Health Tips

When a woman stops experiencing period for more than 12 months, it is known that she hits menopause. In Malaysia, the average age of menopause age is 52 years old. However, menopause can happen between 45 to 55 years old is considered normal.

Menopause is a natural biological process where a woman stops producing eggs and the level of oestrogen in her body declines. As a result, a woman may experience unpleasant symptoms such as :

• hot flushes

• vaginal dryness

• night sweats

• sleep disturbance

• mood swing

•  weight gain

• thinning hair and dry skin. 

Image credit: Colorado Optimal Health

Luckily, these menopausal symptoms can be addressed with hormone replacement therapy (HRT). 

What is HRT?

HRT relieves menopausal symptoms by restoring the level of oestrogen. There are many types of HRT and you may need to explore different types before finding the one that works best for you. 

In general, HRT can come in two types: 

1. Unopposed oestrogen therapy (i.e. contains oestrogen only) for women who have undergone a hysterectomy. 

2. The combination of oestrogen and progestin therapy for women with an intact uterus. The progestin is added to reduce the risk of endometrial cancer induced by oestrogen among women with an intact uterus. 

What you need to know about oestrogen in HRT:

1. Oestrogen relieves hot flushes in postmenopausal women

A hot flush is often described as a sudden feeling of heat that seems to come from nowhere and spreads throughout the body. Women who experience hot flushes can also experience sweating, heart palpitations and flushing of the face. It can happen without warning throughout the day and night, but can also be triggered by other factors such as eating spicy foods, caffeine and alcohol, smoking, stress etc.

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In a meta-analysis of 24 trials involving 3329 postmenopausal women, the frequency of hot flush and the severity decreased more in those receiving oestrogen. The same result is also observed in a randomized prospective double-blind study, which shows that use of oestrogen (in the form of a transdermal patch) significantly reduced the frequency of hot flush.

For these reasons, HRT is usually recommended to post-menopausal women who experience hot flushes. Other added benefits can also include reducing the risk of osteoporosis and other menopausal symptoms, although they are unlikely to be the primary reason for initiating an HRT.

2. There are different types of oestrogen available for HRT

Oestrogen is technically a class of hormones. Among them, 17-beta estradiol is preferred than other types of conjugated equine oestrogens because it is structurally similar to the oestrogen secreted by the ovary. 

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HRT oestrogen also can be administered in many different methods: oral pills, transdermal patch, cream, gel, vaginal ring and subcutaneous implants. The doses and potency of oestrogen may differ based on the route of administration, but generally, they are equally effective in alleviating hot flushes. 

Hence, the choice of preparation is based on patient preference, co-morbidities, drug availability and costs.  For instance, oral oestrogen may increase the level of triglycerides, hence should be avoided in women with hypertriglyceridemia. Women with migraine headaches with auras are recommended to use transdermal oestrogen instead. If a post-menopausal woman experience vaginal dryness as a primary symptom, then an oestrogen-containing vaginal gel is preferred over oral oestrogen.

3. HRT may not be suitable for every postmenopausal woman.

The following individuals may not be suitable for HRT:

• History of or currently having breast cancer or endometrial cancer.

• History of or having a myocardial infarction (heart attack) or coronary heart diseases.

• History of vein thrombosis or stroke

However, this is not to say that these women should not use HRT. Consulting a healthcare professional will be helpful in this case, as the doctor will take a thorough clinical history on each individual and analyse the risks and benefits associated with HRT.

Image credit: Woman's Health Concern

How long should you take HRT?

HRT by enlarge is safe and offers benefits that outweigh the health risks associated with it. A doctor would usually recommend you to take it for up to 5 years. This is because of the slight increase in the risk of breast cancer if taken more than 5 years. Your doctor may reduce the dose gradually before completely stopping the HRT, to avoid recurrence of a hot flush.

Another group of women who should take HRT are those who have had premature menopause or those who attain menopause earlier than 45 years. Those who have had their ovaries removed surgically at an earlier age would also need HRT until 50 years of age or longer if the patient requests it.

References:

1. http://www.myhealth.gov.my/en/hormone-replacement-therapy/

2. https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397

3. https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

4. UpToDate

5. Cover image credit: Health Harvard Edu

Written by

Ms Joyce Toh