Menopause occurs when ovarian function declines, leading to a drop in oestrogen and progesterone levels. This typically happens between the ages of 45 and 55 but can occur earlier due to:

Natural Aging

Surgical Removal of Ovaries (oophorectomy)

Premature Ovarian Insufficiency (POI)

Medical Treatments (e.g., chemotherapy, radiation)

Common Symptoms of Menopause

Vasomotor Symptoms: Hot flashes, night sweats

Psychological Symptoms: Mood swings, anxiety, depression, memory issues

Urogenital Symptoms: Vaginal dryness, urinary frequency, dyspareunia

Sleep Disturbances: Insomnia, disrupted sleep

Musculoskeletal Issues: Joint pain, muscle stiffness

Sexual Dysfunction: Reduced libido, vaginal discomfort

Newer Types of HRT: Pros, Cons, and Contraindications

1. Body-Identical HRT

Description: Uses hormones chemically identical to those produced naturally (e.g., micronized progesterone, oestradiol).

Pros:

Lower risk of breast cancer compared to synthetic progesterone.

Fewer side effects like bloating and mood changes.

Safer for long-term use.

Cons:

May require individual dose adjustments.

Contraindications:

History of hormone-sensitive cancers (breast, endometrial).

Active liver disease or thrombosis.

2. Tibolone

Description: Synthetic steroid with estrogenic, progestogenic, and androgenic properties.

Pros:

May improve libido and reduce hot flashes.

Beneficial for bone health.

Cons:

Increased risk of stroke in older women.

Contraindications:

History of breast cancer or thromboembolic disorders.

3. Low-Dose Vaginal Oestrogen (Topical)

Description: Creams, pessaries, or rings delivering oestrogen locally.

Pros:

Effective for urogenital symptoms like dryness and painful intercourse.

Minimal systemic absorption, safe for many women.

Cons:

Does not relieve systemic symptoms like hot flashes.

Contraindications:

Rare, but caution in hormone-sensitive cancers.

4. Combined HRT (Oestrogen + Progestogen)

Description: Used in women with an intact uterus to prevent endometrial hyperplasia.

Pros:

Effective for hot flashes, mood changes, and bone health.

Protects the endometrium.

Cons:

Slightly increased risk of breast cancer with long-term use.

Increased risk of venous thromboembolism (VTE).

Contraindications:

History of thromboembolism, stroke, or hormone-sensitive cancers.

5. Oestrogen-Only HRT

Description: Suitable for women who have had a hysterectomy.

Pros:

Lower risk of breast cancer compared to combined HRT.

Excellent for symptom relief and bone health.

Cons:

Increased risk of endometrial cancer if the uterus is intact.

Contraindications:

Similar to combined HRT.

General Contraindications for HRT

History of breast or endometrial cancer.

Undiagnosed vaginal bleeding.

Active or recent thromboembolic events.

Liver disease.

Known or suspected pregnancy.

Conclusion

Choosing the right HRT depends on the individual's symptoms, medical history, and preferences. A thorough risk-benefit discussion is essential, and regular monitoring is required to ensure safety and efficacy.

 

Dr Geranmayeh