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Menopause refers to the retrospective cessation of menstrual cycles in women. Menopause leads to vasomotor, psychological, and genito-urinary symptoms, and cognitive inefficiencies among patients.
Hormone replacement therapy for women involves external administration of sex hormones, estrogen and progesterone. HRT can be beneficial for women undergoing menopause but only when prescribed by a specialist, keeping medical histories and age in mind.
There are multiple HRT side effects to take note of. Self-medication is injudicious and strictly prohibited.
How To Know If A Woman Needs Hormone Therapy?
A woman in her mid-to-late forties or early fifties will start experiencing symptoms like frequent mood swings, hot flashes and night sweats, irritability, interrupted sleep patterns, anxiety and depression and other psychological issues, and genito-urinal symptoms like vaginal dryness and change in libido among others. These symptoms are due to menopause which is defined as the gradual cessation of menstrual cycles in women and is marked by abrupt changes in ovarian hormone levels. (1)
Women just about to enter menopause (known as perimenopause), and those just after the transitional period (post-menopause) also suffer from these symptoms, collectively known as the climacteric symptoms (another name for menopause syndrome). (2)These symptoms can persist for more than a decade. (3)
In case of climacteric syndromes, it is crucial to consult a professional before resorting to any form of treatment. Not everyone who undergoes such symptoms needs hormones. Menopause is a normal part of the female reproductive cycle and hormonal balance is restored gradually in the body with the help of a few crucial but easy lifestyle and dietary changes. (4) However, for patients experiencing chronic symptoms and severe implications in their lifestyle, pharmacological intervention is always available.
What are ovaries and ovarian hormones? What is their impact on the body?
Ovaries are the reproductive regulators (gonads) in the body concerned with producing steroidal and non-steroidal hormones. Estrogen and progesterone are the two main hormones secreted by the ovaries which are instrumental in maintaining sexuality and fertility. Apart from the secretion of hormones, ovaries also produce eggs (known as the ova) stored within follicles. (5)
A lot of eggs die in the pre-pubertal age due to the unavailability of the required gonadal hormones. The remaining eggs continue to mature in post-pubertal life with the increased secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland.
Thus begins a constant cycle wherein the ovarian follicles release estrogen, these eggs undergo maturation, break open from their follicles, are released from the ovaries, and travel down the fallopian tube towards the uterus (ovulation). They release progesterone via the corpus luteum while doing so. (6) Additionally, estrogen also uses a feedback mechanism to reduce the amounts of FSH and LH secreted.(7) This is the menstrual cycle and it continues till all the eggs are depleted. This phase is then called menopause and it occurs in the fourth or fifth decade of life.(5)
Estrogen is a group of sex steroid hormones released by the ovarian follicles during the maturation of the eggs in the ovulation phase of the menstrual cycle. Apart from the ovaries, some amount of estrogen is also secreted by the adrenal glands and the fat cells. (8)
There are three major estrogens – namely estradiol, estrone and estriol. Estradiol is specifically instrumental in the regulation of menstrual cycles, development of the breasts, fat distribution in the hips, legs and breasts and development of the reproductive organs.(6) Estrogen is also known to affect the genito-urinary, musculoskeletal, and cardiovascular systems, especially in bone formation.(8)
Progesterone is another sex steroid hormone released when the egg travels down the fallopian tube (the second half of the menstrual cycle). It is secreted with the help of the corpus luteum – a temporary gland formed within the ovary after ovulation. Progesterone causes the uterine endometrium to thicken and prepares the body for a pregnancy wherein the fetus is not disturbed due to uterine contractions.(6) The corpus luteum disappears if a woman is not pregnant. Progesterone also prepares the breasts for lactation during pregnancy. Progesterone is also instrumental in reducing water retention in the body and stimulates normal libido.(9)
The gradual depletion of all eggs in the ovaries leads to a drastic reduction in the amounts of estrogen and progesterone secreted in the body, resulting in increased amounts of FSH and LH.(10) This causes climacteric syndromes which are characteristic of perimenopausal and menopausal women. Changes in estrogen and progesterone ratio also cause thinning of tissues, making the skin appear wrinkled, making the urinary tract more prone to infections, vaginal dryness and atrophy, osteoporosis, abnormal bleeding, weight gain, headaches, and making the body more prone to cardiovascular diseases. (11) (12)
What Is Hormone Replacement Therapy (HRT)?
Hormone therapy or hormone replacement therapy for menopause refers to the artificial administration of sex hormones to restore the balance between estrogen and progesterone in the body and treat chronic menopause symptoms. (1) HRT for women can be tricky and dependent on several factors including age and medical histories.
What Are The Different Types Of Hormone Therapy?
HRT for women can vary as per their formulation (combination of estrogen and progesterone, or separate), ways of administration (gels, pills, patches), and their frequency of administration (cyclic or continuous).(13)
The formulation of the hormone replacement therapy for menopause is the most crucial determinant for HRT efficacy. Women who have a womb are free to take both estrogen and progesterone as per their doctor’s recommendations and risk factors. However, if without a womb (having undergone a hysterectomy), only estrogen replacement therapy is necessary.(14)
There are different pros and cons of different modes of administration of HRT for women. Pills are easier to consume but can have more side effects. Patches and gels are easier options if one tends to forget to take pills in the first place. However, patches might leave marks on the skin, cause rashes and redness or may easily get off due to moisture issues. Gels, on the other hand, need time to dry and get absorbed completely by the body. Sprays can be used as well, but one would need to wait an hour before stepping into the shower.
Implants like the Mirena coil (an intra-uterine device) is often inserted to avoid unwanted pregnancies, blood clots and as a complementary progesterone-releasing system in women taking estrogen pills, gels or sprays. It is only useful if women have difficulties in sticking to a routine, and can last up to five years.(13)
Irrespective of everything else, women need to get a specialized practitioner or an ob-gynae to approve any HRT depending on individual habits and medical histories.
Are There Actual Benefits Of Hormone Therapy? Do Hormone Replacement Therapy Side Effects Exist?
Like every other medication, HRT also comes with its own shares of benefits and adverse effects depending on an individual’s health concerns. Estrogen-based HRT improved vasomotor symptoms (estrogen has been shown to reduce symptoms by 75% and their frequency by 87% within six-to-eight weeks when given in low doses), improved sexuality and libido (topical gels and patches have shown better results in reducing vaginal dryness and atrophy). (15)
Similarly, benefits of progesterone after menopause, especially in oral formulations include improved sleep patterns and cognitive capabilities.(15) (16) Standard systemic doses of estrogen have also shown to prevent bone loss, improve mental health and overall quality of life.(17)
HRT side effects can be severe if not advised by the right practitioner following proper guidelines.(18) The most common side effects of estrogen therapy include swollen breasts, nausea, increased risks of heart attacks and strokes, blood clots (especially with implants like the Mirena coil), stomach aches, headaches, increased vaginal bleeding, and rashes, especially for patients aged above 60 years.(19)
Side effects of estrogen and progesterone include flatulence, increased appetite, indigestion, weight gain, and a higher risk of breast cancers and Alzheimer’s disease as compared to estrogen alone.(20) (21) (22) Even the duration and dosage cause a significant difference in hormone replacement therapy side effects.
Patients with a high blood pressure, liver diseases, and histories of heart attacks, strokes, and ovarian and breast cancers, irrespective of their age, should avoid HRT or speak to an expert before resorting to one.
The Bottom Line Remains….
HRT is not all good or all bad for anyone and everyone. hormone therapy for women may work wonders for those experiencing chronic climacteric syndrome, but not everyone needs to pop estrogen and progesterone pills every now and then.(23) HRT side effects when taken in uncontrolled, unprescribed routines can be counter-productive.
Women (and people of the other genders who feel climacteric syndromes affecting their lifestyle) are ALWAYS advised to speak to their specialists before resorting to any form of pharmacological intervention. (24) (25) Self-awareness, education, and support are the keys to getting through this phase of life and ensuring a healthy quality of life for oneself and loved ones.
Q. Does every woman need hormone therapy?
A. No. There are multiple natural remedies available for non-severe cases. Please consult an expert before resorting to any form of hormone therapy. Menopause is not a diagnosis but a natural part of the reproductive cycle.
Q. What to do when the doctor does not prescribe HRT?
A. Practising a healthy, active lifestyle, including moderate exercises and nutrition-rich food in the diet can help alleviate most symptoms if not severe. Supplements should only be taken if they are recommended by physicians or the ob-gynaes.
Q. Are bioidentical hormones suitable for menopause?
A. This totally depends on the specialist’s advice on menopause management. Please be aware that there are plenty of options available in the market, but not all are regularized. Keeping in mind the frequent shortage of HRT products, please ensure the product under consideration is a regularized one and is prescribed by a legalized, medical professional with a valid license.(26)
Q. Are there any other uses of hormone therapy?
A. If prescribed by a practitioner, HRT is also used to treat osteoporosis, infertility, gender transitions and alleviate some cancer symptoms.