Women’s Health
Patient Guide

Understanding Menopause: Changes in Women's Bodies and the Role of Menopausal Hormone Therapy

Menopause is a natural biological process that marks the end of a woman's reproductive years. It typically occurs in women between the ages of 45 and 55, with the average age of onset around 51 years old. During menopause, the ovaries gradually decrease their production of estrogen and progesterone, leading to a cessation of menstrual periods and various changes in the body. Here we'll explore the natural course of changes in women's bodies during menopause and the role of Menopausal Hormone Therapy (MHT), including its risks, benefits, and contraindications.

The Natural Course of Menopause

• Perimenopause: This transitional phase usually begins several years before menopause when the ovaries start to produce less estrogen. Women may experience irregular menstrual cycles, hot flashes, night sweats, mood changes, anxiety, depression, insomnia, and other symptoms during perimenopause.

• Menopause: Menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months. Estrogen levels continue to decline, leading to symptoms such as vaginal dryness, sleep disturbances, mood swings, anxiety, and changes in libido.

• Postmenopause: Postmenopause refers to the years following menopause. Estrogen levels stabilize at a lower level, and many of the symptoms experienced during perimenopause and menopause may diminish. However, women remain at increased risk for certain health conditions, such as osteoporosis and heart disease, due to the decline in estrogen.

  Role of Menopausal Hormone Therapy

  Menopausal hormone therapy (MHT), also known as Hormone replacement therapy (HRT), involves the use of estrogen or a combination of estrogen and progesterone to alleviate symptoms of menopause and reduce the risk of certain health conditions associated with hormonal changes. Here are some key considerations regarding MHT:

Benefits:

• Relief of Menopausal Symptoms: MHT can effectively alleviate symptoms such as hot flashes, night sweats, vaginal dryness, and mood disturbances, improving quality of life for many women.

• Prevention of Bone Loss: Estrogen helps maintain bone density, so MHT may reduce the risk of osteoporosis and fractures in postmenopausal women.

• Potential Cardiovascular Benefits: Some studies suggest that early initiation of MHT may reduce the risk of heart disease and stroke in women within a few years of menopause onset.

  Risks:

• Increased Risk of Breast Cancer: Long-term use of combined estrogen- progestin therapy has been associated with a slight increase in the risk of breast cancer. The risk appears to be higher with combined therapy compared to estrogen alone. However, mortality rates do not appear to increase with MHT.

• Risk of Blood Clots: Estrogen-containing MHT may increase the risk of blood clots, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE).

• Endometrial Cancer Risk: Estrogen therapy without progesterone in women who have not had a hysterectomy may increase the risk of endometrial cancer.

  Contraindications:

  MHT may not be suitable for all women, and certain contraindications should be considered before initiating therapy:

• History of Breast Cancer: Women with a history of breast cancer or certain types of estrogen-sensitive tumors should generally avoid MHT due to the potential risk of cancer recurrence.

• History of Blood Clots: Individuals with a history of blood clots or clotting disorders may be at increased risk of thromboembolic events with MHT.

• Endometrial Hyperplasia or Cancer: Women with a history of endometrial hyperplasia or cancer should avoid estrogen therapy without concurrent progestin to reduce the risk of endometrial cancer.

  Conclusion:

  Menopause is a natural phase of life that involves hormonal changes and various physical and emotional symptoms. Hormone replacement therapy can be an effective treatment option for managing menopausal symptoms and reducing the risk of certain health conditions associated with hormonal decline. However, it's essential for women and their healthcare providers to weigh the potential risks and benefits of MHT carefully and consider individual factors such as age, medical history, and personal preferences.

  Close monitoring and periodic reevaluation are necessary to ensure the safety and efficacy of hormone replacement therapy for menopausal women.

  MHT for women during menopause typically involves the administration of estrogen and, in some cases, progesterone or progestins. Testosterone may also be used in certain circumstances. Here are the common hormones used for MHT in women during menopause:

• Estrogen: Estrogen replacement therapy is the cornerstone of MHT for menopausal women. Estrogen can effectively alleviate symptoms such as hot flashes, night sweats, vaginal dryness, and mood changes. It also helps maintain bone density and may reduce the risk of osteoporosis. Estrogen can be administered orally, transdermally (creams/patches), vaginally (creams, rings), or intramuscularly.

• Progesterone/Progestins: In women who have an intact uterus, estrogen therapy is often combined with progesterone or a synthetic progestin to protect the endometrium (lining of the uterus) from the potential risk of hyperplasia or cancer. Progesterone or progestins are typically administered cyclically or continuously, depending on the regimen. Common progestins include medroxyprogesterone acetate (MPA), micronized progesterone, and norethindrone acetate.

• Testosterone: While estrogen and progesterone are the primary hormones used in MHT for menopausal women, testosterone may also be prescribed in certain cases to address symptoms such as reduced libido, decreased energy levels, and loss of muscle mass. Testosterone therapy for women is usually administered in lower doses than for men and is available in various forms, including patches, gels, creams, and intramuscular injections.

  It's important to note that the decision to use hormone replacement therapy, as well as the specific hormones and dosages prescribed, should be based on individual factors such as symptoms, medical history, risk factors, and personal preferences. Women considering MHT should discuss the potential risks and benefits with their primary care provider to make an informed decision about treatment. Additionally, regular monitoring and follow-up are essential to ensure the safety and efficacy of hormone replacement therapy during menopause.