Menopause: Does Menopausal Hormone Therapy or MHT help to manage symptoms?

When a woman goes through a complete year of no menstrual cycles, that is when her menopause officially begins. This stage is marked by an absence of ovulation, which means that you can no longer become pregnant. However, menopause is often accompanied by a variety of other symptoms that often become challenging to cope with. That’s where Menopausal Hormone Treatment or MHT for menopause comes into the picture.

During menopause, your hormones automatically start to decline, and so you often experience symptoms such as night sweats, hair loss and hot flashes. Undergoing MHT for menopause symptoms can work well. Health Shots got in touch with obstetrician and gynecology Dr Daksha Mukund Bakre to understand how MHT works for menopause.

What is menopause?

Menopause is a natural phase of transition in a woman’s life. Just like how girls start their periods during puberty, menopause is when periods stop altogether. The National Institute of Health states that menopause takes about seven years to manifest.

“It’s a normal part of ageing, and it happens because a woman’s ovaries stop producing the hormones that regulate menstrual cycles and fertility, namely estrogen and progesterone,” says Dr Bakre. During menopause, women may experience various symptoms like hot flashes, night sweats, mood swings, and changes in sleep patterns. Some women may also experience vaginal dryness and changes in libido.

When does menopause happen?

The World Health Organization states that women often begin menopause between 45- 55 years. However, it could differ in each individual. Some women may even experience early menopause.

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What do you mean by menopause management?

Menopause management refers to the ways in which women can deal with the symptoms and changes associated with menopause to improve their overall quality of life. “Women experience a variety of physical and emotional changes during this phase. These changes are not easy and can take a toll on their wellbeing,” says Dr Bakre. Menopause brings with it varying levels of estrogen, progesterone, as well as other hormones, states this study, published in Endocrinology and Metabolism Clinics of North America.

Challenges women face during menopause

Your body will begin to show signs of menopause in different ways:

1. Cessation of monthly periods for over 12 months

End of periods is the primary signal indicating menopause. While it can make some women happy but might make others feel a bit sad because it means they can’t have babies anymore.

2. Feeling hot and sweaty

Many women get sudden hot flashes, where they feel very hot and start sweating, especially at night. This can make it hard to sleep and feel comfortable.

3. Mood swings

Hormone changes during menopause can make women feel moody, grumpy, sad or sometimes even angry and irritable.

4. Vaginal dryness

Some women experience dryness and discomfort in their private parts because of lower hormone levels. This can make sex painful or increase the chances of getting infections.

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5. Decreased libido

Women might feel less interested in having sex than before. This can affect how close they feel to their partners.

6. Trouble sleeping

Hot flashes, increased frequency of urination and hormonal changes can make it hard to get a good night’s sleep, leaving women feeling tired during the day.

7. Weaker bones

After menopause, bones can become weaker and more prone to fractures. Proper nutrition and exercising can help keep bones strong.

8. Heart health

Women’s risk of heart disease goes up after menopause, primarily due to changes in hormone levels, particularly a decline in estrogen. Staying active, eating well, and managing things like high blood pressure and cholesterol are important for good cardiovascular heath.

What is Menopausal Hormone Therapy?

Menopausal Hormone Therapy (MHT), also known as Hormone Replacement Therapy (HRT), is a treatment used to help manage the symptoms of menopause by externally supplementing the hormones that the body stops producing during this time. “It is like giving the body a little extra help in order to keep things running smoothly,” says Dr Bakre. According to this study, published in Drugs in Context, MHT helps with estrogen deficiency.

It involves taking medications that contain estrogen, progesterone, or both, to replace the hormones the body is no longer producing in the quantity that the woman is accustomed to. “By taking these hormones, women can often reduce or even eliminate some of the bothersome symptoms of menopause, making this transition in life a bit easier to manage,” says Dr Bakre. However, Hormone Therapy isn’t right for everyone, and it’s essential to talk to a Gynaecologist about the benefits and risks before starting this treatment.

What are the different types of MHT

There are primarily two types of Menopausal Hormone Therapy (MHT), each containing different combinations of hormones:

1. Estrogen-only Therapy (ET):

• This type of therapy contains use of estrogen alone.
•  ET helps relieve symptoms like vaginal dryness. It can also prevent bone loss after menopause.
•  Usually, this estrogen is recommended in women who have had a hysterectomy. In a woman, who still has her uterus, using estrogen alone can increase the risk of developing endometrial cancer.

2. Estrogen plus Progestin Therapy (EPT)

• EPT combines estrogen with progestin, a synthetic form of progesterone.
•  It’s commonly prescribed for women who haven’t had their uterus removed.
•  EPT helps with menopausal symptoms and can also prevent bone loss. However, it might have a slightly higher risk of certain health issues like breast cancer and heart disease compared to estrogen-only therapy.

So, ET is for women without a uterus, and EPT is for women with a uterus. Both help manage menopause symptoms, but they have different risks depending on a woman’s health history. It’s important to talk to a doctor to figure out which one is best for each woman.

What is vaginal oestrogen therapy?

When women go through menopause, their bodies produce less estrogen, which in turn can cause the vagina to become dry and uncomfortable. “This can make sex painful and increase the risk of vaginal infections. Vaginal estrogen therapy involves using a small amount of estrogen in the form of cream, tablet, or ring that is inserted into the vagina,” says Dr Bakre. This helps to replenish the estrogen in the vaginal tissues, making them healthier and more elastic. It can reduce dryness, itching, and discomfort, having sex more comfortable and enjoyable. It’s important to know that vaginal estrogen therapy primarily works locally in the vagina and doesn’t significantly affect estrogen levels in the rest of the body. This means it’s generally considered safe for women who can’t or don’t want to use systemic hormone therapy.

What is Tibolone?

Tibolone is a medication that works a bit like the hormones in our bodies. According to this study, published in Nature Reviews Endocrinology, tibolene makes taking MHT for menopause the most effective choice. It can help to reduce those menopause symptoms by giving the body a little extra help with hormones. “It’s not exactly like estrogen or progesterone, but it acts a bit like both of them in the body. One of the advantages of tibolone is that it can also help keep bones strong, which is important because menopause can make bones weaker,” says Dr Bakre. So, it’s like a two-in-one medicine – helping with menopause symptoms and keeping bones healthy.

However, like any medicine, tibolone can have side effects, and it might not be right for everyone. It’s important to talk to a doctor before starting tibolone to make sure it’s safe and suitable for you.

Side effects of MHT

Side effects of Menopausal Hormone Therapy (MHT) can vary from person to person, but here are some common ones and how to deal with them:

•  Nausea: Some women may feel nauseous when they first start MHT. Eating smaller, more frequent meals and avoiding spicy or greasy foods can help reduce nausea.
• Breast Tenderness: MHT can sometimes make breasts feel sore or tender. Wearing a supportive bra and applying a warm compress can help alleviate discomfort.
• Headaches: Headaches can occur as a side effect of MHT. Drinking plenty of water, getting enough rest, and practicing relaxation techniques like deep breathing or meditation may help reduce headache frequency and severity.
• Bloating: MHT may cause bloating or fluid retention. Eating a balanced diet with plenty of fruits and vegetables, limiting salt intake, and staying physically active can help reduce bloating.
• Mood Swings: Changes in hormone levels from MHT can affect mood. Engaging in regular exercise, getting enough sleep, and talking to a trusted friend or counselor about feelings can help manage mood swings.
• Vaginal Discharge or Irritation: Some women may experience changes in vaginal discharge or irritation with MHT. Sitz bath and wearing cotton underwear can help maintain vaginal health.
• Spotting or Irregular Bleeding: MHT may cause spotting or irregular bleeding, especially during the first few months of treatment. This is usually temporary and resolves on its own. If bleeding persists or becomes heavy, it’s essential to consult a doctor.
• Blood Clots: There’s a small risk of developing blood clots with MHT. Staying physically active, avoiding prolonged periods of sitting or standing, and notifying a doctor immediately if experiencing symptoms like swelling, pain, or warmth in the legs can help reduce this risk.

Lifestyle changes for menopause management

To make menopause easier, women can focus on eating healthily, staying active with regular exercise, managing stress, and ensuring they get enough sleep. The Centres for Disease Control and Prevention instructs 150 minutes of moderate exercise as well as resistance sessions twice a week.

Limiting alcohol and caffeine, quitting smoking, and maintaining a healthy weight are also important. Regular check-ups with a doctor help monitor health and address any concerns early on.