What is hormone replacement therapy (HRT)
Media coverage, advanced scientific research, freedom of expression: menopause is now a more freely discussed topic in our society. However, solutions to alleviate symptoms, including hormone replacement therapy (HRT), remain unknown.
Used by 5 million women in Europe, HRT can treat symptoms of menopause such as vaginal dryness, hot flashes or sleep disorders. Menopause is a natural consequence of aging in women, and corresponds to a decrease in estrogen and progesterone levels. The symptoms of menopause can be numerous and affect not only mental and physical health, but also professional and social life. When the discomfort is severe, taking HRT can improve the symptoms of menopause and therefore the quality of life.
What is HRT?
Hormone replacement therapy is a commonly used treatment for menopausal symptoms. This treatment acts as a replacement for the main female hormones produced by the ovaries, estrogen and progesterone, whose levels begin to decrease naturally due to cellular aging.
What are the signs that I need HRT,
During menopause, the intensity of symptoms is variable, and many women do not need treatment. However, it may be offered when symptoms become severe and affect quality of life.
HRT can affect some or all of the symptoms of menopause:
Hot flushes;
excessive sweating ;
irregular cycles;
mood disorders (irritability, anxiety);
fatigue, insomnia;
decreased libido;
vaginal dryness ;
urinary problems such as incontinence;
sweat.
A doctor can also advise you for HRT in the following cases:
you are under 50 years of age and have symptoms of menopause: early menopause affects about 5% of women;
you develop menopausal symptoms before the age of 40: this phenomenon called early ovarian failure (IOP) affects approximately 1% of women;
You are menopausal and are at risk of osteoporosis (a disease that causes bone density to deteriorate and decrease, making them more fragile and at risk of fractures) or a contraindication to the treatment and prevention of osteoporosis.
What are the different types of HRT,
There are two types of HRT:
Combined HRT: is a combination of estrogen (which acts on symptoms and prevents osteoporosis) and progesterone (which reduces the risk of uterine cancer); it is not indicated if you have had a hysterectomy (a procedure that removes the uterus);
estrogen only: This type of HRT contains only estrogen.
There are several ways to take TRH, the treatment will be decided by the doctor according to your needs and possibilities related to your state of health.
To treat symptoms globally, estrogen will be used more specifically in the form of:
tablets;
gel to be applied to the skin;
transdermal patches.
Progestins will be taken in tablet form. There are also tablets for combined HRT.
To treat the symptoms of vaginal dryness, estrogen is used as a local vaginal treatment: it comes as a cream, egg, or vaginal ring.
How to start HRT,
If menopausal symptoms are affecting your daily life, it's important to talk to a doctor. They will choose the most appropriate type of HRT based on your symptoms.
As a general rule, tests are not necessary to confirm menopause. However, in certain situations, especially if early menopause is suspected or if you have particular risk factors, you may be offered checkups to confirm the diagnosis and determine whether other conditions may be behind your symptoms.
Before starting HRT, a thorough history and complete clinical examination, as well as a mammogram, are still necessary.
HRT can work early in treatment. Some women feel better very quickly, while others have to wait a little longer to see the effects. The dose can be adjusted so that the treatment relieves your symptoms without causing too many side effects.
Can I take HRT for life?
Currently, the High Health Authority (HAS) recommends the use of low doses for a period of 2 to 3 years maximum. But the treatment is defined individually, and if the benefits outweigh the risks, it is possible to prolong its intake on medical advice.
What are the advantages of HRT,
Relief of menopausal symptoms
HRT is the most effective way to alleviate the debilitating symptoms of menopause, including hot flashes, vaginal dryness, and sexual symptoms, but it also reduces the impact of other symptoms, for example, on sleep quality, probably through the reduction of nocturnal hot flashes or mood disorders. In the long term, the beneficial effect of estrogen in the urogenital sphere may play a role in preventing the occurrence of prolapse (dropping of an organ) and urinary incontinence in postmenopausal women.
bone health
HRT may also be beneficial for bone health: it can prevent osteoporosis, which is common after menopause due to decreased bone mass due to lower estrogen levels.
There are some risks associated with taking HRT,
Despite its benefits, it is also important to be aware of the risks inherent in taking HRT, which can vary from person to person.
breast cancer
Studies show that combination HRT slightly increases the risk of breast cancer (mainly due to the progestin).
In return, an HRT based on seuls estrogens is associated with a high risk of cancer du sein.
Les risques de cancer du sein increases proportionnellement à la durée de prize du HRT, et ils sont plus élevés si le traitement est administré pendant plus de 5 ans. Le risque diminishes cependant rapidly après l'arrêt du THS.
Endometre cancer (muqueuse interne de l'uterus)
Les études montrent une increase du risque de cancer de l'endometre lors de l'administration d'un HRT à base d'oestrogene seuls. Le risque est diminué lors de l'ajout d'un progestatif.
Therefore, HRT with estrogen is only reserved for women who have had a hysterectomy.
Ovarian cancer
HRT increases the risk of ovarian cancer when HRT is used, either as combination therapy or estrogen-only therapy, especially when the duration of treatment exceeds 5 years.
The risk would gradually decrease after stopping treatment.
Thrombosis
There is a significantly increased risk of thromboembolic events (clot formation in the veins causing phlebitis and/or pulmonary embolism) if risk factors are present.
However, the risk of thrombosis is not increased by the TRH gel or patch.
Cardiovascular health
The increased vascular risks (heart attack, stroke) depend on the risk factors, the products used and the duration of taking TRH. The risk is due to estrogens administered orally.
If you are concerned about the risks, do not hesitate to discuss them with your gynecologist or doctor.
HRT is contraindicated in the following cases:
have a history of breast, ovarian, or uterine cancer;
have untreated or uncontrolled high blood pressure despite treatment;
have a history of thrombosis;
have liver disease;
you have gynecologic bleeding that has not been diagnosed;
she is pregnant.
What are the possible side effects of HRT,
When you start taking HRT, you may develop estrogen and progesterone-related side effects, including:
breast tenderness or swelling;
Swelling ;
Water retention ;
headaches ;
vaginal bleeding (growth or increase of a fibroid of the uterus, awakening of endometriosis) ;
Humor;
digestive disorders ;
Nausea ;
leg cramps.
The side effects of HRT usually go away in a few weeks. If this is not the case after 3 months or the symptoms are too disabling, the doctor may suggest alternative treatment or discontinuation of treatment.
How to stop HRT,
If you are thinking of stopping HRT, your doctor may advise you to gradually reduce your dose or stop taking treatment immediately. It is imperative to seek medical advice before changing, stopping or resuming any treatment.
What are the alternatives to HRT,
Menopause, although natural, can be experienced very differently depending on each woman. It is the source of sometimes disabling symptoms and can also be the source of psychological suffering. It is important not to hesitate to discuss the matter with your doctor or a psychologist if you are experiencing distress related to this period of your life.
Also, if you don't want to or can't take HRT, there are simple steps you can take to help manage bothersome symptoms.
1. Lifestyle adaptations
Living a healthy lifestyle is essential for many reasons, and it can also help alleviate the symptoms of menopause, including:
be physically active regularly;
have a healthy and diversified diet, rich in calcium and vitamin D;
reduce the consumption of sugar, caffeine and alcohol;
Stop smoking.
2. Psychotherapy
If you're having trouble managing the psychological symptoms of menopause, cognitive behavioral therapy (CBT) is a form of psychotherapy that can help you develop practical ways to deal with problems. It also helps find strategies to deal with the anxiety, depression, and stress that sometimes accompany menopause.
There is also evidence that CBT can help you control night sweats, hot flashes, sleep disorders, and insomnia.
3. Non-hormonal treatments
There are non-hormonal treatments that can be beneficial and lead to an improvement in symptoms:
herbal medicine;
homeopathy;
certain trace elements and vitamins;
beta-alanine
certain dietary supplements.
If you're looking for other options to treat your menopausal symptoms, you may also hear about bioidentical or "natural" hormones, or bioidentical HRT. These are hormones that resemble the hormones naturally produced by our body, especially progesterone. These hormones are of plant origin.
However, it is important to note that the High Health Authority (HAS) has warned against these treatments, as well as components containing plant estrogens (phytoestrogens) because they have not yet been sufficiently studied to establish whether they are dangerous to the body. body or not
When to consult about HRT or menopausal symptoms,
It is also better to consult a doctor in the following cases:
you have bleeding after menopause;
you feel depressed or suffer from depressive symptoms;
You have trouble sleeping.
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