Menopause will affect 100% of women and for some the transition is uneventful but for others it is quite disruptive. The symptoms of hot flashes, night sweats, mood swings, sleep disturbance, urogenital dryness, decreased libido and depression can be distressing and interfere with the quality of life. Fortunately there are a number of remedies available to relieve these symptoms and hormone replacement therapy sits at the forefront of these therapies. The benefits of hormone replacement therapy will be reviewed.
Estrogen is the most effective treatment for symptoms of hot flashes, mood changes and urogenital atrophy. It is also helpful in other menopausal related symptoms such as sleep disturbance and even palpitations. Estrogen also has some other health related benefits, some subjective but others supported with objective data.
The progestin component of hormone replacement therapy is design to counteract the negative effects on the uterine lining, also called the endometrium. Estrogen causes the endometrium to grow and proliferate. Progestin counteracts this effect, preventing the growth of the lining. In the absence of progestin, the endometrium would continue to grow and transition to endometrial cancer. Progestin should be taken in women who still have their uterus, if they start estrogen replacement therapy.
In women with symptomatic menopause, hormone replacement therapy should be considered if other conservative measures are not working. HRT is highly effective at relieving the symptoms of hot flashes, night sweats, mood swings, sleep disturbance and urogenital dryness. Some women reported that they “just feel better” on HRT.
Estrogen has a positive effect on the bones. The presence of estrogen helps to maintain bone density. Once a woman goes through menopause, she has a significant reduction in bone density, which then places her at higher risk of osteoporosis and related fractures. Women on estrogen have a much lower risk of osteoporotic related bone fractures and even though estrogen replacement should not be the first line therapy for osteoporosis prevention it should certainly be considered in many cases.
There are other notable benefits of estrogen replacement. Women on HRT have a much lower risk of developing Type 2 Diabetes Mellitus. This is thought to be due to the favorable effect on insulin utilization. There is less insulin resistance in those on HRT. Women taking HRT were also less likely to develop colorectal cancer. Finally, menopausal women can develop recurrent urinary tract infections due to the effects of urogenital atrophy. Local estrogen therapy reduces this risk.
The general recommendations for HRT is that it should be utilized in symptomatic women, at the lowest effective dose and for the shortest time frame possible and no longer than 5 years. Individualization of treatment can be made for those who have no other risks since longer-term treatment is an option. It is important that these decisions be made after in depth evaluation and counseling with an experienced healthcare provider.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!