What should we know about hormone therapy?

We cannot stop time, nor would we want to, but we can do a lot to reach menopause in the best way possible.

As we approach menopause, our hormones fluctuate and decline.

We have all heard of estrogen. Estrogen, a crucial hormone during a woman's reproductive cycle, has many functions, from regulating menstrual cycles and contributing to bone strength to even influencing the regulation of our skin temperature.

As estrogen levels become unstable, a series of symptoms may appear, such as hot flashes, night sweats, anxiety, and joint pain, among others.

Up to 90% of women will experience some of these symptoms. The most frequent are vaginal dryness, the dreaded insomnia, and hot flashes.

It is well known that many women suffer more during the transition stage than in postmenopause, as hormone levels tend to stabilize from this point on, and with that hormonal stability, symptoms tend to improve—though not always and not in all cases.

It is time to understand what is happening to our bodies, talk, break myths, and seek solutions. This stage is not the end but a new beginning, and we are here to help you. There are many solutions to make our experience with menopause much better.

All experts agree that Hormone Replacement Therapy (HRT) is, in the vast majority of cases and under medical supervision, the best treatment to follow. The sooner it is started, the greater the benefits it will provide.

Until a few years ago, this type of therapy had bad press due to a published study that had to be halted in 2002 because it suggested that hormone replacement treatments had more harmful than beneficial effects. This was the WHI (Women’s Health Initiative randomized controlled trial) study, which brought about a paradigm shift in hormone replacement therapy.

But you should know that ALL national and international guidelines published after the WHI study indicate that the benefits of using hormone replacement therapy clearly outweigh the risks in the case of symptomatic women without additional risk factors.

The main ingredient in hormone replacement treatments is estrogen, but one of the most common forms is combination therapy, in which estrogen is administered together with progesterone. There are many forms and routes of administration, from oral pills, patches, and transdermal gels to vaginal rings. The indication for HRT would be the treatment of vasomotor symptoms and the genitourinary syndrome of menopause. And the optimal hormone replacement therapy regimen would consist of transdermal estrogen and micronized progesterone.

But the choice of the type of therapy will vary from person to person and will depend on the patient's symptoms and lifestyle. The goal is to start with the lowest effective dose possible, and it may take three to six months to notice the effects. It is possible that the dose and type of hormone therapy will need to be adjusted or changed. Most experts recommend starting hormone replacement therapy when the first symptoms appear.

There are some special compounds, including medications such as: TIBOLONE (Boltín® 2.5 mg), a synthetic steroid that improves vaginal atrophy and vasomotor symptoms, increases bone mass, and does not alter the lipid profile. OSPEMIFENE (Senshio® 60 mg), a selective estrogen receptor modulator used for the treatment of vulvovaginal atrophy in women who are not candidates for local estrogens. DEHYDROEPIANDROSTERONE (DHEA), a precursor to estrogens and testosterone. In Spain, it is marketed as prasterone (Intrarosa® 6.5 mg ovules), a chemical compound identical to endogenous DHEA, authorized for the treatment of vaginal atrophy via vaginal administration. In the US, it is an over-the-counter oral dietary supplement.

Apart from hormonal treatments, there are other non-hormonal treatments as an alternative for those patients with vasomotor symptoms who cannot or do not want hormonal treatment. Antidepressants (selective serotonin reuptake inhibitors: venlafaxine, paroxetine, fluoxetine) that will control vasomotor and depressive symptoms. Phytoestrogens (soy isoflavones: genistein, daidzein, and black cohosh) and gabapentin. The latter is an anticonvulsant used for the relief of night sweats and sleep disorders.

And you may have heard of bioidentical hormones (17β-estradiol, estrone, estriol, micronized progesterone, testosterone, and DHEA). This topic generates a wide debate that we will discuss in another post.

But regarding them, it must be mentioned that there are bioidentical hormones approved by the FDA and the AEMPS, such as 17β-estradiol or micronized progesterone, and customized bioidentical hormones formulated by a pharmacist in response to a prescription from an authorized doctor.

As for hormone pellets, these are microcapsules with fat-compressed hormones that are implanted subcutaneously under local anesthesia in the upper part of the buttock, and their use is common in anti-aging medicine.

Beyond Hormone Replacement Therapy, and no less important, there are many solutions and habits in our lifestyle and diet that we can adopt to make our experience with menopause much better. Among others, physical exercise, yoga, and meditation.

The key to menopause lies in education and in having the knowledge and tools necessary at our disposal to make the best decisions at this natural stage of life.

Every woman is unique, hence the importance of putting yourself in the hands of an expert who evaluates your case individually and, considering the woman as a whole, designs a treatment tailored to you that minimizes possible adverse effects.