Menopause management: Does hormone replacement therapy help?

Menopause is that time in a woman’s life when the periods stop permanently. This is a retrospective diagnosis and a woman is said to have gone through the menopause if she has not had any vaginal bleeding, including spotting, for one full year after her last period. If your mother or an elder lady at home is hitting this phase of life, you should make them aware about effective ways of menopause management.

The average age of menopause in India is 47 years as opposed to the West where it is 51 years. However, in recent times women in India are also going through the menopause at a later stage, which is around early fifties.

For a lot of women, freedom from periods is a huge relief, especially if they have been suffering from heavy painful periods. However, along with this, come the not-so-pleasant symptoms.

What are the symptoms of menopause?

Menopausal symptoms may begin suddenly and maybe very noticeable or they may be transient and mild. They may begin about 6 years before the menopause and continue for several years after the menopause.

The symptoms are:

1. Irregular menstrual periods.
2. Heavy or light periods
3. Hot flushes – feeling hot and sweating even in cold temperatures
4. Weight gain and bloating
5. Mood swings, sleeplessness and depression
6. Vaginal dryness and loss of libido
7. Frequent urination, increased incidence of urinary infection, urinary incontinence
8. Loss of balance and increased frequency of falls

The other changes include loss of bone density, giving rise to brittle bones and increased risk of fractures, especially hip fractures. During this period, the risk for heart attacks and strokes are also increased because of the declining levels of estrogen hormone.

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What can be done for menopause management?

The aim of menopause management are:

* Relief from hot flushes
* Reduce the risk of disease
* Improve the quality of life

What is hormone replacement therapy and how does it help?

This is the most commonly used drug therapy for the management of menopause. It can help relieve menopause symptoms such as hot flushes, night sweats, mood swings, vaginal dryness, reduced sex drive and to help prevent osteoporosis.

Types of Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy includes the hormones Estrogen and Progesterone. Estrogen can be used singly if the woman has had a hysterectomy. Estrogen and Progesterone are used in combination if the uterus is intact. Estrogen therapy (with or without progesterone) is the best treatment for hot flushes and night sweats. It also helps alleviate vaginal dryness and protects against bone loss. These drugs are available as tablets, gels, patches, implants and vaginal inserts such as cream, ring.

Side Effects of Hormonal Replacement Therapy for woman hitting menopause

* Breast tenderness
* Vaginal bleeding – monthly or irregular
* Headaches
* Abdominal pain
* Indigestion

What are the risks of Hormonal Replacement Therapy

The benefits of this therapy usually outweigh the risks for most women. The risks are usually very small, and depend on the type of therapy, how long it is taken for and individual health risks.

1. Breast cancer

There is little or no change in the risk of breast cancer if you take estrogen-only HRT. Combined HRT can be associated with a small increase in the risk of breast cancer. The increased risk is related to how long you take HRT, and it falls after you stop taking it. Because of the risk of breast cancer, it’s especially important to undergo regular breast cancer screening if you’re taking HRT.

2. Blood clots

The evidence shows that: there’s no increased risk of blood clots from HRT patches or gels, however taking HRT tablets can increase your risk of blood clots – but this risk is still small

3. Heart disease and strokes

HRT does not significantly increase the risk of heart disease and strokes if started before the age of 60 years. In fact, it may reduce your risk. Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.

Who should avoid Hormone Replacement Therapy?

Women with a history of:

* Breast cancer/ovarian cancer/uterine cancer
* Blood clots
* Heart attack, stroke or increased risk for vascular disease
* Liver disease
* Untreated high blood pressure

Is Tibolone good for menopause management?

This is similar to the combined HRT. It is suitable for women who have had their last period more than one year ago. Risks of Tibolone are similar to HRT.

Non-hormonal medications such as ‘Selective Estrogen Receptor Modulators’ –SERMS act like estrogens in some parts of the body and as anti-estrogens in some others. They are very useful in improving bone density and can reduce the risk of fractures. They do not, however, alleviate hot flushes. Newer SERMs are available which help reduce the hot flushes and night sweats.

Alternative medicines like plant estrogens, include isoflavones and lignans. These are found in soyabeans, lentils, chickpeas and other legumes. However, whether they help ease the symptoms of menopause remains to be proven. Similarly, bioidentical hormones, black cohosh, yoga, acupuncture and hypnosis are advocated for symptom control, but their efficacy is not medically proven.

Lifestyle changes women must make for menopause management

You can choose to make these lifestyle changes during menopause:

* Dress in cottons.
* Have cold glass of water and find a cooler place to go to.
* Avoid hot beverages, caffeine, stress, spicy food, alcohol, warm rooms and hot weather.
* Consume a balanced diet and drink at least 2.5-3 liters of water per day * Include calcium and Vitamin D supplements in your diet
* Exercise regularly
* Sleep for at least 8 hours
* Reduce your stress levels
* Practice relaxation techniques
* Avoid smoking

The last words

Menopause is a natural transition in a woman’s life and cannot be avoided. Whether boon or bane, it is here to stay. The good news is that the symptoms associated with the menopause are temporary. There are medicines and lifestyle changes that can help you cope with menopausal symptoms and ease this transition period.