Description
Hormone Replacement Therapy (HRT) is a medical treatment that involves supplementing or replacing hormones, typically estrogen and progesterone in women and testosterone in men, to address hormonal imbalances associated with aging, menopause, or certain medical conditions. In women, HRT is often prescribed to alleviate symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness. It can also help prevent bone loss (osteoporosis) and reduce the risk of fractures.
HRT can be administered through various forms, including oral tablets, patches, gels, creams, or injections. The choice of administration depends on individual preferences, medical history, and the specific goals of therapy. While HRT can be highly effective in managing symptoms, its use has been a subject of debate and research due to potential risks, such as an increased risk of breast cancer, blood clots, and cardiovascular events. The decision to use HRT should be individualized, considering factors such as age, overall health, and personal medical history.
Résumé
- Menopause is defined retrospectively as the time following 12 months of amenorrhea, with the average age worldwide being 52 years, slightly earlier in Indian populations. The STRAWs classification is a tool to grade a woman's stage, informing medication decisions. Early menopause, before age 40, poses increased health risks due to prolonged estrogen deficiency.
- Menopausal symptoms include hot flashes, night sweats, mood swings, libido changes, sleep disturbances, weight gain, vaginal dryness, and bone density loss. Estrogen plays a vital role via the hypothalamic-pituitary-ovarian axis, and its decline leads to both central (vasomotor, mood) and local (urogenital) effects. Diagnosis is primarily based on symptoms in women over 45, with FSH testing reserved for early cases.
- Hormone replacement therapy (HRT) involves estrogen and progesterone for women with a uterus to prevent endometrial hyperplasia and cancer. Women without a uterus can receive estrogen alone. HRT is indicated for symptomatic women, those at high risk of osteoporosis, and those with premature menopause, focusing on improving quality of life.
- Prior to initiating HRT, a comprehensive evaluation including history, physical exam, blood pressure monitoring, thyroid and lipid profiles, Pap smear, mammography, and ultrasound is required. HRT is ideally started before age 60, within 10 years of the final menstrual period, using conjugated estradiol or 17 beta-estradiol, along with progestogens like dydrogesterone.
- Administration routes include oral, transdermal (patches, gels), and vaginal applications. Transdermal options are beneficial for those with contraindications to oral HRT, such as liver disease or high blood pressure. Tibolone, a selective tissue estrogen activity regulator, and testosterone may also be used in specific cases.
- Contraindications for HRT include breast or uterine cancer, previous thromboembolic disorders, liver or gallbladder disease, and coronary artery disease. HRT should be initiated cautiously, with regular follow-ups to assess efficacy and side effects. There is no defined period for stopping.
- Non-hormonal treatments for hot flashes include SSRIs, SNRIs, gabapentin, evening primrose oil, melatonin, and phytoestrogens. Low-dose paroxetine is FDA-approved for hot flashes. Gabapentin can be used for nighttime symptoms. Dietary changes and lifestyle modifications may help alleviate symptoms.
- Estrogen is cardioprotective, but HRT should be started early in the menopausal transition. In postmenopausal women, vaginal estrogen can manage genital urinary syndrome without systemic effects.
- Osteoporosis is a significant concern, with bone density decreasing rapidly after menopause. Management involves calcium and vitamin D, HRT, bisphosphonates, denosumab, teriparatide, and calcitonin sprays. Preventative measures include safety precautions to minimize fall risks. Individualized risk assessment is necessary prior to initiating any therapy.
Exemple de certificat
À propos des intervenants
Dr Yamini Dhar
Spécialiste en obstétrique et gynécologie, hôpitaux AlZahra, Émirats arabes unis
Commentaires
Commentaires
Vous devez être connecté pour laisser un commentaire.