Meno Health. Clinical Evidence.

TWC #009: Ist eine Hormonersatztherapie das richtige für mich? 

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Is hormone replacement therapy right for me?

If you’re going through the menopause, you’ve probably already heard about hormone replacement therapy. A lot has been written about it in recent years. This has often led to uncertainty among women.

We would therefore like to explain what hormone replacement therapy is, the various forms of it and the benefits and risks.

What is hormone replacement therapy?

When you enter the menopause, usually between the ages of 45-55, your oestrogen levels drop. This can lead to unpleasant vasomotor symptoms. You can read about the symptoms that can occur in our symptom checker.

Hormone replacement therapy (also known as hormone therapy, menopause hormone therapy or oestrogen replacement therapy) can effectively treat these symptoms.

There is oestrogen therapy on the one hand and combination therapy (hormone therapy with oestrogen/progesterone/progestins) on the other.

Oestrogen therapy

In oestrogen therapy, the hormone oestrogen is administered in various forms in order to compensate for declining production. It is particularly suitable for women who no longer have a uterus.

Oestrogen is available in various forms as a patch, pill, vaginal, gel and spray.

Oestrogen patch

The patch is applied to the abdomen. Depending on the dose, some patches need to be changed every few days, while other patches can be worn for up to a week.

Oestrogen pill

The pill is the most common form of treatment for menopausal symptoms. Most oestrogen pills are taken once a day without food. Some have more complicated dosing schedules.

Vaginal oestrogen

Vaginal oestrogen comes in the form of creams, vaginal rings or tablets. These treatments are usually intended for women who suffer from vaginal dryness, itching, burning or pain during sexual intercourse. The intake schedules vary depending on the product. The application of the creams can be daily, several times a week or on a different schedule. Most vaginal rings need to be replaced with new rings every three months. Vaginal tablets are often taken daily for a few weeks, after which only two applications per week are necessary.

Oestrogen for external use

Gels, sprays and creams are other ways of introducing oestrogen into the body. Like the patch, this type of oestrogen treatment is absorbed directly into the bloodstream via the skin. The application of these creams varies, but is usually once a day.

Hormone therapy with oestrogen/progesterone/progestins

This therapy is often referred to as combination therapy as it combines oestrogen and progestogen, the synthetic form of progesterone, in one dose. It is aimed at women who still have a uterus.

Compared to taking oestrogen alone, taking oestrogen and progesterone reduces the risk of endometrial cancer.

Progesterone is generally used for contraception, but can also help with menopausal symptoms such as hot flushes.

A distinction can be made between oral and intrauterine progestins.

Oral progestogens

Progestogen preparations that are taken in tablet form include medroxyprogesterone acetate and the synthetic progestogen pills (norethindrone, norgestrel). Many specialists now treat most of their menopausal patients with natural progesterone rather than synthetic progestogens. Research suggests that natural progesterone has no negative effects on blood lipid levels and is a good choice for women with high cholesterol levels.

Intrauterine progestogens (hormonal coil)

Intrauterine devices (IUDs) are small, flexible, T-shaped plastic bodies that are inserted into the uterus. They are used for contraception and bleeding control. They are sometimes used «off-label» in combination with oestrogen.

This raises the question of the benefits and risks of hormone replacement therapy.

Advantages of hormone replacement therapy
  • Reduction of hot flushes
  • Fewer outbreaks of sweating
  • Relief from dryness and itching in the vagina
  • Reduction in pain during sexual intercourse
  • Reduction in bone fractures due to osteoporosis (bone loss)
  • Improved sleep
  • Reduction of dementia

Research over the last 20 years has shown that the benefits are greater than the risks. However, hormone replacement therapy also harbours risks that need to be taken into account.

Risks of hormone replacement therapy
  • Stroke
  • Breast cancer
  • Blood clots
  • If the uterus is still present and oestrogen is administered without progestogen: Uterine cancer

The risk can be reduced if the following instructions are followed.

Measures to reduce the risk
  • Hormone replacement therapy should be started within 10 years of the menopause or before the age of 60.
  • Always set the dosage as low as possible.
  • Regular examinations (mammography and skin) should be carried out.
  • If the uterus is present, progesterone or progestogen should be taken.

However, hormone replacement therapy is not suitable for every woman. Hormone replacement therapy should be avoided in the case of the following conditions.

Avoidance of hormone replacement therapy 
  • Cancer (e.g. breast, uterine or ovarian cancer)
  • heart attack
  • Blood clots
  • Heart, liver or gallbladder disease
  • Known or suspected pregnancy
  • Stroke
  • Unexplained vaginal bleeding

Side effects must also be taken into account and should be reported to the doctor.

Possible side effects of hormone replacement therapy
  • Nausea
  • Mood swings 
  • flatulence
  • Headaches
  • Swollen or tender breasts
  • Vaginal bleeding

You have now learnt the basics of hormone replacement therapy. Of course, the question now is whether hormone replacement therapy is right for you.

Is hormone replacement therapy right for me?

Our experts can help you weigh up the benefits and risks and suggest a decision based on the severity of your symptoms and your medical history.

Here are some questions you should consider before you speak to our experts.

  1. do I have a pre-existing condition (e.g. cancer) that precludes hormone replacement therapy?
  2. can your symptoms also be treated with alternative methods or have you already used them (homeopathy, herbal medicines, lifestyle adjustments, etc.) (our experts can help you with this on an individual basis)?
  3. could hormone replacement therapy have side effects (e.g. did you have problems with the contraceptive pill)? 
  4. am I a good or bad candidate for hormone replacement therapy (Hormone replacement therapy can reduce your risk of osteoporosis if your mother had osteoporosis. Talk to your doctor if your mum has had breast cancer).
  5. what type of hormone replacement therapy is best for me?

Hormone replacement therapy is a complex subject and it’s worth finding out more. 

Joëlle & Adrian

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