Women in menopause undergo challenging experiences that make it a mid-life crisis. The natural process of a complete stop of menstruation, triggers symptoms that cause discomfort and also affect health. From vasomotor symptoms, disturbances during sleep and dryness in the vagina, women contend with multiple possible issues. In the US hot flushes and sudden profuse sweating in the night is known to affect as much as 50 million women. Various therapies are in place to help women cope with the problem, but hormone related therapies are considered as a better option when compared with non-hormonal options. However, it is not free from possible adverse effects; here is a good look at possible hormone replacement therapy side effects to help women cope with menopause effectively.
Overview of HRT
One of the primary reasons for greater effectiveness of HRT is its ability to offer relief from multiple symptoms. This is quite unlike non-hormone-based therapies and treatments which are effective in handling or mitigating a single symptom.
As the name suggests, hormone replacement therapy or HRT as the acronym is known, is a therapy that replaces the lower level of hormones in women in different stages of menopause. The lowered levels of hormones are the reasons for most of the symptoms associated with menopause, and replacement helps to relive part of the symptoms to an extent that makes life a lot easy. There are different stages associated with the condition, including advanced reproductive stage, late reproductive stage, early menopause, late menopause and post menopause. Therapies are generally intended to work for women in post-menopausal stages.
Unsuitability of HRT for women with certain conditions
At the outset, it is best to identify categories of women with certain conditions who are considered as unsuitable recipients of the therapy. For instance, women who have either had breast cancer in the past or who are diagnosed with the condition are considered as unsuitable to take the therapy. Similarly, women diagnosed with estrogen malignant conditions or with past conditions are also advised to avoid the therapy. Bleeding from the genitalia that has not been diagnosed or attributed to any specific condition also makes the individual incompatible for availing the therapy.
Other conditions include untreated endometrial hyperplasia and hypertension apart from any existing liver conditions. Similarly, women with any form hypersensitivity to ingredients that form part of HRT are also advised to choose alternative forms of therapy. Regardless of the suitability of the patient, HRT is always recommended to be administered in small dosages that are determined to be effective enough in offering relief. The therapy is also always advised to be limited to a short duration, with a clear goal of meeting specific goals in handling or mitigating post-menopausal symptoms.
Why do women opt for hormone replacement therapy?
Despite the fact that a section of women is hesitant to opt for HRT, there are many who consider it as a safe or effective option. The reasons are straightforward – there are possible adverse outcomes associated with the therapy, but the proven benefits exceed the undesirable outcomes and this makes the therapy a good choice. Menopausal symptoms and conditions affect a very high percentage of women – almost 85% of women in menopausal stage experience one of many possible symptoms. This includes hot flushes, profuse sweating in the nights, sudden and abnormal mood swings that affect routines. In addition, women also experience dryness in the vagina which in turn has an impact on the desire to have sex. The reduced desire to indulge in sex could end up affecting relationships between married couples.
Apart from the above conditions, women in menopause are also exposed to the risk of thinning of the bones which can result in possible fractures. Osteoporosis frequently occurs, even in settings where there are no intense physical activities that could cause fractures. Many symptoms outlined above are known to resolve after years, but the process of going through the symptoms makes it extremely challenging for many women. It also deprives women of the opportunity to lead normal lives, especially during mid-life when other conditions are favorable for a relaxed lifestyle.
Different hormone replacement therapies presently available
The different hormone replacement therapies presently available depend on the hormones that need replacement. For instance, women are known to typically take a therapy that offers a combination of both oestrogen and progestogen. However, in certain instances, women are known to opt for only oestrogen therapy. This is primarily for women whose womb has been removed through hysterectomy or women with non-existent wombs due to certain rare medical conditions. The different modes of therapy include tablets, topical application of creams and gels, apart from the use of skin patches, rings and pessaries. Treatment plans may involve cycles of taking progestogen intermittently, while the oestrogen is continued for a longer time without breaks. The ideal way of determining the most suitable type of therapy is an assessment by a qualified medical practitioner.
Form of treatment – tablets
The most convenient and common form of treatment is tablets, that are recommended to be taken once daily. Tablets come in oestrogen only formulations as well as combined HRT formulations. The ease of use makes tablets a very convenient option, and eliminates the need for topical applications that can have an impact on activities. However, it is essential to add that tablets pose a relatively higher degree of risk when compared with other types of HRT, with respect to the formation of blood clots.
Form of treatment – application of skin patch
The application of skin patches is another relatively convenient option for women. The patches are generally worn for a few days, before being replaced with fresh patches. Here again, the patches come as either combined formulations or oestrogen only formulations. There are distinct advantages with skin patches over tablets, such as the absence of indigestion that is sometimes experienced with tablets. Additionally, skin patches also have the advantage of not exposing women to the risk of formation of blood clots. He disadvantages include the need to periodically clean the area of application, and replace the patches. Women who are more conscious of their bodies may experience little discomfort when undressing with the patches still on.
Form of treatment – application of gel
The application of oestrogen gel is also regarded as another common and preferred form of HRT treatment. The gel is typically applied once daily, and also helps eliminate the risk of blood clots associated with tablets. As it applied on the skin, women may not find it embarrassing, unlike skin patches. However, gels contain only oestrogen, which may make it necessary to choose and include another option for progestogen intake. A combination of the oestrogen gel and progestogen formulation in some form will help reduce the risk of womb cancer among women.
Form of treatment – implants
Another form of hormone replacement therapy is the use of implants, which help to release oestrogen periodically. This may last for as long a few months before a replacement implant is inserted. The process involves insertion of small implants in the form of pellets, beneath the skin. This is typically performed under local anesthesia, and the ideal location or preferred location is the stomach. This option eliminates the need for daily medication or the application of patches/gels.
However, the downside to this option is the need for a separate form of progestogen intake, as the pellets only release oestrogen. Since progestogen is taken intermittently, the implants are only oestrogen release pellets. There are other options that can be considered for progestogen, including contraceptive cum hormone replacement through intrauterine system. Despite the apparent ease of use, and the duration of effects, implants are not as popular or preferred as tablets or applications.
Form of treatment – vaginal oestrogen
Another form of treatment is the use of vaginal cream, pessary, rings in the vagina. One of the advantages of these options is the ability to offer greater relief from vaginal dryness which is a common symptom experienced by women. However, the effectiveness does not extend to hot flushes, which are another common symptom associated with the condition. Women therefore, typically choose this when there is a specific need to overcome dryness in the vagina. Tis is relatively safe when compared with other options, as it will not expose the individual to the risk of breast cancer. Additionally, it is also considered as safe for use without the intake of progestogen, that is generally considered as a requirement.
Form of treatment – testosterone gel
Testosterone gel has a limited use and is not directly connected to relieving symptoms of menopause. It is effective only in help women restore interest in sex. Apart from helping improve libido in women, it does not offer any other symptomatic relief from menopause. It is however, used as a part of combination therapy with other forms of HRT. This is a more effective choice, as other forms of treatment extend symptomatic relief, while the testosterone gel helps in restoring sex drive.
Common risks associated with hormone replacement therapy
As outlined earlier, the possibility of hormone replacement therapy side effects cannot be ruled out among women who are regarded as suitable for the therapy. The single biggest risk of the therapy is the possibility of elevated exposure to breast cancer. Commonly reported side effects of the therapy are known to typically resolve in a few months after commencement of the therapy. Only certain effects are known to be long term in nature. For instance, commonly reported side effects such as tenderness in the breast or headaches may last for only a short period. This also includes the possibility of a sick feeling, while some women are known to experience indigestion, especially when on tablet forms of HRT.
Other undesirable effects include the possibility of pain in the stomach, while some are known to have vaginal bleeding, at levels that are unusual when compared with pre-treatment time. Women may also experience bloating as a result of the indigestion, while some may experience swelling in certain parts of the body, not attributed to other reasons or conditions. Cramps in the legs are another possible side effect which may also be temporary in nature. A simple method to deal with indigestion is to consume tablets along with food, which can
Education: Bachelor’s in Journalism with a minor in Nutrition from Northwestern University. Experience: 15 years as a health journalist, writing for major publications like The New York Times and TIME, with a focus on diet, exercise, and chronic disease management.
