Menopause causes a significant decrease in a woman's production of the hormones estrogen and progesterone, causing symptoms that impact her quality of life. These include hot flashes, psychological changes, sleep disturbances, and fatigue. Thankfully, hormone replacement therapy (HRT) can be used to reduce symptoms by rebalancing hormone levels in the body. Read on and learn all about hormone therapy: how it works, its benefits, and its side effects.

What is hormone replacement therapy?

Hormone replacement therapy is a medical treatment that rebalances the decline in a woman’s natural hormones, mainly estrogen, as she goes through menopause, helping to reduce symptoms like hot flashes, sleep disturbances or vaginal dryness.

Which hormone therapy is right for a menopausal woman?

Here are the main forms of hormones used in HRT for menopause. Note that each form has its own advantages and disadvantages. So, you should rely on your healthcare professional to find the best option to meet your needs and health status.

When to start hormone therapy for menopause?

Doctors generally recommend starting HRT for menopause at the first signs and symptoms of menopause: hot flashes, sleep disturbances or vaginal dryness. These generally start occurring when menopause starts, at around the age of fifty.

The ideal time to start HRT:

• From late perimenopause (the period just before menopause) or just after menopause, when symptoms become troublesome (hot flashes, sleep disturbances, vaginal dryness, etc.).
• Before 60 or within 10 years of the last menstrual period, when the benefits are greatest and the health risks are lowest.
• Early treatment increases effectiveness on symptoms and offers better protection of bone reserves.

To help decide which type of HRT is right for you, consult with a doctor, who’ll factor in your symptoms, general health, and personal risk factors.

How long does menopause last?

Menopause only occurs once, and it’s defined as the permanent cessation of menstruation for 12 consecutive months. However, the hormonal changes linked to menopause happen in three consecutive phases, and their duration varies for each woman:

Phase 1: Perimenopause (transition before menopause)

• Duration: 2 to 10 years, average 4 to 5 years.
• The ovaries decrease the production of estrogen and progesterone.
• Irregular symptoms: hot flashes, unstable periods, fatigue, etc.

Phase 2: Menopause (when periods stop)

• Menopause is defined as 12 consecutive months without menstruation.
• Average age: around 51 years old, but it varies from 45 to 55.

Phase 3: Post-menopause (after menopause)

• Duration: Life after menopause.
• Some women continue to experience symptoms of hormonal changes (hot flashes, decreased libido, and vaginal dryness) for 5 to 10 years or more.

Can all post-menopausal women use hormone therapy?

No, not all post-menopausal women can benefit from HRT. While this type of treatment is beneficial for many women, there are contraindications and precautions that must be respected.

Common contraindications:

• History of breast cancer or certain other hormone-dependent cancers.
• History of deep vein thrombosis or pulmonary embolism.
• Serious cardiovascular diseases (heart attack, recent stroke).
• Severe liver disease.
• Unexplained vaginal bleeding.

What’s more, HRT should always be customized according to age, symptoms, personal and family risk factors, and general health.

The decision to start HRT should always be made after a complete medical evaluation and consultation with your healthcare professional.

Is hormone therapy effective for menopause?

H2: Is hormone therapy effective for menopause?

HRT can be an effective treatment option with several benefits for menopausal women:

1. Relief of climacteric symptoms
• Significant reduction in hot flashes and night sweats.
• Improved quality of sleep.
2. Improving genitourinary health
• Reduction of vaginal dryness.
• Reduction of pain during sexual intercourse.
• Prevention of frequent urinary tract infections.
3. Bone protection
• Decrease in bone density loss.
• Reduced risk of osteoporosis and fractures.
4. Positive effects on moods and sense of well-being
• Improved mood and reduced symptoms of depression linked to menopause in certain women.
5. Cardiovascular effects (short term)
• In some younger post-menopausal women, HRT may have a protective effect on the heart.

Some research shows that long-term use of combined HRT (for 5 years or more) may cause a slight increase in the risk of getting breast and ovarian cancer, heart disease, and stroke. The risks associated with HRT vary from one woman to another and are influenced by a variety of factors including:

• age;
• health history;
• the duration of HRT use;
• the amount of time between menopause and the start of HRT;
• the dose of the hormones;
• the type of hormones (estrogen alone or a combination of estrogen and progestin).

What are the possible side effects of hormone therapy for menopause?

Side effects of HRT on menopausal symptoms can vary and depend on the treatment, the dose, and the way it’s administered (oral, cutaneous, vaginal). Here are the most common side effects, which usually subside after a few weeks:

• Breast tension or pain;
• Bloating, nausea;
• Headaches;
• Slight, irregular vaginal bleeding (spotting);
• Mood changes or irritability;
• Water retention, feeling of heavy legs.

Your Jean Coutu affiliated pharmacist can help you manage these side effects.
Feel free to ask for advice.

Other, rarer side effects may occur and should be monitored:

• Weight gain (related more to hormonal changes than to the treatment itself);
• Increased risk of blood clots (phlebitis, pulmonary embolism);
• Slightly increased risk of breast cancer (especially after several years, and for combined estrogen and progestin therapy).
• Risks of endometrial cancer if estrogen is taken alone.
• Increased risk of stroke or cardiovascular disease if treatment is started late (after age 60 or 10+ years following menopause).

What are bio-identical hormones?

Bio-identical hormones are hormones made in a laboratory but have the same chemical structure as those produced by the human body. They can be used as a replacement for HRT. Unlike traditional synthetic hormones, they are designed to be identical to the natural hormones estrogen and progesterone, so they may be better tolerated and closer to the body's natural hormone functions. While they have the potential to be safer; thereès no scientific data to confirm this.

How long does it take for bio-identical hormones to work?

Bio-identical hormones (or hormones identical to the body's natural hormones) can begin working within a few days to a few weeks, but full improvement of symptoms may take several weeks to a few months, depending on several factors:

• How they are administered
  The way hormones are absorbed into the body plays a key role. For example, creams and gels applied to the skin diffuse into the bloodstream more slowly, while oral tablets can work quickly, but their effect may be less stable. Topical treatments (like vaginal suppositories) work primarily on targeted areas and can provide faster relief for some symptoms.
• Adapted dosage
  The effectiveness of treatment depends primarily on the dose. Too little may not relieve symptoms; while too much can cause side effects. The right balance for each woman is often found after making slight adjustments as directed by a healthcare professional.
• Initial hormonal state
  Every woman begins treatment at a different stage in menopause. Those with more pronounced hormonal imbalances might need more time to feel an improvement, as their bodies need greater rebalancing.
• Lifestyle and overall health
  Diet, physical activity, sleep, and stress management can all affect the way the body reacts to HRT. A healthy lifestyle can also enhance the effectiveness of bio-identical hormones.
• Rate of adaptation
  Some women respond quickly to HRT, while others need more time, depending on the woman and the functioning of the liver, which plays a role in the transforming and eliminating hormones.
• Medical monitoring and adjustments
  Proper monitoring is vital. Regular hormone assessments enable professionals to measure the effectiveness of treatment and adjust the dosage as needed, to ensure optimal results and minimal risks.
  
  

What are the other solutions to counter the symptoms of menopause?

Changes in lifestyle can help you cope with the symptoms of menopause. Here are some examples:

1. Eat a balanced diet:
   - Choose foods rich in phytoestrogens (soy, flax, chickpeas), calcium and vitamin D (to preserve bone density (dairy products, green vegetables, oily fish).
   - Reduce your intake of sugar, coffee, alcohol and processed foods because they can contain hormone disruptors.
2. Exercise:
   - Being physically active for at least 30 minutes a day can help improve mood, bone density, sleep, and reduce hot flashes.
3. Use a lubricant during sex: Vaginal dryness during sex can cause discomfort and pain.
4. Prioritize quality sleep: Limiting screen time to at least one hour before bedtime, going to bed at the same time, using relaxation techniques, and establishing proper sleeping conditions can all help reduce stress and maximize the amount of restful sleep you get.
5. Consider using natural products in your routine: Some natural solutions claim to alleviate menopause symptoms. However, since the scientific evidence of effectiveness is still limited or sometimes conflicting, it's essential you speak to your pharmacist for advice on choosing the best products for your particular situation.

If you have any questions about menopause or hormone therapy,
feel free to make an appointment with your pharmacist.  

Your Jean Coutu affiliated pharmacist can:

• Explain how hormonal and non-hormonal treatments work and help with dosage compliance.
• Provide sound advice to ensure the safe use of natural or OTC products to avoid any contraindications or interactions with other medications.
• Help you manage the side effects of menopause or prescribed HRT.
• Refer you to a doctor or other healthcare professional as needed.