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Menopause: hormone replacement therapy

Hormone replacement therapy: that's why it's used!

Hormone replacement therapy (HET) aims to relieve menopausal symptoms with the help of hormone preparations. These include hot flashes, night sweats, mood swings, nervous restlessness and sleep disorders.

These complaints are related to changes in the hormonal balance: During menopause, the body reduces the production of female sex hormones such as estrogen, which can trigger the symptoms mentioned.

The hormone replacement therapy is not intended to restore previous hormone concentrations in the body, but only to specifically reduce symptoms caused by estrogen deficiency. So the term hormone replacement therapy is not entirely correct; “hormone therapy” (HT) would be more correct.

Hormone Replacement Therapy: Preparations - Overview

Various preparations are available for hormone replacement therapy in menopause:

  • Estrogen-progestin supplements
  • Estrogen preparations
  • Tibolone Preparations

Estrogen-progestin supplements

In the vast majority of cases, doctors prescribe hormone replacement therapy preparations with a combination of estrogen and progestin. Both sex hormones are mainly produced in larger quantities in the ovaries before menopause. Other parts of the body, such as adipose tissue, also produce small amounts of these hormones. Menopause begins with the ovaries slowly stopping their work and with it the production of hormones. The hormone levels in the body drop. As part of hormone replacement therapy, estrogen-progestin preparations can counteract the symptoms associated with the decrease in hormones.

Pure estrogen supplements

Menopausal symptoms arise from the increasing lack of estrogen. So pure estrogen preparations should be enough to combat the symptoms. These are actually used in hormone replacement therapy - but only in certain cases. They have a decisive disadvantage: pure estrogen preparations often trigger growths in the lining of the uterus (endometrium). Endometrial or uterine body cancer can develop from these. But if the estrogen is combined with a progestin, no growths occur. Pure estrogen preparations are therefore only suitable for hormone replacement therapy in women after the uterus has been removed.

Tibolone Preparations

In Germany, preparations containing the artificial hormone tibolone are rarely used for menopausal symptoms. The active ingredient has both an estrogen and progestin-like effect and helps against hot flashes. Research shows, however, that it is less effective than estrogen-progestin preparations. As with all medications, side effects can also occur (see below).

When is hormone replacement therapy performed?

Hormone replacement therapy is an option if women have severe menopausal symptoms such as hot flashes and sweats. Treatment is generally particularly useful when started as early as possible, when the menopause begins.

Before the attending physician prescribes hormone preparations, however, he must carefully weigh up the benefits and risks of the treatment in each individual case. He will take into account individual factors such as general health, age, previous hormone treatments and other aspects.

Benefits of hormone replacement therapy

Menopause is often accompanied by hot flashes and night sweats. Their number can be significantly reduced with hormone preparations that contain estrogen and progestin or estrogen alone. As a further effect, the sleep of women who were previously often awakened by hot flashes at night may improve.

Studies have shown that hormone replacement therapy can also relieve other menopausal symptoms such as insomnia, mood swings, depressed mood and painful intercourse. The sex life and quality of life of the women affected benefit from it.

In addition, hormone replacement therapy should also protect against other diseases, such as heart attacks. Today, however, some of these assumptions are considered refuted.

What are the risks of hormone replacement therapy?

Side effects can generally occur with all drugs, including the hormone preparations used in hormone replacement therapy.

Short-term side effects are, for example, menstrual-like bleeding and a feeling of tightness in the chest with estrogen-progestin preparations or spotting with tibolone. Incidentally, the treatment does not cause weight gain - as is often feared: Most women gain weight with age - whether with without hormone replacement therapy.

Side effects of prolonged hormone therapy

More serious are the side effects that occur with prolonged hormone replacement therapy. Depending on the preparation, the risk of various diseases increases:

Estrogen-progestogen supplements, as well as pure estrogen supplements, increase the risk of:

  • stroke
  • Blood clots in the legs and / or lungs (thromboembolism)
  • Gallbladder disorders that require surgery

Estrogen-progestin preparations also increase the risk of breast cancer and heart attacks. With long-term use, women are also slightly more likely to die of lung cancer. In addition, the risk of dementia increases in women over 65 years of age.

Long-term use of tibolone appears to increase the risk of the tumor returning in women who have had breast cancer. In addition, the risk of stroke could increase in women over the age of 60.

Due to these serious side effects, hormone replacement therapy during menopause should only be carried out when absolutely necessary and in as short a time and in low doses as possible.

What happens if you stop taking the hormones?

It is still unclear what happens when women stop hormone replacement therapy. It is conceivable that prolonged use of hormones will bridge the “critical” phase so that menopausal symptoms will no longer occur after the end of therapy. However, hormone replacement therapy can only postpone the hormone change: After stopping the drug, the symptoms can return.

As for the side effects: studies have shown that the risk of breast cancer remains increased even after stopping the estrogen-progestogen preparations if the hormone replacement therapy has been carried out for more than five years.

How do I take the hormone preparations?

Estrogen-progestin preparations are available in various dosage forms. It is available as a tablet or capsule to swallow, as a nasal spray, plaster, gel (for application to the skin) or syringe (injection). Hormone replacement therapy can also be carried out by applying the hormones directly to the vagina: the active ingredients are available as a cream, tablet, suppository or insertable ring.

Pure estrogen preparations are also available in various application forms such as tablets, creams, plasters or syringes. The artificial hormone tibolone is available in tablet form.

The exact application of the hormone preparations depends on the dosage form. For example, the tablets usually have to be taken daily. The hormone patch is changed once or twice a week, the vaginal ring about every three months. The doctor will provide you with detailed information on the correct use of your hormone preparation.

Menopause: treatment without hormones

Many women want treatment without hormones during the menopause and use medication or dietary supplements of plant origin for their symptoms. Here you can find out more about menopause, medicines and medicinal plants.

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