Menopausal Hormone Therapy

When a woman goes into the menopausal transistion, one of the concerns is whether she should take hormone replacement. Menopusal Hormone Therapy or MHT is a treatment to replace hormones, mainly estrogen, that the body significantly makes less of during the menopausal stage.

Who should take MHT?

If a woman in perimenopause has bothersome complaints like frequent hot flushes or severe dryness causing painful sexual intercourse, then MHT maybe bebeficial. MHT (also called Hormone Replacement Therapy or HRT) is used to treat several menopausal symptoms. It is the most effective way to treat moderate to severe vasomotor symptoms like hot flushes or night sweats. It can also treat dryness, painful sexual intercourse and urinary symptoms associated with genitourinary syndrome of menopause (GSM). It may also be given to prevent bone loss or osteoporosis. MHT is the treatment for women who have premature menopause or primary ovarian insufficiency.

Can all women in perimenopause or menopause take MHT?

There are women who should not be given MHT. These are women who have unexplained vaginal bleeding after menopause, cancers which are estrogen or progesterone responsive, active or history of deep vein thrombosis, pulmonary embolism and stroke, unstable heart disease, and liver failure. Without contrainidications, MHT is generally safe. In fact the US FDA has recently removed the black box warning (regarding cancer risk, heart disease risk, etc) from all MHT.

Timing is also important. MHT ideally should be started in the perimenopause but not later than 10 years after menopause.

Detailed history, symptomatology and examination should be done by your doctor to assess the need and benefit versus any relative contraindication. There should also be regular follow-ups with your doctor to monitor response to MHT.

What is the best MHT?

There is no straight answer to this. MHT comes in different forms and preparations. Treatment is individualized based on the patients needs and medical history. Age, whether a woman has had a hysterectomy and medical illenesses are among the factors we consider when choosing which MHT to give.

Are there any side effects when taking MHT?

Most women do not experience side effects. If they do, they are usually temporary. Common side effects include breast tenderness, bloating and light vaginal bleeding.

When is the best time to start MHT?

MHT can be started during the perimenopause or menopausal transistion when patients start to experience symptoms. Women more than 60 years of age or those who have been menopause more than 10 years should not start MHT because of the lower risk:benefit ratio.

How long should MHT be taken?

There is no specific time frame or age limit for taking MHT. Continuing hormone therapy even beyond 65 years of age is an option with appropriate counselling, regular assessment of risks and benefits and shared-decision making between the patient and her doctor.

In summary, MHT are safe and have many benefits for the perimenopausal or menopausal women. There is no one-size-fits-all MHT. So consult your doctor so the appropriate MHT can be discussed and prescribed according to your specific concerns.