Hormonal agent treatment: Is it right for you?

Hormonal agent treatment was as soon as regularly utilized to deal with menopausal signs and safeguard long-lasting health. Then big medical trials revealed health threats. What does this mean for you?

By Mayo Center Personnel

Hormonal agent replacement treatment is medication which contains female hormonal agents. You take the medication to change the estrogen that your body stops making throughout menopause. Hormonal agent treatment is usually utilized to deal with typical menopausal signs, consisting of hot flashes and vaginal pain.

Hormonal agent treatment has actually likewise been shown to avoid bone loss and minimize fracture in postmenopausal ladies.

Nevertheless, there are threats connected with utilizing hormonal agent treatment. These threats depend upon the kind of hormonal agent treatment, the dosage, the length of time the medication is taken and your specific health threats. For finest outcomes, hormonal agent treatment need to be customized to each individual and reviewed once in awhile to be sure the advantages still exceed the threats.

What are the standard kinds of hormonal agent treatment?

Hormonal agent replacement treatment mostly concentrates on changing the estrogen that your body no longer makes after menopause. There are 2 primary kinds of estrogen treatment:

  • Systemic hormonal agent treatment. Systemic estrogen — which is available in tablet, skin spot, ring, gel, cream or spray type — usually consists of a greater dosage of estrogen that is soaked up throughout the body. It can be utilized to deal with any of the typical signs of menopause.
  • Low-dose vaginal items. Low-dose vaginal preparations of estrogen — which can be found in cream, tablet or ring type — lessen the quantity of estrogen soaked up by the body. Due to the fact that of this, low-dose vaginal preparations are generally just utilized to deal with the vaginal and urinary signs of menopause.

If you have not had your uterus eliminated, your medical professional will usually recommend estrogen together with progesterone or progestin (progesterone-like medication). This is due to the fact that estrogen alone, when not stabilized by progesterone, can promote development of the lining of the uterus, increasing the danger of endometrial cancer. If you have actually had your uterus eliminated (hysterectomy), you might not require to take progestin.

What are the threats of hormonal agent treatment?

In the biggest medical trial to date, hormonal agent replacement treatment that included an estrogen-progestin tablet (Prempro) increased the danger of specific major conditions, consisting of:

  • Cardiovascular disease
  • Stroke
  • Embolism
  • Breast cancer

Subsequent research studies have actually recommended that these threats differ depending upon:

  • Age. Ladies who start hormonal agent treatment at age 60 or older or more than 10 years from the beginning of menopause are at higher danger of the above conditions. However if hormonal agent treatment is begun prior to the age of 60 or within 10 years of menopause, the advantages appear to exceed the threats.
  • Kind of hormonal agent treatment. The threats of hormonal agent treatment differ depending upon whether estrogen is provided alone or with progestin, and on the dosage and kind of estrogen.
  • Health history. Your household history and your individual case history and danger of cancer, heart problem, stroke, embolism, liver illness and osteoporosis are necessary consider identifying whether hormonal agent replacement treatment is suitable for you.

All of these threats need to be thought about by you and your medical professional when choosing whether hormonal agent treatment may be an alternative for you.

Who can take advantage of hormonal agent treatment?

The advantages of hormonal agent treatment might exceed the threats if you’re healthy and you:

  • Have moderate to extreme hot flashes. Systemic estrogen treatment stays the most reliable treatment for the relief of frustrating menopausal hot flashes and night sweats.
  • Have other signs of menopause. Estrogen can reduce vaginal signs of menopause, such as dryness, itching, burning and pain with sexual intercourse.
  • Required to avoid bone loss or fractures. Systemic estrogen assists safeguard versus the bone-thinning illness called osteoporosis. Nevertheless, physicians generally advise medications called bisphosphonates to deal with osteoporosis. However estrogen treatment might assist if you either can’t endure or aren’t gaining from other treatments.
  • Experience early menopause or have estrogen shortage. If you had your ovaries surgically eliminated prior to age 45, stopped having durations prior to age 45 (early or early menopause) or lost regular function of your ovaries prior to age 40 (main ovarian deficiency), your body has actually been exposed to less estrogen than the bodies of ladies who experience common menopause. Estrogen treatment can assist reduce your danger of specific health conditions, consisting of osteoporosis, heart problem, stroke, dementia and state of mind modifications.

If you take hormonal agent treatment, how can you minimize danger?

Speak to your medical professional about these techniques:

  • Discover the very best item and shipment approach for you. You can take estrogen in the type of a tablet, spot, gel, vaginal cream, or slow-releasing suppository or ring that you position in your vaginal area. If you experience just vaginal signs associated with menopause, estrogen in a low-dose vaginal cream, tablet or ring is generally a much better option than an oral tablet or a skin spot.
  • Decrease the quantity of medication you take. Utilize the most affordable reliable dosage for the fastest quantity of time required to treat your signs. If you’re more youthful than age 45, you need enough estrogen to supply defense versus the long-lasting health impacts of estrogen shortage. If you have enduring menopausal signs that substantially hinder your lifestyle, your medical professional might advise longer term treatment.
  • Look for routine follow-up care. See your medical professional frequently to make sure that the advantages of hormonal agent treatment continue to exceed the threats, and for screenings such as mammograms and pelvic tests.
  • Make healthy way of life options. Include exercise and workout in your everyday regimen, consume a healthy diet plan, keep a healthy weight, do not smoke, restrict alcohol, handle tension, and handle persistent health conditions, such as high cholesterol or hypertension.

If you have not had a hysterectomy and are utilizing systemic estrogen treatment, you’ll likewise require progestin. Your medical professional can assist you discover the shipment approach that uses the most advantages and benefit with the least threats and expense.

What can you do if you can’t take hormonal agent treatment?

You might have the ability to handle menopausal hot flashes with healthy-lifestyle methods such as keeping one’s cool, restricting caffeinated drinks and alcohol, and practicing paced unwinded breathing or other relaxation methods. There are likewise numerous nonhormone prescription medications that might assist ease hot flashes.

For vaginal issues such as dryness or unpleasant sexual intercourse, a vaginal moisturizer or lube might supply relief. You may likewise ask your medical professional about the prescription medication ospemifene (Osphena), which might assist with episodes of unpleasant sexual intercourse.

The bottom line: Hormonal agent treatment isn’t all excellent or all bad

To figure out if hormonal agent treatment is an excellent treatment choice for you, talk with your medical professional about your specific signs and health threats. Make certain to keep the discussion going throughout your menopausal years.

As scientists discover more about hormonal agent treatment and other menopausal treatments, suggestions might alter. If you continue to have annoying menopausal signs, evaluation treatment choices with your medical professional regularly.

June 09, 2020

  1. AskMayoExpert. Menopausal hormonal agent treatment (grownup). Mayo Center; 2019.
  2. Martin KA, et al. Treatment of menopausal signs with hormonal agent treatment. https://www.uptodate.com/contents/search. Accessed March 25, 2020.
  3. Martin KA, et al. Menopausal hormonal agent treatment: Advantages and threats. https://www.uptodate.com/contents/search. Accessed March 25, 2020.
  4. American College of Obstetricians and Gynecologists. Practice Publication No. 141: Management of menopausal signs. Obstetrics & Gynecology. 2014; doi: 10.1097/01.AOG.0000441353.20693.78. Declared 2018.
  5. North American Menopause Society. The 2017 hormonal agent treatment position declaration of The North American Menopause Society. Menopause. 2017; doi: 10.1097/GME.0000000000000921.
  6. North American Menopause Society. Nonhormonal management of menopause-associated vasomotor signs: 2015 position declaration of The North American Menopause Society. Menopause. 2015; doi: 10.1097/GME.0000000000000546.

See more Thorough