What should we know about hormone therapy?

We cannot stop time, nor do we want to, but we can do a lot to reach menopause in the best way possible.

As we approach menopause, our hormones fluctuate and decrease.

We've all heard of estrogen. Estrogen, a crucial hormone during a woman's reproductive cycle, has many functions, from regulating menstrual cycles and contributing to bone strength to even influencing the regulation of our skin temperature.

As estrogen levels become unstable, a number of symptoms may appear, including hot flashes, night sweats, anxiety, and joint pain, among others.

Up to 90% of women will experience some of these symptoms. The most common are vaginal dryness, insomnia, and hot flashes.

It is well known that many women suffer more during the transition stage than in postmenopause, since from this point onwards hormone levels tend to stabilize and with that hormonal stability the symptoms tend to improve, but not always and not in all cases.

It's time to understand what's happening with our bodies, to talk about it, break down myths, and find solutions. This stage isn't the end, but a new beginning, and we're here to help. There are many solutions to make your menopause experience much better.

All experts agree that Hormone Replacement Therapy (HRT) is, in the vast majority of cases and under medical supervision, the best treatment option. The sooner it is started, the greater the benefits.

Until a few years ago, this type of therapy had a bad reputation due to a published study that had to be halted in 2002 because it suggested that hormone replacement therapies had more harmful than beneficial effects. This was the WHI (Women's Health Initiative randomized controlled trial) study, which marked a paradigm shift in hormone replacement therapy.

But you should know that ALL national and international guidelines published after the WHI study indicate that the benefits of using hormone replacement therapy clearly outweigh the risks in the case of symptomatic women without additional risk factors.

The main ingredient in hormone replacement therapy (HRT) is estrogen, but one of the most common forms is combination therapy, in which estrogen is administered along with progesterone. There are many forms and routes of administration, from oral pills, patches, and transdermal gels to vaginal rings. HRT is indicated for the treatment of vasomotor symptoms and genitourinary syndrome of menopause. The optimal HRT regimen consists of transdermal estrogen and micronized progesterone.

However, the choice of therapy will vary from person to person and will depend on the patient's symptoms and lifestyle. Treatment typically begins with the lowest effective dose, and it may take three to six months for effects to become noticeable. The dose and type of hormone therapy may need to be adjusted or changed. Most experts recommend starting hormone replacement therapy at the first sign of symptoms.

There are some special compounds, including medications such as: TIBOLONE (Boltin® 2.5 mg) A synthetic steroid that improves vaginal atrophy, vasomotor symptoms, increases bone mass, and does not alter the lipid profile. OSPEMIFENE (Senshio® 60 mg) Selective estrogen receptor modulator used to treat vulvovaginal atrophy in women who are not candidates for local estrogen therapy. Dehydroepiandrosterone (DHEA) is a precursor to estrogen and testosterone. In Spain, it is marketed as prasterone (Intrarosa® 6.5 mg vaginal suppositories). It is a chemical compound identical to endogenous DHEA and is authorized for the treatment of vaginal atrophy via vaginal administration. In the US, it is an over-the-counter dietary supplement administered orally.

Besides hormonal treatments, there are other non-hormonal treatments available as an alternative for patients with vasomotor symptoms who cannot or do not wish to undergo hormonal treatment. These include antidepressants (selective serotonin reuptake inhibitors: venlafaxine, paroxetine, fluoxetine) that will control vasomotor and depressive symptoms; phytoestrogens (soy isoflavones: genistein, daidzein, and black cohosh); and gabapentin. Gabapentin is an anticonvulsant used to relieve night sweats and sleep disorders.

And you may have heard of bioidentical hormones (17β-estradiol, estrone, estriol, micronized progesterone, testosterone, and DHEA). This topic generates a wide debate, which we will discuss in another post.

But in relation to them, it should be mentioned that there are bioidentical hormones approved by the FDA and the AEMPS such as 17β-estradiol or micronized progesterone and personalized bioidentical hormones formulated by a pharmacist in response to a prescription from an authorized physician.

As for hormonal pellets, these are microcapsules containing hormones compacted with fat that are implanted subcutaneously under local anesthesia in the upper part of the buttocks and are commonly used in anti-aging medicine.

Beyond Hormone Replacement Therapy, and equally important, there are many lifestyle and dietary solutions and habits we can adopt to make our menopause experience much better. These include physical exercise, yoga, and meditation.

The key to menopause lies in education and having the necessary knowledge and tools at our disposal to make the best decisions during this natural stage of life.

Every woman is unique, hence the importance of putting yourself in the hands of an expert who evaluates your case individually and, considering the woman as a whole, designs a treatment tailored to you, minimizing possible adverse effects.