Menopause Hormone Therapy: 30 Fast Facts
Well, maybe not so fast, but here’s the go on oestrogen/progestagen Menopause Hormone Therapy (MHT).
Menopause is a natural stage in a woman's life, typically occurring between the ages of 45 and 55, when her menstrual cycle comes to an end. During this time, women may experience various symptoms like hot flushes, sweating, vaginal dryness, reduced libido (sex drive), irritability, sleep disturbances, and muscle or joint pain. If the symptoms cause distress, oestrogen therapy is a highly effective way to treat many of them and prevent bone loss. For women who haven’t had a hysterectomy, it's important to also take a progestogen hormone to protect against endometrial overgrowth (hyperplasia) and cancer.
Menopausal hormone therapy can be given in two ways: cyclical or continuous. Cyclical MHT involves daily oestrogen intake and 10-14 days of progestogen per month, while continuous MHT combines daily doses of both hormones. Cyclical MHT is generally preferred by women who are transitioning into menopause or are newly postmenopausal, while continuous MHT is often chosen by older women for convenience.
Oestrogen and progestogen can come in various forms, including tablets, skin patches, and gels.
Patches or gels (transdermal oestrogen) may be more suitable for those with gut absorption issues - in fact transdermal is preferable for almost everyone because improved lipid and clotting profile.
Patches or gels are especially important if you have high triglyceride or cholesterol concentrations or if you’re at risk of venous thromboembolic disease.
Vaginal oestrogen can be applied as creams, pessaries, or tablets to alleviate vaginal dryness or painful intercourse. Vaginal oestrogen is better at treating vaginal menopause symptoms than tablet/patch/gel.
Progestogens are primarily taken orally, with norethisterone being the only one absorbed through the skin in MHT patches.
Micronised progesterone capsules are a natural, body-identical option available in Australia and New Zealand.
The levonorgestrel intrauterine system (Mirena) delivers progestogen directly to the endometrium.
Progesterone creams are not advised, as they may not provide sufficient endometrial protection.
Tibolone, a synthetic progestogenic hormone, acts like oestrogen, progestogen, and testosterone.
Bazedoxefine, a selective oestrogen receptor modulator (SERM), is combined with conjugated equine oestrogens as Duavive™ to treat menopausal symptoms and prevent osteoporosis without requiring a progestogen.
Testosterone may be added to MHT to improve libido and energy in some women. Most women do not need this.
A full medical history and examination should be conducted before prescribing MHT.
Mammograms, breast checks, and cervical screening should be up-to-date for women over 50.
Any unexplained vaginal bleeding needs to be investigated.
Women need personalised and accurate advice about the benefits and risks of MHT.
Oestrogen dosage should be determined by symptom relief and well-being, not blood levels. If someone suggests titrating dosage to blood levels, be aware this is not evidence based.
Intolerance issues are often related to the progestogen, and a change in formulation or delivery method may help.
Some irregular bleeding can be expected but after 6 months of MHT, any unusual bleeding should be investigated.
MHT is effective at treating hot flushes, night sweats, vaginal dryness, and improving quality of life.
MHT reduces the risk of postmenopausal bone fractures, including hip fractures.
MHT is not associated with weight gain.
Regular breast checks and screening mammograms are important for women over 50, regardless of MHT use.
When discontinuing MHT, it is generally advised to taper off gradually to minimise the risk of symptom recurrence.
For women with a history of breast cancer, alternatives to MHT should be considered, such as non-hormonal options for symptom management.
Women with a history of venous thromboembolism, stroke, or other contraindications should consult their healthcare provider before starting MHT to assess potential risks and benefits.
MHT is not a form of contraception, and women should continue using contraception until they have been confirmed to be postmenopausal.
Lifestyle changes, such as maintaining a healthy diet, getting regular exercise, and reducing stress, can also help alleviate menopausal symptoms and improve overall well-being.
Regular follow-up appointments with healthcare providers are essential to monitor progress, adjust dosages, and address any concerns or side effects that may arise during MHT. This should be at least annually.
If MHT is not suitable or effective for a woman, alternative treatment options should be explored to ensure her health and well-being are prioritised during menopause.
Communication is crucial for successful MHT management and achieving the desired benefits.
In summary, menopausal hormone therapy (MHT) can significantly improve the quality of life for many women experiencing menopause by alleviating common symptoms such as hot flushes, night sweats, and vaginal dryness. Additionally, MHT can help prevent bone loss and fractures. It is important for women to work closely with their healthcare provider to develop a personalized treatment plan that considers their individual needs and medical history. There are various types of oestrogens and progestogens available, as well as different methods of administration, to suit each woman's unique situation.
While MHT offers many benefits, it is essential for women to understand the potential risks and to regularly review their treatment plan with their healthcare provider. Thorough assessments, including mammograms and cervical screenings, should be performed to ensure the safety and efficacy of MHT. By carefully considering the benefits and risks, along with regular monitoring and open communication with healthcare providers, women can successfully navigate menopause and maintain their overall well-being.