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Menopause: What are the treatment options?

One of the main reasons for menopause symptoms (such as night sweats, hot flashes, and aging skin)1 is the decline of estrogen levels in women’s bodies.

To address these symptoms, it is necessary to help the body function normally by using estrogen supplements. There are two ways to do this:

1. Natural methods such as special foods, a targeted diet, or changes in exercise habits
2. Medications such as menopausal hormone therapy (MHT)

What is MHT?

MHT is used to maintain the level of estrogen in the body during menopause and help manage symptoms.1 It is available in a range of options and doses.

Before starting MHT, it is crucial to consult your doctor.

There are various MHT options.1 Your treatment should be selected by your healthcare professional to meet your individual needs, profile, and benefits/risks ratio.

BENEFITS5

  • Reduce hot flashes
  • Lessen night sweats
  • Prevent osteoporosis
  • Manage mood swings
  • Help with vaginal dryness
  • Boost sex drive

What are the main types of MHT?

MHT3 involves replacing two female hormones that a woman’s body no longer produces due to menopause, namely, estrogen and progestogen.

There are three main types of MHT:3

1. Estrogen-only MHT is generally suggested for women who have had their womb and ovaries removed in a hysterectomy.
2. Continuous-combined MHT is suggested for women who have not bled for 12 consecutive months and who still have their wombs. It requires taking both female hormones, estrogen and progestogen, every day on an ongoing basis.
3. Cyclical MHT, also known as sequential MHT, is recommended for women who have menopausal symptoms but still have their periods. With cyclical MHT, women continue having monthly menstrual periods.

What if I cannot take MHT?

MHT may not be an option for women with the following:5

  • A history of breast, ovarian, or womb cancer
  • A history of blood clots
  • Untreated blood pressure (blood pressure must be under control before starting MHT)
  • Liver disease
  • Pregnancy*

In the following cases, women can treat the symptoms directly:

  • Hot flashes can be limited4 using health and lifestyle approaches.
  • Using a vaginal moisturizer or lubricant may provide relief for vaginal dryness or painful intercourse.

Do not hesitate to talk to your doctor about alternatives.

Does MHT cause cancer?

Scientific studies have associated MHT with an increased risk of breast cancer, but this risk depends on age, MHT duration, and the MHT regimen followed.2, 6 To mitigate the risk of breast or ovarian cancer, an individualized approach should be used when prescribing MHT.

Let’s have a closer look at the risks.

Breast cancer

For women in their 40s and 50s who have taken MHT for five years, the risk has been measured as follows:2

  • One extra case for every 200 women taking estrogen-only MHT
  • One extra case for every 70 women taking cyclical MHT
  • One extra case for every 50 women taking continuous MHT

As you can see, breast cancer is a risk, but it is relatively small. Furthermore, women who take MHT for less than one year reduce their risk of breast cancer to the same levels as women who have never been on MHT. Talk to your doctor to establish the right regimen for you.

Ovarian cancer

MHT is unlikely to increase your risk of ovarian cancer. Studies have found that for every 1,000 women taking MHT for five years, there will be only one case of ovarian cancer.2

Blood clots

The risk of menopausal women developing blood clots is usually low, and the overall risk incurred by taking MHT is small. It is estimated that for women taking MHT for 7.5 years, 99.9% will NOT develop a blood clot.2

*Pregnancy is possible while taking MHT, so you should use contraception until two years after your last period if you’re under 50 or for one year if you are over the age of 50.

Consult your doctor to learn more about the different treatment options and the challenges that you may face.

References

  1. NHS. Menopause – Treatment. https://www.nhs.uk/conditions/menopause/treatment/ Published 2020. Accessed October 23, 2020.
  2. NHS. Hormone replacement therapy (HRT) – Risks. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/ Published 2020. Accessed October 23, 2020.
  3. Twistwest. Types of HRT. https://twistwest.org/health-categories/types-hrt Published 2020. Accessed October 23, 2020.
  4. Mayo Clinic. Hormone therapy: Is it right for you? https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 Published 2020. Accessed October 23, 2020.
  5. NHS. Hormone replacement therapy (HRT) – Overview. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/#:~:text=The%20main%20benefit%20of%20HRT,mood%20swings Published 2020. Accessed October 23, 2020.
  6. Brusselaers N, Tamimi RM, Konings P, Rosner B, Adami HO, Lagergren J. Different menopausal hormone regimens and risk of breast cancer. Ann Oncol, 2018 Aug 1; 29(8):1771–1776.

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