What is menopausal hormone therapy?

Article by Doctor, Doctor Le Thi Huong - Department of Examination - Vinmec Times City International Hospital

Menopausal hormone therapy (MHT), also known as postmenopausal hormone therapy or hormone replacement therapy, is a treatment your doctor may recommend to relieve common symptoms of menopause. menopause and address long-term physiological changes in women.

Menopausal hormone therapy usually includes treatment with estrogen alone or estrogen plus progestin (a synthetic hormone that works like progesterone). Women who have a uterus - that is, have not had a hysterectomy - are often prescribed estrogen plus progestin for hormone replacement therapy.
In fact, estrogen alone may increase the risk of endometrial cancer. However, it is safe to combine estrogen plus progestin in hormone replacement therapy. Estrogen is used alone in women who have had a hysterectomy.

The hormones used in MHT come from many different plants and animals or are made in a lab. The chemical structures of these hormones are similar, but often not the same, as the hormones produced by the female body.

The WHI Estrogen and Progestin study was conducted, in which women with a uterus were randomly assigned to receive either 1 hormonal pill containing both estrogen and progestin (Prempro TM) or a placebo. The mean duration of treatment was 5.6 years.
The WHI Estrogen-Alone study was conducted, in which women without a uterus were randomly assigned to receive either 1 estrogen-only hormone pill (Premarin TM) or a placebo. The mean duration of treatment was 7.2 years.
More than 27,000 healthy women aged 50 to 79 years at the time of enrollment participated in the WHI hormone therapy trial. The goal of these trials was to see if MHT prevents heart disease and fractures in postmenopausal women. Also determine if MHT affects breast cancer and endometrial cancer risk for women with uterus? However, both trials were stopped early (2002 and 2004 respectively), when it was determined that both therapies were associated with specific health risks.

Research has shown that hormone replacement therapy is associated with the following health effects:
Hip and vertebral fractures: Women who take estrogen alone or estrogen plus a progestin have an increased risk of hip fracture and lower vertebrae than women taking placebo. In both cases, the benefits disappeared after the women stopped taking hormone therapy. Vaginal bleeding: Women taking estrogen plus progestin who experience heavy vaginal bleeding should be evaluated with endometrial biopsy than women taking placebo.

Urinary incontinence: Women taking estrogen alone or estrogen plus a progestin have a higher risk of urinary incontinence. Dementia: Among women 65 and older, those taking estrogen alone or estrogen in combination with a progestin have a higher risk of dementia. Stroke, blood clots, and heart attacks: Women using combined hormone therapy or estrogen alone have an increased risk of stroke, blood clots, and heart attack. However, for women in both groups, the risk returned to normal after they stopped taking the drug. Breast cancer: Women taking only estrogen had a lower risk of breast cancer than women taking a placebo. After nearly 11 years of follow-up, the risk of breast cancer among women taking only estrogen was still lower than in women taking a placebo. Women who took estrogen plus a progestin were more likely to be diagnosed with breast cancer than women who took a placebo. The breast cancer in these women is larger and more likely to have spread to the lymph nodes by the time they are diagnosed. The risk of breast cancer was higher the longer a woman took combination hormone therapy, but it decreased markedly when the use was stopped. Lung cancer: Women taking combination hormone therapy had a similar risk of lung cancer as women taking a placebo. However, among those diagnosed with lung cancer, women who took estrogen plus a progestin had a higher risk of dying from the disease than those taking a placebo. Colorectal cancer: In the original study report, women taking combined hormone therapy had a lower risk of colorectal cancer than women taking a placebo. However, colorectal tumors arising in the combined hormone treatment group were more detectable than those in the placebo group. Additionally, a follow-up study found that the reduction in colorectal cancer risk disappeared after study participants stopped taking the combination hormone therapy drug. Mortality: During 18 years of follow-up, women who took estrogen plus progestin for a mean of 5.6 years or estrogen alone for a median of 7.2 years had a similar risk of death. free from any cause, from cardiovascular causes and from any cancer (including breast cancer) as the women taking the placebo.

Indications for systemic and local treatment for menopausal hormone therapy depend on the menopausal symptoms the treatment will address. Systemic MHT is commonly prescribed to treat hot flashes and prevent osteoporosis. Systemic MHT with estrogen plus a progestin or with estrogen alone can be used as an oral pill, patch, gel, or spray that penetrates the skin and is implanted.
Local menopausal hormone therapy is prescribed to treat urogenital symptoms such as vaginal dryness. Local MHT contains only low-dose estrogen and is prescribed to women regardless of their hysterectomy status. Local (intravaginal) MHT with low doses of estrogen only includes creams, tablets (pessaries) and rings. Results from the study showed that, among women with an intact uterus, vaginal estrogen use was associated with no increased risk of stroke, invasive breast cancer, colorectal cancer, and endometrial cancer. and pulmonary embolism/deep vein thrombosis.

One of the roles of natural estrogen is to promote the normal growth of cells in the breast and uterus. Some cancers also use estrogen to promote their growth. Therefore, it is generally believed that menopausal hormone therapy may promote further tumor growth in women who have been diagnosed with breast cancer.
However, studies of the use of menopausal hormone therapy in breast cancer survivors have produced conflicting results. Some studies show an increased risk of breast cancer recurrence and others show no increased risk of recurrence.

Should women looking to reduce hot flashes and vaginal dryness talk to their doctor about hormone replacement therapy? What are the possible risks of using MHT and what alternatives might be right for them? The FDA currently advises women to use hormone replacement therapy for the shortest time and at the lowest possible dose to manage menopausal symptoms.

Women who are concerned about the naturally occurring change along with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of these effects. certain health. For example, eating foods rich in calcium and vitamin D or taking supplements containing these nutrients can help prevent osteoporosis. FDA-approved drugs such as alendronate (Fosamax®), raloxifene (Evista®), and risedronate (Actonel®) have been shown in randomized trials to prevent bone loss.
FDA-approved drugs to treat depression and seizures can help relieve menopausal symptoms such as hot flashes. Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine (Effexor®), desvenlafaxine (Pristiq®), paroxetine (Paxil®), fluoxetine (Prozac®). , citalopram (Celexa®), gabapentin (Neurontin ®), and pregabalin (Lyrica®).
Some women seek to relieve menopausal symptoms with complementary and alternative therapies. Some of these remedies contain phytoestrogens, which are estrogen-like compounds derived from plants such as soy products, whole grains, oilseeds (mainly flaxseeds), legumes or black seeds. A systematic review and meta-analysis of randomized clinical trials found that some phytoestrogen-containing therapies were associated with a modest reduction in the frequency of hot flashes and vaginal dryness but not in the number of primary sweating. night, compared with placebo or no treatment.

In summary, the WHI trials are landmark studies that have changed our understanding of the health effects of hormone replacement therapy. It is important to note that the women who participated in the WHI trial were on average 63 years old, although about 5,000 of them were under 60, so the results of the study may also apply to younger women. than. In addition, the WHI trials examined single dose intensity of an estrogen-only drug (Premarin) and an estrogen plus progestin drug (Prempro). Subsequent studies have extended and refined the initial findings of these two trials.
Currently, Vinmec International General Hospital has a package of pre-menopausal health examination and counseling. When registering for an examination package, customers will be examined and consulted with a specialist in Gynecology; Perform tests to assess hormonal status such as:
Gynecological examination Gynecological examination, breast examination Transabdominal ultrasound of uterus and ovaries Taking samples for cervical-vaginal cytology Mammogram (2 sides) Measuring osteoporosis Perform tests such as: quantitative FSH (Follicular Stimulating Hormone), quantitative FSH (Follicular Stimulating Hormone), quantitative LH (Luteinizing Hormone), quantitative AMH (Anti-AMH) - Mullerian Hormone), Estradiol quantification, Testosteroned determination, Cholesterol determination, LDL-C (Low density lipoprotein Cholesterol) quantification, HDL-C (High density lipoprotein Cholesterol) quantification, Glucose determination AST (GOT) determination. measure ALT activity (GPT), total urinalysis (By automatic machine),... Customers can check at any time, however, it is best to come to the clinic when there is no vaginal bleeding. The package of pre-menopause health care examination and consultation is not available for customers with estrogen-dependent genital cancer, embolism, hepatobiliary disease.

References: PubMed Abstract