Menopausal Hormone Therapy (MHT), previously known as Hormone Replacement Therapy (HRT), is experiencing a global resurgence as medical understanding evolves, prompting a renewed focus on its efficacy and safety for women navigating the natural biological transition of menopause. This shift involves a careful re-examination of the therapy’s potential to alleviate disruptive symptoms and improve the quality of life for millions.
Information was available with The Chenab Times detailing the evolving perspectives on MHT, highlighting that while menopause is a natural life stage and not a disease, its associated symptoms can significantly impact women’s daily lives, including sleep, relationships, and professional engagement. In India, menopause typically occurs in the late forties, with an average age of around 47, though individual experiences can vary widely. The preceding perimenopausal phase, characterized by irregular periods and fluctuating hormone levels, can extend over several years. The decline in ovarian function associated with menopause affects various bodily systems. Reduced estrogen levels can disrupt the brain’s thermoregulation, leading to hot flushes and night sweats. Additionally, vaginal and urinary tissues may lose elasticity, causing dryness, discomfort, and urinary issues. Bone loss accelerates during this period, increasing the risk of osteoporosis, while changes in body fat distribution, muscle mass, cholesterol levels, and insulin sensitivity can also occur. For many women in India, symptoms like fatigue and body aches might be dismissed as signs of aging or daily responsibilities, while vaginal and sexual concerns often remain unaddressed due to social taboos or embarrassment. It is crucial to determine the extent to which a woman’s suffering is impacting her daily life.
MHT is recognized as the most effective treatment for mitigating hot flushes and night sweats, thereby improving sleep and overall quality of life for menopausal women. It also plays a vital role in preventing bone loss and reducing the risk of fractures. For genitourinary symptoms such as vaginal dryness and discomfort during intercourse, low-dose vaginal estrogen therapy has demonstrated considerable effectiveness. Emerging research is exploring estrogen’s potential contribution to increased healthspan, the period of life lived in good health. However, definitive evidence supporting MHT’s role in extending overall longevity is still considered incomplete. It is important to note that MHT is not a universal anti-aging solution and should not be routinely prescribed for the prevention of heart attacks, dementia, cognitive decline, or for weight loss, as these benefits lack sufficient established evidence.
The suitability of MHT is generally considered most favourable for healthy women experiencing bothersome menopausal symptoms, particularly when initiated before the age of 60 or within ten years of menopause. While these serve as clinical guidelines, they are not absolute exclusions. Some experts in India suggest that treatment may be more appropriate for women under 55 and within five years of menopause. MHT can also be considered during perimenopause if symptoms are significantly disruptive. For managing hot flushes and night sweats, estradiol can be administered orally or via transdermal patches and gels. To minimize the risk of blood clots, transdermal estrogen is often preferred as it bypasses the liver’s first-pass metabolism of oral estrogen.
Women who have not undergone a hysterectomy require a progestogen alongside systemic estrogen to safeguard the uterine lining. Oral micronised progesterone is the preferred progestogen option. Sequential treatment, where progestogen is taken for a portion of each month, typically results in a withdrawal bleed. Continuous combined treatment, involving both estrogen and progesterone throughout the cycle, aims to eliminate scheduled bleeding and is generally prescribed later in menopause. Women who have had a hysterectomy can safely use estrogen-only therapy.
The risk profile associated with MHT is not uniform; it varies significantly based on factors such as age, the specific formulation used, the route of administration, the duration of treatment, and the individual’s medical history. In carefully selected cases, especially for younger women, MHT can offer substantial symptom relief with a demonstrably favourable benefit-risk balance, particularly when utilizing transdermal estrogen and micronised progesterone. The risk of breast cancer is influenced by age, the regimen, and the duration of use. Combined estrogen-progestogen therapy may increase breast cancer risk with prolonged use in older women (typically over 60), whereas estrogen-only therapy generally presents a more favourable risk profile in this regard.
Certain hormone-sensitive cancers, including breast, uterine, ovarian, and thyroid cancers, along with a history of unexplained vaginal bleeding, previous or active blood clots, stroke, or significant liver disease, may preclude the use of systemic MHT or necessitate specialist evaluation. Prior to prescribing MHT, clinicians are expected to conduct a thorough review of the patient’s symptoms, medical history, breast and gynaecological health, cardiovascular and clotting risks, blood pressure, and relevant screening results. Mammography is considered essential. The treatment should be reassessed after approximately three months and then periodically, often annually, once the patient is stable.
Effective menopause care requires moving beyond apprehension and exaggerated claims. MHT is a valuable treatment option for appropriately selected women, but its benefits and risks are dynamic and contingent upon age and individual circumstances. The objective is to provide MHT to women who stand to benefit while avoiding its unnecessary prescription for others, ultimately aiming to help women navigate these years with comfort, confidence, and good health.
The Chenab Times News Desk