Media coverage, extensive scientific research, freedom of speech: menopause is now a subject more freely discussed in our society. However, the solutions to relieve the symptoms, including hormone replacement therapy (HRT), remain unknown.
Used by 5 million women in Europe, HRT is used to treat symptoms of menopause such as vaginal dryness , hot flushes or sleep disturbances. Menopause is a natural consequence of aging in women, and corresponds to a drop in estrogen and progesterone levels. The symptoms of menopause can be numerous and affect not only mental and physical health, but also professional and social life. When the inconveniences are severe, taking HRT can improve the symptoms of menopause, and therefore the quality of life.
What is HRT?
Hormone replacement therapy is a commonly used treatment for menopausal symptoms. This treatment acts as a replacement for the main female hormones produced by the ovaries, estrogen and progesterone, the level of which begins to drop naturally due to cell aging.
What are the signs that indicate that I need HRT?
During menopause, the intensity of symptoms is variable, and many women do not need treatment. However, it can be offered when the symptoms become severe and affect the quality of life.
HRT can act on some or all of the symptoms of menopause:
- hot flushes;
- excessive sweating ;
- irregular cycles;
- mood disorders (irritability, anxiety);
- fatigue, insomnia;
- low libido ;
- vaginal dryness ;
- urinary disorders such as incontinence ;
- night sweats.
A doctor may also advise you to take HRT in the following cases:
- you are under 50 and have symptoms of menopause: premature menopause affects approximately 5% of women;
- you develop symptoms of menopause before the age of 40: this phenomenon called premature ovarian failure (POI) affects approximately 1% of women;
- you are postmenopausal and are at risk of osteoporosis (a disease causing the alteration and reduction of the density of the bones, making them more fragile and at risk of fractures) or a contraindication to the treatment and prevention of osteoporosis .
What are the different types of HRT?
There are two types of HRT:
- combined HRT : this is a combination of estrogen (which acts on symptoms and prevents osteoporosis) and progesterone (which reduces the risk of uterine cancer); it is not indicated if you have had a hysterectomy (a procedure to remove the uterus);
- estrogen alone : this type of HRT contains only estrogen.
There are several ways to take HRT, the treatment will be decided by the doctor according to your needs and the possibilities related to your state of health.
To treat the symptoms in a global way, we will more specifically use estrogens in the form of:
- tablets;
- gel to be applied to the skin;
- transdermal patches.
The progestins will be taken in the form of tablets. There are also tablets for combined HRT.
To treat the symptoms of vaginal dryness, estrogen is used as a local treatment through the vagina: it comes in the form of a cream, egg or vaginal ring.
How to start an HRT?
If the symptoms of menopause are affecting your daily life, it is important to talk to a doctor. He will choose the most suitable type of HRT based on your symptoms.
As a rule, it is not necessary to perform tests to confirm menopause. However, in certain situations, in particular in the event of suspicion of premature menopause or if you present particular risk factors, assessments will probably be proposed to you in order to confirm the diagnosis and to determine if other conditions are possibly hiding behind your symptoms.
Before starting HRT, an in-depth questioning and a complete clinical examination remain necessary, as well as the performance of a mammogram .
HRT can act from the start of treatment. Some women feel better very quickly, while others have to wait a little longer to see the effects. The dose can be adjusted so that the treatment relieves your symptoms without causing too many side effects.
Can I take HRT for life?
Currently, the High Authority for Health (HAS) recommends the use of low doses over a period of 2 to 3 years maximum. But the treatment is defined individually, and if the benefits outweigh the risks, it is possible to extend its intake on medical advice.
What are the benefits of HRT?
Relief of symptoms of menopause
HRT is the most effective way to relieve disabling symptoms of menopause including hot flashes, vaginal dryness and sexual symptoms, but this treatment also reduces the impact of other symptoms, for example on quality of sleep , no doubt thanks to the reduction of nocturnal hot flashes, or on mood disorders. In the longer term, the beneficial effect of estrogens on the urogenital sphere could play a role in preventing the appearance of prolapse (descent of an organ) and urinary incontinence in postmenopausal women.
Bone health
HRT can also be beneficial for bone health: it can prevent osteoporosis, which is common after menopause due to the reduction in bone mass following the drop in estrogen levels.
Are there any risks associated with taking HRT?
Despite its benefits, it is also important to be aware of the risks involved in taking HRT, which can vary from person to person.
Breast cancer
- Studies show that combined HRT slightly increases the risk of breast cancer (mainly due to progestins).
- In contrast, estrogen-only HRT is associated with a lower risk of breast cancer.
The risks of breast cancer would increase proportionally to the duration of HRT intake, and they are higher if the treatment is administered for more than 5 years. However, the risk decreases rapidly after stopping HRT.
Endometrial cancer (inner lining of the uterus)
- Studies show an increased risk of endometrial cancer when taking estrogen-based HRT alone. The risk is reduced when adding a progestogen.
- HRT with estrogen alone is therefore reserved for women who have had a hysterectomy.
Ovarian cancer
- HRT increases the risk of ovarian cancer when using HRT, either as combination therapy or as estrogen-only therapy, especially when treatment duration exceeds 5 years.
The risk would gradually decrease after discontinuation of treatment.
Thrombosis
- There is a significant increase in the risk of a thromboembolic accident (formation of a clot in the veins causing phlebitis and/or pulmonary embolism) if there are risk factors.
- However, the risk of thrombosis is not increased with HRT gel or patch.
Cardiovascular health
- The increase in vascular risks (infarction, cerebrovascular accidents ) depends on the risk factors, the products used and the duration of taking HRT. The risk is due to estrogens administered orally.
If you are worried about the risks, do not hesitate to discuss them with your gynecologist or general practitioner.
HRT is contraindicated in the following cases:
- you have a history of breast, ovarian or uterine cancer ;
- you suffer from untreated or uncontrolled high blood pressure despite treatment;
- you have a history of thrombosis;
- you suffer from liver disease;
- you have undiagnosed gynecological bleeding;
- you are pregnant.
What are the possible side effects of HRT?
When you first start taking HRT, you may develop estrogen and progesterone related side effects, including:
- breast tenderness or swelling;
- bloating ;
- water retention ;
- headache ;
- vaginal bleeding (growth or increase of a fibroid in the uterus, emergence of endometriosis );
- mood swings ;
- digestive disorders ;
- nausea ;
- leg cramps .
The side effects of HRT usually wear off after a few weeks. If this is not the case after 3 months or if the symptoms are too debilitating, the doctor may suggest an alternative treatment or discontinuation of treatment.
How to stop HRT?
If you are thinking of stopping HRT, your doctor may advise you to reduce your dose gradually or to stop taking it immediately. It is imperative to seek medical advice before modifying, stopping or resuming any treatment.
What are the alternatives to HRT?
Menopause, although natural, can be experienced very differently depending on each woman. It is the source of sometimes disabling symptoms and can also be the source of psychological suffering. It is important not to hesitate to raise the subject with your doctor or with a psychologist if you feel suffering in connection with this period of your life.
Also, if you don’t want or can’t take HRT, there are simple steps you can take to help manage bothersome symptoms.
Doctors on Livi recommend the following good habits.
1. Lifestyle adaptations
Having a healthy lifestyle is essential for many reasons, and can also help you relieve the symptoms of menopause, including:
- engage in regular physical activity;
- have a healthy and diversified diet, rich in calcium and vitamin D;
- reduce your consumption of sugar, caffeine and alcohol;
- stop smoking .
2. Psychotherapy
If you’re struggling to manage the psychological symptoms of menopause, cognitive behavioral therapy (CBT) is a form of psychotherapy that can help you develop practical ways to manage the issues. It also helps to find strategies to cope with anxiety , depression and stress that sometimes accompany menopause.
There is also evidence that CBT can help manage night sweats, hot flashes, trouble sleeping , and insomnia .
3. Non-hormonal treatments
There are non-hormonal treatments that may be beneficial and lead to an improvement in symptoms:
- phytotherapy;
- homeopathy;
- certain trace elements and vitamins;
- beta-alanine;
- certain dietary supplements.
If you’re looking for other options to treat your menopausal symptoms, you’ll probably also hear about bioidentical or “natural” hormones, or bioidentical HRT. These are hormones that resemble the hormones made naturally by our body, in particular progesterone. These hormones are of plant origin.
However, it is important to note that the High Authority for Health (HAS) has warned against these treatments as well as components that contain plant estrogens (phyto-estrogens) because they have not yet been studied enough to establish s ‘they are dangerous for the organism or not.
When should you consult about HRT or menopausal symptoms?
If you have symptoms of menopause or pre-menopause that affect your daily life, make an appointment with your doctor, your gynecologist, or if these are not available, with a doctor on Healthlinerx.
It is also best to consult a doctor in the following cases:
- you have bleeding after menopause;
- you feel depressed or suffer from depressive symptoms ;
- you have trouble sleeping.
