TLDR: Menopausal hormone therapy (MHT) remains the most effective treatment for menopausal symptoms, particularly hot flashes and night sweats. These symptoms affect up to 80% of women, often lasting for years. Recent studies have shown that MHT can be both safe and beneficial when used appropriately. The key is knowing the details. Timing - starting MHT within 10 years of menopause or before age 60 generally offers more benefits than risks for healthy women. Dosing - instead of focusing on using the lowest dose for the shortest time, experts now recommend finding the right balance of dose, duration, hormone levels, and method of delivery for each woman. Method of delivery - using bioidentical hormones that are the same as those made by the endocrine glands, choosing transdermal and vaginal methods, can reduce risks of possible side effects.
Following this personalized approach aims to provide symptom relief while maximizing health benefits. With these advancements in hormone replacement therapy protocols, women can look forward to better management of menopausal symptoms and potentially improved long-term health. Always consult with a healthcare provider to determine the best MHT plan for individual needs.
Hormone Replacement Therapy And The Window Of Opportunity
Menopausal Hormone Therapy (MHT), also referred to as hormone replacement therapy, has undergone significant advancements in recent years, offering improved options for women experiencing menopausal symptoms. The concept of a “Window of Opportunity“ has emerged as a crucial factor in MHT's effectiveness and safety. This theory suggests that initiating MHT within 10 years of menopause onset or before age 60 can maximize benefits while minimizing risks. During this period, MHT has shown potential to alleviate vasomotor symptoms, protect cardiovascular health, and maintain bone density. However, starting MHT later may alter the risk-benefit balance. This insight has reshaped our understanding of MHT timing and its impact on women's health during the menopausal transition.
Reducing The Risk Of Therapy for Menopause Symptoms
Recent improvements in how menopausal hormone therapy (MHT) is given have potentially made it safer and more effective. One major change is using skin patches or gels to deliver estrogen instead of pills. This method, called transdermal application, reduces the risk of blood clots, a common concern with MHT. When estrogen is taken as a pill, it goes through the liver first, which can increase the chances of blood clots forming. However, when applied to the skin, estrogen bypasses the liver and enters the bloodstream directly. This approach lowers the risk of venous thromboembolism, a serious condition where blood clots form in veins and could cause a pulmonary embolism. Studies have shown that women using skin patches or gels have a much lower risk of blood clots compared to those taking estrogen pills. This advancement allows more women to benefit from MHT with fewer worries about potential complications.
Bioidentical Hormone Replacement Therapy Versus Traditional Hormone Therapy
When it comes to menopausal hormone therapy (MHT), the type of progesterone used matters. Researchers have been studying micronized progesterone, a form that closely resembles the body's natural progesterone. This can be taken orally or applied vaginally. Oral micronized bioidentical progesterone was once thought to be safer than synthetic progestins, especially regarding breast cancer risk. However, recent studies have shown mixed results. Some research suggests that oral micronized progesterone 100mg might not fully protect the uterus from cancer when used with estrogen therapy. Vaginal application of micronized progesterone seems promising, as it delivers the hormone directly to the uterus with less entering the bloodstream. This method may help prevent uterine problems without increasing risks elsewhere in the body.
However, "after reviewing 40 studies, an expert committee concluded that oral MP, if applied sequentially for 12–14 days/month at 200 mg/day, provides endometrial protection for up to 5 years." (Davey, 2018, p. 4)
Intrauterine Device (IUD) Treatment Option for Menopausal Hormone Therapy
Intrauterine devices (IUDs) that release levonorgestre, a synthetic progestogen, are becoming an interesting option for menopausal hormone therapy. These devices, such as Mirena and Skyla, were originally designed for contraception but have shown promise for perimenopausal women. They work by releasing small amounts of levonorgestrel directly into the uterus, which helps prevent endometrial problems in women taking estrogen. This targeted approach means less of the hormone enters the bloodstream, potentially reducing side effects. IUDs offer several benefits for perimenopausal women, including contraception and reduced menstrual bleeding, which is often heavy during this time. However, more research is needed to fully understand their long-term effects, especially regarding breast cancer risk. While these devices seem promising, it's important for women to discuss this option with their healthcare providers to determine if it's suitable for their individual needs and health situation.
Conclusion
When it comes to menopausal hormone therapy (MHT), a personalized approach is crucial. Every woman's experience with menopause is unique, so treatment plans should be tailored to individual needs. Doctors consider various factors when recommending MHT, including a woman's age, specific symptoms, overall health, and medical history. It's important to have open discussions with healthcare providers about the potential benefits and risks of MHT for each person. Regular check-ups and reassessments are essential, as the balance of benefits and risks can change over time.
Davey, D. A. (2018). Menopausal hormone therapy: a better and safer future. Climacteric, 21(5), 454-461. https://doi.org/10.1080/13697137.2018.1439915
Call 918-518-1636 For Your Appointment Today
We are conveniently located in Tulsa, Oklahoma. However, we also serve South Carolina, Texas, and Florida through telehalth. We take a holistic approach knowing that you are unique and the hormone treatment for you must be safe, effective, and affordable. Before starting bioidentical hormone therapy, we begin the process with a thorough detailed assessment that identifies your symptoms and the hormone deficiencies involved. Then, we order extensive laboratory testing and present you a specialized treatment plan.
Frequently Asked Questions - FAQ
What are the signs and symptoms of perimenopause or menopause?
Typical signs of perimenopause or menopause include the following:
Hot flashes and night sweats
Mood changes and irritability
Sleep disturbances
Vaginal dryness and discomfort
Decreased libido
Bone loss (increasing the risk of osteoporosis)
Wrinkled skin
Weight gain and slowed metabolism
Forgetfulness
All of these symptoms can be treated with bioidentical hormone replacement therapy.
What causes menopause?
Menopause, the cessation of periods for at least 12 months, is a normal part of aging. It occurs when the body produces insufficient amounts of estrogen, progesterone, and the periods stop. Perimenopause is a decrease in estrogen and progesterone, however menstrual periods continue off and on.
What are compounded bioidentical hormones?
These are hormones tablets, creams, gels, patches, troches, and injections that compounding pharmacies create by mixing raw ingredients, typically powders, into specialized doses. While the hormones are made from plants, they are chemically identical to the hormones produced by the human body. These differ from the synthetic hormones used in traditional hormone replacement therapy. Bioidentical hormone products are also found at non-compounding pharmacies. There are controversies with using compounded bioidentical hormones having to do with consistent doses, delivery methods, and stability of the medications. I will present another article discussing these concerns in more details.
When is it safe to start bioidentical menopause hormone replacement therapy?
Starting MHT within 10 years of menopause or before age 60 may offer more benefits with fewer risks. However, for women starting MHT later, the risk-benefit balance might be different. By working closely with their doctors, women can find the most appropriate MHT plan that addresses their symptoms and supports their overall health and well-being.
*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes.
Call 918-518-1636 For Your Appointment Today
We are conveniently located in Tulsa, Oklahoma. However, we also serve South Carolina, Texas, and Florida through telehalth. We take a holistic approach knowing that you are unique and the hormone treatment for you must be safe, effective, and affordable. Before starting bioidentical hormone therapy, we begin the process with a thorough detailed assessment that identifies your symptoms and the hormone deficiencies involved. Then, we order extensive laboratory testing and present you a specialized treatment plan.
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