World Women’s Health Day: This brings hormone therapy during menopause

Petra Stute says a woman should seek advice from her gynecologist as soon as she feels limited in daily life due to symptoms. One in three women experience intense symptoms during menopause. These include sweating, severe hot flashes, and heavy or prolonged bleeding. The cause of the symptoms is that the ovaries produce less and less sex hormones (estrogen and progestin) during menopause. This leads to changes in the diencephalon (hypothalamus) where body temperature and emotions are controlled.

With hormone replacement therapy, the concentration of sex hormones is increased by supplying the body “from the outside”. The most effective way to relieve symptoms, according to the mare. “It gives women more control in a phase of life where many feel things are going to spiral out of control.” Hormone replacement therapy also protects against osteoporosis, reduces the risk of diabetes and slows the formation of calcification in blood vessels.

Hormone replacement therapies are either pure estrogen therapies or combined preparations containing estrogen and progestin, the so-called whole body hormone replacement therapies. Depending on the preparation and the way it is used, the therapy is associated with certain risks. The three biggest:

• endometrial cancer risk
  Estrogen stimulates the lining of the uterus, which can lead to cancer cell growth. For this reason, whole-body hormone replacement therapy is recommended for women who still have a womb. “It needs progestin as an antagonist to protect the uterine lining,” says Stute. Pure estrogen therapy is possible for women after hysterectomy. Such an operation may be necessary because of cancer or endometriosis, among other things.
• breast cancer risk
  According to Stute, current research shows that the risk of breast cancer is slightly increased after 5½ years of whole-body hormone replacement therapy because hormones change breast tissue. With pure estrogen therapy, the risk of breast cancer does not increase. Women with breast cancer should not take hormone replacement therapy because of the risk of recurrence. If a family member has had breast cancer, the risk is already increased. Hormones do not contribute to this.
• thrombosis risk
  The risk of thrombosis may increase if women swallow the hormones as tablets. This is because hormones alter liver metabolism, which causes the blood to clot too quickly. This danger is not present if hormones enter the body through the skin in the form of patches or gels. This way they bypass the liver. “For women over 60, patches or gels are recommended,” says Stute. Because the risk of thrombosis increases at this age.

“The benefits outweigh the risks if treatment is started early after the onset of symptoms,” says Stute. Hormone replacement therapy improves symptoms in 900 out of 1000 women. Each woman should weigh individual advantages and disadvantages with her gynecologist.

Petra Stute (51) is head of the Menopause Center in Inselspital, Bern and has been the Deputy Chief Physician for gynecological endocrinology and reproductive medicine for 14 years. As a hormone specialist, she conducts scientific studies on menopause and publishes various specialist journals in the field of women’s health. She studied medicine in Germany and was already interested in hormones when she was at school.