The Truth About Menopausal Treatment

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The Truth About Menopausal Treatment

Many women experience hot flashes, night sweats, sleep disturbances, mood swings, vaginal dryness and other physical changes with menopause. For some women, the symptoms are mild and do not require any treatment.

Symptoms can also be moderate or severe and interfere with daily activities. Hot flashes improve with time, but some women have bothersome hot flashes for many years. Menopause symptoms often improve with lifestyle changes and nonprescription remedies, but prescription therapies are also available.

Hormone therapy is the most effective treatment for hot flashes. During the menopause transition, women with hot flashes are more likely to report reduced sleep. Hormone therapy improves sleep in women with bothersome nighttime hot flashes, by reducing nighttime awakenings, and improving duration, disruption, latency, and sleep cycles.

Hormone therapy involves taking estrogen in doses high enough to raise the level of estrogen in your blood, to treat hot flashes and other symptoms. Because estrogen stimulates the lining of the uterus, women with a uterus need to take an additional hormone, progestogen, to protect the uterus. Women without a uterus just take estrogen. If you are bothered only by vaginal dryness, you can use very low doses of estrogen placed directly into the vagina. These low doses generally do not raise blood estrogen levels and do not treat hot flashes. You do not need to take a progestogen when using only low doses of estrogen in the vagina.
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Concerns about compounded bioidentical hormone therapy

Unique concerns about safety surround use of compounded bioidentical hormone therapy are the lack of regulation and monitoring, possibility of overdosing or under dosing; lack of scientific efficacy and safety data; and lack of a label outlining risks.

Hormone therapy and bone health

Hormone therapy effectively prevents post-menopause osteoporosis and fractures. Women in the estrogen-alone and estrogen-progestogen therapy overall cohorts in the Women’s Health Initiative (WHI) had significant 33% reductions in hip fracture. After treatment discontinuation in the WHI, beneficial effects on bone dissipated rapidly, but no rebound was seen, women in this study showed less joint pain or stiffness.

Hormone Therapy and Cardiovascular Disease

  • Hormone therapy initiated fewer than 10 years after menopause onset in postmenopausal women reduces coronary heart disease
  • More favorable benefits if started in women aged younger than 60 years or within 10 years of menopause onset.
  • Greater risks if initiated further from menopause or in women aged older than 60 years.
  • No increased risk of stroke if hormone therapy initiated within 10 years of menopause onset.

Genitourinary Syndrome of Menopause, Sexual Function, and Urinary Tract Symptoms

  • Low-dose vaginal estrogen effective and safe for treatment of vulvovaginal atrophy, with minimal systemic absorption.
  • Advised when estrogen therapy is considered only for symptoms of the genitourinary syndrome of menopause (vulvovaginal atrophy).
  • Non-estrogen alternatives approved for dyspareunia include ospemifene and intravaginal dehydroepiandrosterone.
  • New laser treatment provides many women with relief. The vaginal laser treatment, MonaLisa Touch, was approved by the U.S. Food and Drug Administration for gynecologic use in 2014. It uses laser technology to help treat vaginal atrophy and possibly other issues, such as incontinence.
  • The procedure is made up of three three-minute laser sessions, each six weeks apart. It is relatively painless and no anesthesia or painkillers are required. Before a woman is allowed to take part in the procedure she must undergo a pelvic exam, but if all checks out, a doctor will insert the laser to the vaginal surface. The small size of the actual laser ensures that there is no risk of burns to the woman’s skin.
  • Once activated, the laser removes the dried skin which stimulates the collagen revival.

Hormone Therapy and Cancer

  • The effect of hormone therapy (HT) on breast cancer risk is complex and conflicting. The effect of HT on breast cancer risk may depend on the type of HT, dose, duration of use regimen, and route of administration.
  • Observational evidence shows use of hormone therapy does not alter risk for breast cancer in women with a family history of breast cancer.
  • Family history is one risk among many that should be assessed when counseling women on the use of hormone therapy.
  • Overall neutral effect on lung cancer.
  • Very rare association, if any between hormone therapy and ovarian cancer, absolute risk is likely to be rare (< 1/1,000), possibly only with long duration of use. No increased risk seen in the Women’s Health Initiative.
  • Use of conjugated equine estrogen + medroxyprogesterone acetate across all ages reduced colorectal cancer incidence during treatment.
  • Consideration may be given for low-dose vaginal estrogen therapy for relief of the genitourinary syndrome of menopause for women with early endometrial cancer who have completed successful treatment, including hysterectomy.
  • Systemic hormone therapy is not recommended for survivors of breast cancer.
  • For survivors of breast cancer with bothersome genitourinary syndrome of menopause symptoms, low-dose vaginal ET may be an option.
  • No increased risk of breast cancer in women who are BRCA-positive on hormone therapy after risk-reducing bilateral salpingo-oophorectomy.

In Conclusion

Hormonal therapy is safe for symptomatic women who initiate hormone therapy aged younger than 60 years or within 10 years of menopause onset. Call us today for a consultation!