Estrogens [estrone (E1), estradiol (E2), estriol (E3)], progesterone, testosterone, and dehydroepiandrosterone (DHEA) are hormones produced by the ovaries. Each of them stimulates receptors in our body and thus affects us in various ways, both physically and psychologically. The levels of these hormones gradually decrease over time, resulting in a series of symptoms such as hot flashes (which are the most common symptom of menopause), weight gain, changes in mood, and reduction or loss of sexual desire. Women often feel that “they are no longer themselves/as they used to be.” These symptoms are more likely to occur before your period stops or one year after the menstrual cycle stops (menopause). Many women are interested in learning how to manage these symptoms, as they often disrupt their quality of life. Replacing the missing hormones in the form of medication is effective in reducing the symptoms; however, some women choose to try herbal products or other alternative methods.

The Hormone Replacement Method has been the subject of controversy for several years regarding the benefits and risks of its use. Perimenopause and menopause can be a very stressful time in a woman’s life with all the physical and emotional changes that come with it. These changes can not only vary from month to month but can last for several years. HRM has been shown to be effective in relieving many of these symptoms, but it also has some risks. According to the Women’s Health Initiative (WHI) survey conducted in 2002, HRM was recommended to be administered with the onset of perimenopausal symptoms and up to menopause. Initially, HRM options were limited to a small number of prescription drugs; however, today, there are many prescription and over-the-counter medications, and therefore various HRM methods are available.

In recent years, there has been particular interest in ‘bio-identical’ hormone replacement (bio-identical hormones are compounds chemically similar to the natural hormones produced by the body). Bio-identical hormones have not been shown to be safer than traditional options, but they are certainly effective in addressing hormonal imbalances. An advantage of bio-identical hormones is that they can be prescribed, and the recommended dosage is determined each time based on test results (i.e., depending on the levels of hormones found in the blood or saliva sample) and symptoms. The dosage can be adjusted each time according to the changes observed in your symptoms and needs. For every woman who experiences hormonal transitions, the symptoms show gradual changes.

HRM should be individualized and used in most women to address perimenopausal symptoms in the lowest possible dosage and for as short a time as possible. This standard of care is defined because of possible dangers that may arise from the use of HRM, such as cerebral stroke, heart attack, blood clots (deep vein thrombosis), and increased risk for breast cancer. Women receiving HRM should understand that with HRM, the intensity of symptoms will be significantly reduced, and they will notice physical and psychological improvement, benefits very important for a better life, but at the same time, they should be informed and understand all the possible risks.

Is HRM Safe?

In the 1960s, HRM was widespread, revolutionizing the management of menopause and was prescribed to women to relieve symptoms such as hot flashes, night sweats, sleep disturbances, psychological problems, vaginal problems (frequent urination and vaginal dryness), as well as for the prevention of osteoporosis. In the 1990s, two of the larger studies were conducted on HRM – the Women’s Health Initiative (WHI) in the US and the Million Women Study (MWS) in the UK. Their published results, in 2002 and 2003, raised questions about the safety of two main issues: the increased risk of breast cancer and heart disease. The studies were widely publicized, and UK regulators issued an urgent safety restriction. Many Health Care Providers stopped prescribing HRM, and the number of women taking it dropped by 66%, resulting in the return of menopausal symptoms. Subsequent publication of all WHI results has led to the withdrawal of some of the previous findings on breast cancer and cardiovascular disease but without changing the regulatory directive or covering the issue by the media. A large-scale controlled study conducted in Denmark states that, in 2012, healthy women who received combination HRM for 10 years immediately after menopause had a reduced risk of heart disease, highlighting the benefits women have when taking HRM immediately after menopause.

HRM Today

The majority of women who use HRM for the short-term management of menopausal symptoms believe that its benefits outweigh its risks. Women who want to start HRM should carefully discuss the benefits and risks of treatment with their Health Care Provider in order to decide what is right for them, taking into account their age, medical history, risk factors, and personal preferences. The least effective dose of HRM should be administered with a duration of use that depends on its intended purposes. HRM remains suitable for addressing osteoporosis and may be considered the appropriate choice for women starting treatment under the age of 60, and especially for those who experience premature menopause. Women receiving HRM should be re-evaluated by their Health Care Provider at least once a year. For some, long-term HRM use may be necessary to relieve ongoing symptoms and improve their quality of life. HRM is generally not recommended for women with a history of stroke or deep venous thrombosis, severe liver disease, breast cancer, and endometrial cancer. It is not usually advisable for women over 60 to start HRM, as a WHI study has shown that the risks increase, but this does not mean that women who started it earlier should not continue it after 60. There is no clear answer to the effects of HRM on sexual desire, but some studies show that estrogen in HRM can help maintain or restore sexual drive. HRM will help with the symptoms of menopause such as vaginal dryness and painful sexual intercourse. If vaginal symptoms are the only problem, then the use of topical vaginal estrogen should be preferred.

Duration of Treatment

There are no reasons for mandatory limitation of the duration of HRM. A woman should decide on the continuation or discontinuation of HRM if she is properly informed by her treating physician, and on the one hand, the achievement of the specific objectives and, on the other hand, the assessment of the potential benefits and risks are examined. Women can choose to use HRM for as long as the symptoms of menopause are reduced through treatment. They can stop HRM every few years, but the symptoms of menopause in some women can last for many years and so should be managed with the lowest effective dose.

Dosage

Small doses of HRM can reduce symptoms effectively and maintain a woman’s quality of life.

The Benefits of HRM

• It is an effective option for sweating and atrophy of the urogenital system.

• Muscle aches, mood swings, sleep disorders, and sexual dysfunction (including decreased libido) improve during HRM.

• Corrects the changes due to the lack of estrogen in the urogenital system and maintains the health of the genitals.

• Reduces menopausal bone loss and the incidence of all osteoporotic fractures (including vertebral and hip fractures).

• Effectively limits the loss of cartilage that accompanies menopause.