Developments in medical science have revealed that most of the problems faced by menopausal patients are due to estrogen deficiency. The basic principle in hormone treatment during menopause is to replace the hormones that are missing in women from outside.
Hormone therapy in menopause has been used since the 1960s. At first, the missing estrogen hormone was given alone. However, later on, the benefits of giving estrogen together with progesterone, another female hormone, in order to be compatible with physiology, emerged.
Benefits of hormone replacement therapy:
Relieving complaints such as hot flashes, insomnia, irritability
Estrogen treatment shows its effect most quickly in hot flashes. It provides relief in 75% of patients suffering from menopausal hot flashes. It also corrects sleep disorders.
It is also effective in problems such as anxiety and depression that occur during menopause.
Preventing negative changes in the lower urogenital system
Local or systemic estrogen used during this period; It eliminates problems arising from the vagina such as vaginal dryness and pain during intercourse. Likewise, it also provides improvement in complaints such as frequent urination, difficult urination, and urinary incontinence in the lower urinary tract that develop as a result of menopause.
Reducing adverse skin changes
As a result of estrogen deficiency, skin thinning and wrinkles increase. Complaints such as dry skin, thinning, dry hair and nail breakage occur with menopause. These complaints regress with estrogen treatment.
Improving osteoporosis
It is well known that osteoporosis is stopped and in some cases treated with HRT. While we lose approximately 0.5% of bone mass per year at the age of 40, this loss increases to 3-4% with menopause. Without treatment, a woman will lose 50% of her bone mass by the age of 70. This loss is due to the deficiency of estrogen, which plays a role in bone metabolism. Bone loss is reduced by HRT, which begins with menopause. Hip fractures due to bone loss are 50% less common in women taking HRT.
Regarding hormone therapy in menopause, in previous years, it was thought that giving hormones to almost every woman, even if she had no complaints, had many unnoticed benefits and extended the quality of life and lifespan.
However, when the data obtained from studies on cardiovascular diseases are evaluated collectively; It has been concluded that "in women who do not have any complaints and have not undergone hysterectomy, the health risks of giving hormone replacement therapy only to protect against heart diseases are greater than the benefits it provides" and that hormone replacement therapy should not be given only for this purpose.
On the other hand, the short-term beneficial effects of hormone replacement therapy cannot be ignored in symptomatic patients with complaints such as hot flushes, sweating, and mood changes.
Not every woman is the same, and their needs are also different. The situation is no different in terms of hormone replacement therapy. As a result, as long as hormone replacement treatments are personalized for the patient and followed closely, there is no need for patients to be uneasy due to the news reflected in the media.
What are the ways to use hormone therapy?
Hormone replacement therapy (HRT) It can be applied in different ways. First, some questions need to be answered.
Is there a special situation that would prevent the use of hormones?
Has the person's uterus been removed by surgery?
Can the hormones contained in the drug to be chosen cause side effects on the person?
Does the patient want to menstruate during treatment?
After these questions are answered, the physician chooses the most appropriate treatment method and medication for the person and begins to apply it. Hormone replacement therapy; It can be applied orally or on the skin.
In oral medications, hormones are packaged in tablets and arranged to be absorbed from the intestines.
Medicines used estrogen (E) and progesterone (P) They contain the hormone.
These hormones can be used alone or in combination with each other in treatment.
The main hormone used to prevent the undesirable effects of menopause It is estrogen. However progesterone Estrogen used without addition may have a stimulating and even carcinogenic effect on the uterus. For this reason, progesterone hormone is definitely added to the treatment to prevent this effect of estrogen in menopausal patients whose uterus has not been removed.
The addition of progesterone to estrogen can occur in two ways.
1) Intermittent therapy
2) Continuous combined treatment
Hormones can be given continuously or intermittently throughout treatment.
yet not fully menopausal Since some more estrogen is secreted in the body of women, 21-day medications can also be used. At the end of 21 days, these drugs are taken for 7 days, just like birth control pills, and menstrual bleeding occurs in the meantime.
In this treatment method, patients experience regular menstrual bleeding. In general, this form of treatment in the first years of menopause It is suitable for women with Because during this period, women generally want to see menstrual bleeding.
In the continuous treatment protocol estrogen and progesterone It is taken in the same and low doses every day. In this method, the woman does not experience menstrual bleeding while receiving the hormone she needs. Because the progesterone hormone taken every day prevents the inner layer of the uterus from thickening and bleeding.
It is the treatment applied to women who have passed menopause. During this period, the woman no longer wants to menstruate. However, usually at the beginning of this treatment (especially in the first months) spotting There may be menstrual bleeding. The person must be informed about this.