By: Guest Author
Published: September 8, 2020
Written by Dr. Tee Villanueva- Guest Contributor
Menopause is technically defined as a permanent cessation of menses for 12 months. (1) Three to five years before menopause itself, perimenopause starts to occur. This is when a woman’s hormones become a tad bit erratic. The menstrual cycle length varies while menses are at times missed.
On average, women menopause at the age of 51 years old. (2) This means that less than a third of a woman’s life is spent after menopause. For us women, menopause may be intriguing and a bit scary, but, that does not need to be the case. By understanding what happens in menopause, we could remedy its signs and symptoms.
What happens in menopause?
In menopause, the ovaries become desensitized from the
stimulation made by a specific hormone, gonadotropin. This results in the decline and dysfunction of the ovarian follicles. (2) This cascade of events ultimately results in the body stopping its production of two hormones needed in fertility, estrogen, and progesterone.
Menopause is a physiologic process and it brings a lot of changes in the body. Symptoms of menopause include:
● Vasomotor symptoms
o Hot flashes or flushes
o Weight gain and bloating
o Mood changes
o Irregular menses
o Breast pains
● Urogenital Symptoms
o Dryness and itchiness of the vagina
o Sexual dysfunction (decreased libido)
o Stress incontinence, frequency, urgency, and dysuria
All these physiologic changes also put postmenopausal women at increased risk for developing diseases such as osteoporosis, cardiovascular diseases, breast cancer, and Alzheimer’s disease. (2)
Menopause is a state wherein there is a diminished estrogen and progesterone supply and to alleviate its symptoms, hormone replacement therapy comes in the picture. (3)
What is hormone replacement therapy?
Hormone replacement therapy is a treatment where estrogen and progesterone are supplemented to the body. (4) By replacing the hormones lost in menopause, the body is relieved of the symptoms of menopause. There are two types of hormone replacement therapies available, bio-identical hormones and synthetic hormones.
Synthetic hormones are called such as they are not naturally made. They are made from the mixture of urine of equine mares and progestins. These synthetic hormones include Ethinyl estradiol, and medroxyprogesterone (MPA).
On the other hand, bio-identical hormones are compounds often derived from plant extracts and are chemically modified in the laboratory so that it becomes identical with natural female hormones in the body. (3) The use of bio-identical hormones carries a lesser risk especially in the incidence of breast cancer than in the use of synthetic hormones, this is why naturopathic doctors recommend its use. (5)
HRT in menopause
In hormone replacement therapy, women undergoing menopause are supplemented with hormones they have lost. Hormone replacement therapy in menopause makes use of three different HRT regimens, estrogen-only, progestin-only, and the combination of estrogen and progestin. Estrogen replacement therapy has been promoted for postmenopausal women. (6) For women who have undergone hysterectomy (removal of the uterus), the use of estrogen-only HRT is advised. On the other hand, women who have an intact uterus must have progestin plus estrogen to protect the uterus from endometrial changes and malignancy. (4)
HRT and Vasomotor symptoms
Hot flashes and night sweats are the cardinal symptoms of menopause. Vasomotor symptoms are episodes of heat accompanied by sweating and flushing mostly felt at the head, neck, chest, and back. (7) In menopause, the hormonal change causes a temperature dysfunction that results in excessive hot flashes and sweating. (8) The use of hormonal therapy in vasomotor symptoms changes the levels of estrogen in the body and results in temperature balance. Hormonal therapy is the most effective treatment for menopausal vasomotor symptoms and related issues including impaired sleep, irritability, and decreased quality of life. (9)
HRT and Urogenital symptoms
Urogenital symptoms involve dryness and itching of the vagina with subsequent sexual dysfunction. In menopause, the estrogen deficiency causes atrophy of the skin and as well as the glands that lubricate the vagina. Treatment with hormone replacement therapy has been proven effective. (9) Patients may choose to use systemic hormone replacement therapy, low dose hormone replacement therapy (creams, tablets, or rings), or both. Urogenital symptoms are common in postmenopausal women and with the use of HRT, we could improve women’s quality of life.
HRT and Osteoporosis
Prevention of osteoporosis has been the best-documented benefit of estrogen replacement therapy. (6) Postmenopausal women undergoing estrogen therapy have greatly reduced bone loss. (10) Estrogen is a protective hormone in osteoporosis as it prevents the activation of the enzyme involved in bone loss. (11) In a state of estrogen scarcity like in menopause, hormone replacement therapy prevents bone loss subsequently preventing osteoporosis.
Contraindications of Hormone Replacement Therapy
In medicine, there is no such thing as a foolproof treatment. That is why before getting treatment, we have to first know the contraindications of hormonal replacement therapy to prevent untoward events.
● Known or suspected breast cancer
● Known or suspected endometrial Ca
● Undiagnosed vaginal or genital bleeding
● Active liver or gallbladder disease
● Active thromboembolic disorders
● Heart disease
● History of thromboembolic disease
● Liver or gallbladder disease
Hormone replacement therapy is primarily indicated in women suffering from symptoms of menopause.
(2) The ability to choose the optimal hormone replacement therapy preparation for a given patient is a core medical skill. (12)
Hormone replacement therapy needs to be discussed with your doctor as treatment needs to be individualized based on the woman’s needs, medical history, and preferences. The decision to use hormone replacement therapy also needs to come from the woman herself. Proper understanding of the benefits, risks, and side effects is imperative.
Menopause is a natural physiological phenomenon in a woman’s life. Women at times do not realize that their symptoms could be alleviated. By understanding the mechanism of menopause, we also learn the changes it will bring in our bodies.
Hormone replacement therapy has dramatically improved the quality of life of postmenopausal women but we have to remember that HRT is not only limited to the alleviation of the symptoms of menopause. HRT is effective in the treatment of vasomotor, and urogenital symptoms in menopause. It is also effective in the prevention of osteoporosis in postmenopausal women. Yes, HRT has its risks but it also has its benefits. With proper individualization and dose minimization, the benefits of HRT will outweigh its risks.
When you are suffering from the hot flashes, and heat waves of menopause, get in touch with your doctor and discuss the possible therapy suited for you and your body.
Long before her career as a doctor, Tee Villanueva always had her interest focused in writing. She has worked as a creative and content writer even while in medical school. Currently, she is a licensed resident doctor in Internal Medicine but loves that through writing, she can provide information about complex diseases and treatments to the general public. Combining her clinical knowledge and writing skills, she delivers complicated information in an easy to understand manner. When not writing and going on duty in the hospital, she likes to travel, cook or watch Netflix.
- Peacock, K., & Ketvertis, K.M. (2020) Menopause. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/
- Lobo, R. A., Gershenson, D. M, Lentz, G. M., & Valea, F. A. Comprehensive gynecology. 7th edition.
- Agarwal, S., Alzahrani, F. A., & Ahmed, A. (2018). Hormone Replacement Therapy: Would it be Possible to Replicate a Functional Ovary?. International journal of molecular sciences, 19(10), 3160.https://doi.org/10.3390/ijms19103160
- Harper-Harrison, G., & Shanahan, M.M. (2020). Hormone Replacement Therapy. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Retrieved fromhttps://www.ncbi.nlm.nih.gov/books/NBK493191/
- Moskowitz D. (2006). A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks. Alternative medicine review: a journal of clinical therapeutic, 11(3), 208-223.
- Delva M. D. (1993). Hormone replacement therapy. Risks, benefits, and costs. Canadian family physician Medecin de famille canadien, 39, 2149-2154.
- Thurston, R. C., & Joffe, H. (2011). Vasomotor symptoms and menopause: findings from the Study of Women’s Health across the Nation. Obstetrics and gynecology clinics of North America, 38(3), 489-501. https://doi.org/10.1016/j.ogc.2011.05.006
- Deecher, D. C., & Dorries, K. (2007). Understanding the pathophysiology of vasomotor symptoms (hot flushes and night sweats) that occur in perimenopause, menopause, and postmenopause life stages. Archives of women’s mental health, 10(6), 247-257.https://doi.org/10.1007/s00737-007-0209-5
- Kaunitz, A. M., & Manson, J. E. (2015). Management of Menopausal Symptoms. Obstetrics and gynecology, 126(4), 859-876.https://doi.org/10.1097/AOG.0000000000001058
- University at Buffalo. (2007, March 25). How Estrogen Protects Bones. ScienceDaily. Retrieved September 7, 2020 from www.sciencedaily.com/releases/2007/03/070323171448.htm
- Khaw K. T. (1992). The menopause and hormone replacement therapy. Postgraduate medical journal, 68(802), 615-623.https://doi.org/10.1136/pgmj.68.802.615
- Fait T. (2019). Menopause hormone therapy: latest developments and clinical practice. Drugs in context, 8, 212551.https://doi.org/10.7573/dic.212551
The views expressed herein this article, written by a guest contributor, do not necessarily represent those of the Red Hot Mamas organization. The content is for informational purposes and should not substitute the advice of your doctor.