Hormone therapy during peri- and menopause is recommended based on a balance of benefits and risks, following several general steps.
-First, there is the diagnosis and indication of a treatment:
Depending on the stage of life, the most common symptoms are associated with irregular menstrual cycles, skin changes, hair loss, increased desire to conceive, hot flashes, increased menstrual bleeding, insomnia, a tendency towards weight gain, increased cholesterol and blood pressure, a tendency towards depression, joint pain, etc.
Above all, after menopause, it is necessary to increase and improve the pillars of health, which are basically exercise and diet, also to prevent the increased risk of cardiovascular diseases such as thrombosis, myocardial infarction, ischemia, etc., and bone loss, i.e., osteoporosis.
The decision to start hormone therapy during menopause is highly individual.
It depends primarily on several factors, such as the patient’s age, the intensity of the symptoms, and the time since the onset of menopause. The first 10 years after menopause, or before age 60, are considered the best time to begin treatment.
Possible contraindications or factors to consider are especially relevant for women with a history of breast cancer, endometrial cancer, thrombosis, heart attack, obesity, sedentary lifestyle, etc.
Treatment Procedure
At the beginning of the consultation, a hormonal study is performed (FSH, estradiol, progesterone, free testosterone, DHEAS, etc.). Based on the results, a treatment plan will be prescribed with the primary goal of improving symptoms and maintaining blood levels within the established range.
Therefore, the dosage may vary from patient to patient.
– Monitoring:
Monitoring is performed at the start of treatment to assess its effect, any potential side effects, and, above all, to adjust the dosage until an improvement in symptoms and a better quality of life for the woman is achieved.
– Method of administration:
The most commonly used methods are transdermal, meaning they are applied to the skin in the form of creams, sprays, gels, patches, etc., to avoid first-pass metabolism in the liver. Pellets are subcutaneous devices that release hormones slowly and over a prolonged period, but they are not currently available in Spain due to existing legislation.
The use of capsules is more practical and convenient, and therefore has very good acceptance.
- Hormone therapy. Estrogen therapy works best for easing menopausal hot flashes.
- Vaginal estrogen. To relieve vaginal dryness, you can apply estrogen to the vagina using a vaginal Cream or tablet
- Prasterone (Intrarosa). You put this human-made hormone dehydroepiandrosterone (DHEA) into the vagina. It helps ease vaginal dryness and pain with intercourse.
- Gabapentin (Gralise, Neurontin). Gabapentin is approved to treat seizures, but it also has been shown to help reduce hot flashes. This medicine is useful for people who can’t use estrogen therapy and for those who also have nighttime hot flashes.
- Fezolinetant (Veozah). This medicine is free of hormones. It treats menopause hot flashes by blocking a pathway in the brain that helps manage body temperature. It’s FDA approved for managing menopause symptoms. It can cause abdominal pain, liver problems and make sleep problems worse.
- Ospemifene (Osphena). Taken by mouth, this selective estrogen receptor modulator (SERM) medicine treats painful intercourse linked to the thinning of vaginal tissue. T
Before deciding on any form of treatment, talk with your healthcare professional
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