which in some cases is a normal reaction of the body. In addition, the risks of some complications increase against the background of MGT: 

- Venous thrombosis.
  - Breast cancer.
- Cardiovascular diseases.

To minimize risks, it is important to choose the right hormone therapy regimen, taking into account the characteristics of each patient and regularly undergo examinations by a gynecologist. If any unpleasant symptoms or changes in the state of health occur, the doctor can adjust the treatment regimen, cancel or replace medications.

Alarming symptoms, if they occur, you should immediately seek medical help:

- Acute chest pain or shortness of breath without physical exertion.
- Impaired speech, coordination, fainting.
- Severe pain in the side, abdomen, yellowing of the skin.
- An epileptic seizure, if it occurred for the first time.
- Sudden visual impairment or sudden blindness.
- Severe weakness, numbness of the limbs or one part of the body.

Before starting hormone replacement therapy, a woman should undergo a comprehensive examination, including consultations with a gynecologist and an endocrinologist, as well as the following tests and procedures:

- Tests for hormone levels, including follicle stimulating hormone (FSH).
- Taking venous blood to check the lipid spectrum and sugar levels.
- Smear for oncocytology (PAP test)

Additionally, it is recommended to conduct an ultrasound examination of the pelvic organs, mammography to assess the condition of the mammary glands, as well as an examination by a gynecologist to assess the condition of the mucous membranes of the genitals.
The doctor will also measure blood pressure and pulse, and in the presence of cardiac pathologies or varicose veins, he may recommend additional examinations by cardiologists or phlebologists.

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