Description
Menopause is a natural biological process that marks the end of a woman's reproductive years. It is characterized by a decline in estrogen and progesterone levels, which can cause a range of symptoms. In this webinar, we will explore the benefits and risks of HRT, the different types of HRT, and how to choose the right one for you. HRT is a type of medical treatment that involves supplementing the body with hormones, such as estrogen and progesterone. The goal of HRT is to alleviate the symptoms of menopause by restoring hormonal balance. HRT can be administered in various forms, including pills, patches, creams, gels, and injections. Estrogen-only therapy is recommended for women who have had a hysterectomy and do not have a uterus. Combined estrogen-progestin therapy is recommended for women who still have a uterus, as it reduces the risk of endometrial cancer.
Résumé
- Menopause is a retrospective diagnosis, defined as the cessation of menstruation for 12 consecutive months. It typically occurs around age 52, slightly earlier in Indian women, with a range between 42 and 58 years. Understanding the stages of menopause, from reproductive years to perimenopause and postmenopause, is essential for appropriate management. The STRAW classification helps to grade a woman's menopausal stage, guiding treatment decisions.
- Hormone Replacement Therapy (HRT) is vital for women experiencing significant menopausal symptoms like hot flashes, mood swings, decreased libido, vaginal dryness, sleep disturbances, and bone density loss. Identifying women with premature menopause or primary ovarian insufficiency is particularly crucial, as early estrogen loss can increase the risk of osteoporosis and cardiovascular disease. Risk factors for early menopause include toxic exposures, autoimmune disorders, smoking, chemotherapy, radiation, and genetic abnormalities.
- HRT's primary goal is to alleviate symptoms and improve the quality of life. Estrogen is the key hormone, but it *must* be combined with progesterone in women with a uterus to prevent endometrial hyperplasia and cancer. Unopposed estrogen is *only* safe in women who have had a hysterectomy. HRT is indicated for women with bothersome symptoms, those at high risk of osteoporosis or cardiovascular disease, and those with premature menopause.
- Before starting HRT, a thorough evaluation is necessary, including a detailed history, physical exam, blood pressure monitoring, thyroid function tests, complete blood count, lipid profile, Pap smear, mammography, and baseline ultrasound. HRT should ideally be initiated before age 60 and within 10 years of the final menstrual period, to maximize benefits and minimize risks.
- Estrogen is the principal hormone in HRT, available as conjugated estrogens or estradiol. Progesterones like medroxyprogesterone acetate, micronized progesterone, and dydrogesterone are used in conjunction with estrogen. Administration routes include oral, transdermal (patches, gels), and implants. Transdermal options are advantageous for women with contraindications to oral HRT, such as liver disease, gallbladder disease, or dyslipidemia. Tibolone, a synthetic steroid, offers estrogenic, progestogenic, and androgenic properties, but should be used cautiously due to a potential increased risk of breast cancer recurrence.
- Testosterone can be used transdermally or intravaginally to help with decreased libido, dyspareunia and vaginal dryness. Osmepifene, a selective estrogen receptor modulator (SERM), is another option for treating dyspareunia, particularly in women unable to tolerate estrogen.
- Contraindications to HRT include breast cancer, uterine cancer, thromboembolic disorders, liver or gallbladder disease, and coronary artery disease. However, these contraindications should be assessed on a patient-by-patient basis and tailored to the individual’s circumstances. The woman should be informed of vaginal bleeding that can occur at the start of HRT.
- HRT should be stopped when symptoms subside or after 2-5 years, but there's no fixed time limit if the patient is well and monitored. Tapering the medication is preferable but may not significantly affect symptom return. Even after stopping HRT, continued assessment and annual follow-ups are essential.
- Non-hormonal options for managing menopausal symptoms include SSRIs and SNRIs, gabapentin (especially for nighttime symptoms), evening primrose oil, melatonin, isoflavones, vitamin E, and yams. These alternatives are suitable for women with contraindications to estrogen or those preferring non-hormonal management.
- Local estrogen is considered a safe and effective treatment for genitourinary syndrome of menopause, including vaginal dryness, dyspareunia, and urinary symptoms. The estrogen helps maintain vaginal epithelium and urinary bladder and can be delivered via cream, tablet, or vaginal ring.
- After menopause, bone density decreases significantly, necessitating bone density screening (DEXA scans). Management includes calcium and vitamin D supplementation, HRT, bisphosphonates, denosumab or recombinant human parathyroid hormone. Fall prevention strategies are also important.
- For women with breast cancer or endometriosis, HRT decisions need individual tailoring, careful counseling, and the consideration of non-hormonal alternatives and/or SERMs.
Exemple de certificat
À propos des intervenants
Dr Maitrayee Chennu
Obstétricien et gynécologue consultant, hôpitaux Sankhya, Hyderabad
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