The twelve months after the last menstruation of a woman signals the beginning of menopause with tell tale symptoms. Dryness in the vagina, hot flushes and disturbed sleep are relatively common symptoms that cause discomfort. Additionally, women in various stages of menopause are known to experience some form of depression and anxiety. Treatment is mainly symptomatic as this is a natural progress in the lifecycle of healthy women. This includes the use of topical lubrication for managing vaginal dryness while other conditions are managed with medications. Depending on the severity of menopause, it may be necessary to opt for oral hormone therapy.

Around 50 million women in America are known to experience typical symptoms of menopause – sweating and hot flushes. As mentioned above, hormone replacement is considered for certain conditions and is known to deliver better outcomes. Let us look at the possible hormone replacement therapy side effects among women opting for this therapy.

Why is hormonal replacement therapy better and what are the different menopause stages?

Therapies that are not hormone based primarily treat or manage a single condition or symptom that is linked to menopause. However, hormone-based therapies are known to handle multiple symptoms associated with menopause, thereby offering an elevated level of relief. Menopause is broadly classified into various stages:

What hormone levels drop during menopause?

The whole idea of hormonal replacement therapy is to replace the lowered levels of hormones that occur as during menopause. The hormones that reduce during menopause includes estrogen, progesterone and testosterone. Estrogen is known as the main female hormone and is responsible for the health of reproductive organs and the growth. Various characteristics are determined by the levels of the hormone. For instance, the elasticity, the moisturized levels and the flow of blood are all linked to estrogen. As a result of a dip in estrogen levels, women are likely to experience hot flushes and profuse sweating in the nights.

In a similar manner, progesterone and testosterone levels also decrease during menopause and are responsible for decreased interest in sex, and disturbances in menstrual periods, among others. These symptoms may actually begin in the earlier stages of menopause.

How do hormonal replacement therapy work?

Hormonal replacement therapy works best for post-menopausal symptoms, though it may also be sometimes recommended for women in other stages of menopause, depending on the condition. The purpose of the therapy is to restore or replace the lowered levels of hormones linked to menopause. By restoring the levels of hormones, the therapy helps to manage the symptoms linked to the condition. This is in sharp contrast to medications that work by managing a single or specific condition.

Is hormone replacement therapy suitable for all women?

While hormone replacement therapy is a proven and better option, it is unfortunately, not suitable for all women. Women with certain conditions are not to choose this option to avoid hormone replacement therapy side effects. Women who have either had breast cancer or who are presently diagnosed with breast cancer are not to take the therapy. Another condition that makes it unsafe for women to take up the option are conditions that are broadly classified as estrogen malignant.  Any bleeding from the reproductive organs that has not been diagnosed correctly and treated will also render women unsuitable for the therapy.

In addition to the above, women with untreated endometrial hyperplasia and hypertension are also not to choose HRT. Liver ailments, conditions and any hypersensitivity to ingredients in the oral hormone therapy, also render women unsuitable. The safest method of administering the therapy is to start with small dosages, that may be sufficient to deliver the desired outcomes. Any attempt to administer stronger dosages may actually result in undesirable effects. The therapy is best administered for a short duration, rather than extending it for a longer duration.

Why is hormone replacement therapy a better choice?

Hormone replacement is a safe option that is known to be effective, and the benefits outstrip the possible adverse outcomes. The unwanted outcomes of the therapy can actually be avoided by following safe practices, mentioned above. For instance, women need to ascertain if they are suitable, and those who are suitable, need to ensure that the dosage is restricted to only the amount that is required, and for only a short duration.

Around 85% of healthy women are known to experience some symptom of menopause – hot flushes, profuse sweating, and mood swings. Dryness in the vagina, with an impact on libido can also cause relationship issues in families. On the health front, the risk of thinning of the bones is a possibility in menopause, and this can result in fractures and possible osteoporosis.

What kind of hormone related therapies are presently available? 

Hormone based therapies that are presently available are focused on the hormones that need to be replaced or restored. Common therapies include combination both estrogen and progestogen replacement, though estrogen only replacement is also available.  The latter option is intended for special categories of women who do not have wombs, either due to hysterectomy or medical conditions that are atypical.

Are hormone therapies only oral forms?

Hormone therapies are in different forms, and not only oral. Therapies are presently available as tablets, topical applications, skin patches, and other wearables. Progestogen is typically taken in a cycle with breaks in between, though estrogen is generally taken non-intermittently. The actual suitability of treatment cycle and form of treatment is best decided by a specialist, after a careful evaluation of the symptoms and the condition of the patient.

#1 Tablets

Tablets are considered as convenient and are typically taken once every day. The formulations include estrogen only and combined formulations.  Though tablets pose a relatively higher element of risk due to the possibility of blood clots formation, tablets are considered convenient when compared with topical applications.

#2 Skin patch

Skin patches are also relatively convenient than other topical applications. The patches need to be worn for a couple of days, and replaced with fresh patches, that may either comprise estrogen only formulations or combined formulations. The highlight of skin patches over tablets is the lesser possibility of hormone replacement therapy side effects linked to tablets – indigestion and blood clots. The primary disadvantage of the patches is the need to lean the area and replace the patches ones periodically. This may also cause some kind of embarrassment during the act of undressing.

#3 Gel

Estrogen gel is a preferred form of treatment, applied once every day. This again comes with the advantage of lesser side effects when compared with tablets. Gel also has an advantage over skin patches as it is applied on the skin, and will not be visible like skin patches. The downside is the estrogen only formulation that is available in gels, and this may make it necessary for a separate formulation for progestogen. Specialists’ advice a combination of estrogen gel with some progestogen formulation to lessen womb cancer risk.

#4 Implants

Implants are another option that are increasingly used for periodic release of estrogen.  The implants help release estrogen for a few months as per the desired frequency, following which it is to be replaced with a fresh implant. Small pellets are inserted beneath the skin, generally in the stomach area, under local anesthesia. The advantage of implants is the ability to dispense with a routine regimen of taking tablets daily, or applying gel daily, or applying fresh patches once in a few days.

The primary disadvantage of implants is the estrogen only formulation, which again makes it necessary to look for a separate option for progestogen.  Intrauterine options for progestogen replacement through contraceptives are a possible option, that can be combined with implants.

#5 Vaginal estrogen

Topical applications such as vaginal cream, or wearable such as pessary or rings are known to extend greater relief from vaginal dryness. This makes it a good choice for women looking for options to manage vaginal dryness only. Though this does not offer any relief from hot flushes, it is a better option than other choices, as it reduces the risk of breast cancer among women. Another distinct advantage is that it can be used alone without the need for progestogen formulations that are generally required with other hormonal replacement therapies.

#6 Testosterone gel

This gel is primarily meant for women who wish to increase libido. This is more of a symptomatic management, for women in menopause, with a single outcome and does not offer any relief from discomforting symptoms.  Other medications and formulations are intended to offer relief from some form of discomfort from menopause, while this gel has a relatively limited use – working only on restoring sex drive.

What kind of risks are possible with the therapy?

There is the possibility of certain risks associated with the therapy. In addition to the unsuitability of certain categories of women, as highlighted earlier, there is the elevated risk of breast cancer among women undergoing hormone replacement. Most undesirable effects may resolve quickly; for instance, tenderness in the breast, headaches, a sick feeling, and indigestion are all known to resolve soon, naturally.

Apart from the above undesirable effects, there is also the possibility of women experiencing stomach ache, while others may end up with vaginal bleeding that is abnormal. This may be at levels that are either more or unusual when compared with levels before therapy. Other effects include bloating, that is mainly a result of indigestion. Swelling and cramps in the legs, are also other possible undesirable effects that may be experienced by women on hormone therapy.


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