Many women, although not all, experience uncomfortable symptoms before and after menopause, including hot flushes, night sweats, sleep disturbance and vaginal dryness. These symptoms and physical changes can be managed in various ways, including lifestyle changes such as healthier eating and increased exercise, and by hormone replacement therapy HRT.
HRT is used to treat menopausal symptoms. While HRT reduces the likelihood of some debilitating diseases such as osteoporosis, colorectal bowel cancer and heart disease, it may increase the chances of developing a blood clot when given in tablet form or breast cancer when some types are used long-term. For women who experience premature or early menopause, HRT is strongly recommended until the average age of menopause around 51 years , unless there is a particular reason for a woman not to take it.
Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor. HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:. HRT needs to be prescribed for each woman individually.
Some women experience side effects during the early stages of treatment, depending on the type and dose of HRT. These side effects will usually settle within the first few months of treatment and may include:.
These small risks must be balanced against the benefits of HRT for the individual woman. Talk to your doctor about any concerns you may have. Women over 50 years of age who use combined oestrogen and progestogen progesterone replacement for less than five years have little or no increased risk of breast cancer. Women who use combined HRT for more than five years have a slightly increased risk. Women on oestrogen alone have no increased risk up to 15 years of usage.
There is no evidence to suggest that a woman with a family history of breast cancer will have an added increased risk of developing breast cancer if she uses HRT. The risk with combined oestrogen and progestogen is greater than with oestrogen alone, or with newer HRT agents such as tibolone sold as Livial or Xyvion , and may also depend on the type of progestogen used. Studies suggest that medroxyprogesterone acetate and norethisterone have higher risks than dydrogesterone and progesterone.
Women over 60 have a small increased risk of developing heart disease or stroke on combined oral tablet HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.
Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch.
Similarly, tibolone increases the risk of stroke in women from their mids. Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more. Venous thromboses are blood clots that form inside veins. Tibolone relieves menopausal symptoms, prevents bone loss, and may improve interest in sex. Tibolone, like other continuous therapies, is normally prescribed at least 12 months after the last menstrual period, so many women switch to these continuous types after taking a sequential HRT.
Tibolone has also been shown to be particularly useful in women who are known to have endometriosis and fibroids as it does not appear to stimulate these conditions. As with any drug, there are known short-term and usually mild side effects from HRT which may trouble some women, especially in the first few months of use.
These may include breast tenderness, leg cramps, nausea, bloatedness, irritability and depression. These side effects are related to oestrogen or progestogen, and may be overcome by a change of dosage, ingredients or route in the HRT prescribed. Irregular bleeding or spotting can occur during the first months of taking continuous combined HRT or Tibolone, and is not a cause for alarm. However, you should consult your doctor if you get heavy rather than light bleeding, if it lasts for more than six months, or if bleeding starts suddenly after some time without bleeding.
Irregular bleeding may sometimes be improved by changing the type or route of HRT. Some women do not wish to use, or cannot take, systemic HRT in any form which raises hormone levels throughout the body, but they still appreciate the relief of symptoms such as dry vagina and urinary problems.
In this case, oestrogens can be given locally to the vagina in the form of a low dose cream, tablet or ring. These preparations raise local hormone levels but do not affect the whole body. The types of HRT available are listed below. HRT was first available in the s but became more widely used in the s, creating a revolution in the management of the menopause.
HRT was prescribed commonly to menopausal women for the relief of their symptoms such as hot flushes, night sweats, sleep disturbances, psychological and genito-urinary problems — urinary frequency and vaginal dryness — and for the prevention of osteoporosis.
The published results of these two studies during and raised concerns regarding the safety of HRT. These safety concerns revolved around two main issues: 1 that the extended use of HRT may increase the risk of breast cancer and 2 that the use of HRT may increase the risk of heart disease. The results of the studies received wide publicity, creating panic amongst some users and new guidance for doctors on prescribing. After the results were published, the UK regulatory authorities issued an urgent safety restriction about HRT, recommending that doctors should prescribe the lowest effective dose for symptom relief, should use it only as a second line treatment for the prevention of osteoporosis, and advised against its use in asymptomatic postmenopausal women.
There remains widespread confusion and uncertainty amongst both doctors and HRT users. Many doctors stopped prescribing HRT and many women abandoned HRT immediately, with a return of their menopausal symptoms. The women studied in the WHI were North American women in their mid-sixties, often overweight and thus totally unrepresentative of women in the UK for whom HRT might be considered suitable.
These would usually be around the age of the menopause, namely years. It should also be appreciated that, in a surprising turnabout, subsequent publication of the full WHI results showed the apparent increased risk for breast cancer was only found in those who had taken HRT before entering the study.
The WHI long-term randomised clinical trials published in showed a significant reduction in breast cancer diagnosis and mortality in women using estrogen only HRT.
There is a problem with information submitted for this request. Sign up for free, and stay up-to-date on research advancements, health tips and current health topics, like COVID, plus expert advice on managing your health. Error Email field is required. Error Include a valid email address. To provide you with the most relevant and helpful information and to understand which information is beneficial, we may combine your e-mail and website usage information with other information we have about you.
If we combine this information with your PHI, we will treat all of that information as PHI, and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of e-mail communications at any time by clicking on the Unsubscribe link in the e-mail. Our Housecall e-newsletter will keep you up-to-date on the latest health information. Mayo Clinic does not endorse companies or products.
Advertising revenue supports our not-for-profit mission. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not endorse any of the third party products and services advertised. A single copy of these materials may be reprinted for noncommercial personal use only. This content does not have an English version.
This content does not have an Arabic version. See more conditions. Hormone therapy: Is it right for you?
0コメント