These menopausal medications are a real lifesaver, but they aren’t right for everyone

Obstetrician-gynecologist Heraldas Stankevičius says that some women who have reached menopause do not avoid medical intervention

“There is no question about the extremely positive effect of menopausal hormone therapy on quality of life: its effectiveness in correcting early and intermediate menopausal symptoms and stopping osteoporosis. Systemic hormone therapy for menopause remains the most effective way to overcome the debilitating ailments caused by estrogen deficiency, ”says obstetrician-gynecologist H. Stankevičius.

H. Stankevičius says that systemic treatment when menopausal symptoms occur is given to women under the age of 60, or in any case during the first 10 years after menopause, if there are no contraindications.

Hormone therapy for menopause should not be administered prophylactically, but may be recommended in patients with moderate to severe ailments: hot flashes, sweating, changes in heart rhythm, mood swings, sleep disorders, depression, joint pain, muscle pain, genitourinary syndrome, urinary disorders. organ atrophy, associated decreased libido, sexual dysfunction), postmenopausal osteopenia, and osteoporosis.

Dr. H. Stankevičius says that sex hormones are not treated when you have cancer of the breast, uterus, or genital bleeding of unknown origin, diagnosed cardiovascular disease, active liver disease, and a possible increased risk of thromboembolism.

According to obstetrician-gynecologist H. Stankevičius, when the quality of life deteriorates due to menopause, medications can help, but, as in many cases when it comes to health problems, it is necessary to emphasize the importance of a lifestyle healthy, a rational diet and physical activity.

“These factors do not correct the symptoms of menopause, but they improve health, and this is extremely important in adulthood”, emphasizes the doctor.

“Most postmenopausal women can receive menopausal hormone therapy. The risk-benefit balance is certainly more favorable for women who start treatment in the first 10 years after menopause ”, says the obstetrician-gynecologist.

Hormone therapy for menopause covers a wide range of compounds. Medications can be taken by mouth, given through the skin, inserted into the vagina, into the uterus, or using implants.

Dr. H. Stankevičius emphasizes that there is no ideal product or dosage that is suitable for all women of any age, each combination of hormonal drugs can have unique properties that can be used correctly.

“The wide selection of hormonal preparations allows for dynamic adaptation of therapy by adjusting the dose, selecting the appropriate progestin and the route of administration, taking into account the individual characteristics, goals and preferences of the woman. This is the only way to guarantee the best efficiency and maximum safety, “said obstetrician-gynecologist H. Stankevičius.

Positive effects of menopausal hormone therapy

The benefit-risk balance of menopausal hormone therapy has been studied extensively over the past decade.

Dr. H. Stankevičius says that the benefit-risk balance of menopausal hormones is not absolute and unequivocal. All this varies greatly depending on the clinical situation, the selection of the woman, the age, the start of the treatment, the chosen dose and the route of administration.

Each patient is treated with different doses of hormones, depending on the individual clinical situation.

It is virtually impossible to correct postmenopausal genitourinary syndrome without estrogen therapy, says H. Stankevičius. “Phytotherapy, multivitamins, homeopathy and other treatments with questionable effects, whose mechanism of action is often based on the placebo effect, do not really help in this situation”, emphasizes the doctor.

Hormone therapy for menopause increases the density of bone mass and helps prevent osteoporotic fractures that occur with even minor injuries. No other treatment can match price, effectiveness and side effects, says H. Stankevičius. The risk of osteoporotic fractures not only of the spine but also of the femoral neck is reduced. According to clinical trials, menopausal hormone therapy accounts for about 30 percent of femoral neck reduction and about 50 percent. risk of vertebral fractures.

Influence on cardiovascular disease and cancer risk

The doctor says that the impact of sex hormones on the risk of cardiovascular disease and breast cancer is ambiguous. 2002 The Women’s Health Initiative Study (WHI), a randomized, double-blind, placebo-controlled study, found that women treated with a combination of estrogen and progestin had an increased risk of cardiovascular disease and invasive breast cancer.

The new analysis of the available data showed that for people aged 50 to 59 there was a significant reduction in the overall relative risk of death in the age group compared to the placebo group of women of the same age.

Another study found that women who take menopausal hormone therapy for the first 10 years after menopause cut their risk of heart disease in half, as well as a one-third reduction in the risk of death from all causes. They do not have an increased risk of stroke, but at the age of 60 there is a slight increase in the risk of stroke, although there is no increase in deaths from heart disease in this group.

“At present, based on the available data, menopausal hormone therapy cannot be recommended only for the prevention of cardiovascular diseases,” says obstetrician-gynecologist H. Stankevičius.

The relative risk of venous thromboembolism and pulmonary embolism doubles with hormonal pills during menopausal hormone therapy. The risk of thromboembolic complications after subcutaneous administration of estrogens is not the same as in the general population.

The WHIs study found an increased risk of breast cancer with a combination of estrogen and progestin.

The doctor acknowledges that the impact of menopausal hormone therapy on breast cancer is controversial.

“Contrary to what was shown in a study of the combination of estrogen and progestin in WHI, continuous treatment with estrogen alone in women after hysterectomy did not show an increased risk of breast cancer, even lower than in women of 50 to 79 years who received placebo. The risk of invasive duct cancer was even lower. There were no differences between receptor positive and negative tumors. The overall incidence of breast cancer has decreased significantly after 11.8 years of follow-up, ”said H. Stankevičius.

Risk-benefit balance

The doctor says the benefit-risk balance of menopausal hormone therapy is complex.

“Meta-analyzes of randomized controlled trials show that the first 10 years of menopausal hormone therapy significantly reduce all-cause mortality, but patients’ understandable concerns about breast cancer risk are understandable and their decisions about breast cancer should be considered. menopausal hormone therapy, “says Dr. H. Stankevičius.

– Some women, especially given the initial higher risk of breast cancer, will avoid systemic menopausal hormone therapy. However, for many enlightened women with menopausal symptoms such as hot flashes, sweating, changes in heart rhythm, the decision to start systemic menopausal hormone therapy is a wise decision. “

The doctor says that the benefit-risk balance of hormone therapy for menopause should be evaluated by a specialist on a case-by-case basis.

Therapy should be individualized according to the characteristics of the woman, her personal and family history, as well as the prevailing symptoms, attitudes and expectations, and the results of existing clinical and laboratory studies.

“The patient’s doctor must choose the most appropriate type of menopausal hormone therapy (dose, composition, model, method and duration of use) to achieve the desired treatment goals, it is important to periodically evaluate changes in the woman’s health” says the obstetrician-gynecologist.

– Each year, the doctor should discuss the continued use of menopausal hormone therapy with the patient and evaluate the risks and benefits. The importance of a healthy lifestyle should be emphasized. “

The doctor says that it is important to explain to the patient the pyramid of healthy eating, the benefits of physical activity. Women are advised to lose weight, stop smoking, not abuse alcohol.

“These negative factors undoubtedly significantly increase the risk of cardiovascular disease and breast cancer,” says Dr. H. Stankevičius.