Hormone replacement therapy
"The time should be as short as possible (not exceeding 5 years) and always under medical supervision, which will assess each year the need or desirability of continuing it based on the possible emergence of new risk factors in each woman".
DR. LUIS CHIVA DIRECTOR. GYNAECOLOGY AND OBSTETRICS DEPARTMENT
Hormone replacement therapy based on estrogen or its derivatives may often be recommended during menopause, since most of the symptoms that occur during this stage are related to a drop in blood levels of estrogen,
It is advisable for every woman who reaches menopause to see a specialist to evaluate the convenience of starting hormone replacement therapy.
As a general rule, certain life habits are recommended, such as quitting smoking, adequate intake of calcium and vitamin D in the diet, regular exercise and avoiding excessive weight loss.
Not all patients may need to start hormone replacement therapy if the above advice is followed.
Today, there are various ways of carrying out hormone replacement therapy, which is basically going to be based on taking only estrogen for women who do not have a uterus and associated with progesterone in those who do.
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When is hormone therapy indicated for menopause?
The indications remain the same: hot flushes, night sweats, genital dryness or other symptoms characteristic of menopause, in such intensity or degree of discomfort that they may be deteriorating the quality of life. Also in those with loss of bone mass that will not tolerate other specific treatments for it.
Although hormonal treatment has a positive effect on mood and behavior, it should not be used as an antidepressant. Nor should it be used to improve memory or other cognitive skills. It can even be harmful when started above the age of 65.
Benefits of hormone replacement therapy:
- In the short term it will relieve most patients of hot flashes and sweating, genitourinary discomfort and emotional and libido changes.
- It will not have a major impact on breast and skin changes.
- In the long term, it decreases the risk of cardiovascular disease and osteoporosis. It also improves the blood lipid profile.
Do you have these symptoms during menopause?
It may be necessary to start hormone replacement therapy
How is the treatment with hormone therapy?
The route of administration is varied, and can be taken orally, through transdermal patches, subcutaneous implants, through skin ointments, transcutaneous absorption sprays or even intranasally.
Without a doubt, the most widespread forms of estrogen administration are the transdermal route, using patches, and the oral route.
Before starting a hormone replacement treatment, it is convenient to perform a series of diagnostic tests that rule out the presence of pathology at a gynecological level or at a general level, which could contraindicate the use of such therapy.
All those women who have not had their uterus removed, in addition to receiving estrogen, should receive progesterone, since it has a very important effect in preventing the appearance of lesions at the level of the endometrium (the internal mucous membrane of the uterus), fundamentally hyperplasia and endometrial cancer.
There is still no definitive data as to the most ideal or least risky duration, dose or different hormone preparations.
In general, and for women with a uterus, it is recommended to use the lowest dose of estrogen and progesterone that manages to control the symptoms and whose risk-benefit ratio is provided for each woman. In those who do not have a uterus, the same recommendation is also used, in this case only for estrogens.
It seems that low doses are better tolerated and may have a better risk-benefit profile.
The time should be as short as possible (no more than 5 years) and always under medical supervision that will evaluate each year the need or convenience of continuing it based on the possible appearance of new risk factors in the woman in question.
If after suspending it the symptoms reappear or if in any case the woman understands that the benefit she is enjoying seems greater than the risk, in both circumstances she should evaluate with her doctor whether to resume or prolong it.
Another interesting practical aspect is the route of administration. Essentially they are the oral and transdermal (patches). The latter seems to be accompanied by a lower risk of thrombosis since it reaches the blood circulation without first passing through the liver, which would mean an alteration of some coagulation factors.
When there are only local genital symptoms, vaginal creams or tablets are used.
Thus, it is considered that the presence of these substances is a contraindication for taking this treatment:
- Active liver disease.
- Pathology of the gallbladder.
History of deep vein thrombosis in relation to oestrogens.
- Genetic risk of venous thrombosis.
- Abnormal vaginal bleeding, without a precise diagnosis having been made.
- History of estrogen-dependent cancer, such as breast cancer or endometrial cancer.
They are mainly due to the taking of progesterone in the short term.
Typically they are: headaches, breast tension and lower abdomen discomfort. Estrogen therapy alone has been linked to the appearance of endometrial cancer.
Hence the importance of combining progesterone, since the risk of this disease, making the appropriate treatment, is virtually zero.
As for the association of this therapy with breast cancer, at present there is no definitive evidence that a short-term treatment increases the risk of breast cancer, however there are certain controversies regarding long-term treatment.
Where do we do it?
IN NAVARRA AND MADRID
The Department of Gynecology and Obstetrics of the
of the Clínica Universidad de Navarra
Comprehensive care that includes a wide range of consultation and treatment options from regular preventive screening to the most advanced diagnostic and treatment options for obstetric and gynecological problems at all ages.
The department also offers routine pregnancy monitoring that includes a variety of diagnostic and screening procedures to identify potential problems of the fetus as well as its proper growth and development.
Why at the Clinica?
- Highly specialized team of doctors, nurses and midwives.
- Reproduction and Fertility Unit.
- Pregnancy follow-up with a personalized delivery.
- All the comfort, with the guarantee and safety of a hospital with the most advanced equipment.