There are many forms of treatment at a woman’s disposal to treat the symptoms of menopause. But before contacting a doctor for treatment, simple measures can often improve these symptoms. Hot flushes may be triggered by spicy foods, coffee or alcohol - so avoid these if you are sensitive. Similar comments apply to sleep: avoid stimulating foods and drinks near bedtime, particularly alcohol. Try a warm milky drink instead.
Unfortunately, for severe symptoms, medical treatment may be inevitable.
HRT or Hormone Replacement Therapy
Hormone replacement therapy or HRT does what its name suggests – it replaces the hormones that a woman’s body stops producing after menopause. HRT is not the answer to all a woman’s menopausal problems, but it can help alleviate the hot flushes and exhausting sleepless nights, allowing the patient to feel better and have more energy.
Oestrogen administration also has a positive effect on mood disturbances, palpitations and the atrophic symptoms concerning the vagina and the urinary tract.
HRT can also help protect a woman against the long-term effects of oestrogen loss, like cardiovascular disease or problems of urinary incontinence, and it is sometimes also used for the prevention of osteoporosis (fragile bones). However, the therapy should only be used in postmenopausal women who suffer from osteoporosis if they are at high risk for future fractures and/or if they are intolerant of or contraindicated for other medicinal products that are approved for the treatment of osteoporosis.
Together with your doctor, you may decide to initiate HRT if and when you experience symptoms that have an adverse effect on your quality of life. There are also undesirable effects resulting from oestrogen therapy, such as headaches, weight gain and painful swelling of the breasts.
Recently, a survey study among one million volunteering women showed a slightly increased risk for breast cancer if HRT is continuously used over several years. Although this risk is extremely small, in all cases the risks and benefits of HRT should be carefully assessed at least once a year. Therapy should only be continued as long as the benefits outweigh the risks.
Oral HRT has been prescribed for women since the 1940s in doses designed to mimic the pre-menopausal levels of oestrogen. The oestrogen is taken in a steady dose, so the level remains the same throughout the month. These steady levels of hormone may be advantageous for some women who suffer from the symptoms caused by fluctuating levels, particularly headaches and mood swings.
To alleviate vaginal symptoms, an oestrogen-containing cream or gel is applied locally.
Although oestrogen replacement effectively relieves the symptoms of the menopause, it is also important for women who still have a uterus to have their lost levels of progesterone replaced. Your doctor will prescribe a substance similar to progesterone - progestagen - which mimics the effect of progesterone. In pre-menopausal women, progesterone causes the mucous membrane of the uterus to proliferate, but - if fertilisation does not take place - it also initiates menstruation, the shedding of the lining of the womb. If you were to only be substituted with oestrogen, the membrane of your uterus would continuously grow and eventually cause a certain type of cancer. To prevent this from happening, your doctor will add progestagene tablets, which you take 10 to 12 days a month to initiate an ‘artificial period’. Both hormones can also be contained in a single pill, the so-called combination pill.
Janssen-Cilag is proud of its heritage in female healthcare and has been providing a wide range of Hormone Replacement Therapy to its customers for the past 30 years. Our range includes creams, gels, tablets and matrix patches, which gradually release the hormone through the skin into the bloodstream. We continually strive to innovate and produce new advances in this area in order to improve the healthcare management of women of all ages.
Is HRT suitable for you?
Deciding whether or not to take hormone replacement therapy (HRT) requires weighing the pros and cons together with your doctor and assessing your risk for certain medical conditions, particularly heart disease and breast cancer, because HRT reduces the risk for the former and may increase the risk for the latter.
Ultimately, the decision of whether or not to take hormones is personal.
There are no absolute rules. Always consult your physician for personalised advice, weighing up all the risks and benefits. It is recommended that women who have had a previous thrombosis (whether or not they have an inherited thrombophilia) should be discouraged from taking oral HRT.
Particular caution is also advised in women with multiple risk factors for thrombosis (including a history of cardiovascular disease) and in women with a strong family history of thrombosis.
In addition, precautions are necessary in women taking HRT who are about to undergo elective surgery, as it is thought that HRT may increase the chances of developing thrombosis after the operation. It may be appropriate to stop HRT before the operation (at least 6 weeks before) in women with multiple or severe risk factors for thrombosis. However, HRT need not be stopped in most other women undergoing surgery, provided that the clotting risk is reduced by the use of low-molecular-weight heparin, with or without elastic graduated compression stockings.
Treatment of osteoporosis
Although HRT used to be the standard treatment to prevent and stabilise osteoporosis since the 1940s, recent clinical studies have revealed a potentially higher risk for developing breast cancer, associated with long-term use of hormone therapy. Fortunately, pharmaceutical research has resulted in a new category of drugs to fight osteoporosis - the biphosphonates.
Biphosphonates prevent the decalcification of the bones, thereby making them denser and more resistant to fractures. Tablets are taken on a daily or weekly basis.
Nowadays, biphosphonates can be prescribed only if the density of your bones has dropped below a certain level, which is measured during a bone-densitometry, commonly known as bone-scan. Unfortunately, this type of drug has quite a lot of unpleasant side effects, such as:
- nausea and vomiting
- diarrhoea
- gastro-intestinal ulcers
Treatment with biphosphonates has replaced HRT as the standard treatment for severe osteoporosis, but if you can not tolerate biphosphonate therapy or are contraindicated for it, HRT still is a worthy alternative.
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