Currently, the aging of China’s population has become a key policy challenge. According to the 2000 national census, there are more than 100 million perimenopausal women in China, and epidemiological studies show that at least 60% of this population has menopause-related symptoms. So the question arises: Should I use medication when I am menopausal? Is hormone therapy safe? Will it be more likely to cause cancer?
What is menopause?
Menopause is the perimenopausal period. It generally begins at age 45, and some women may experience menstrual cycle changes (irregular menstrual cycles due to progesterone deficiency, with the length of the menstrual cycle changing by ≥ 7 days compared to the past), with or without other menopause-related symptoms (hot flashes, insomnia, and mood swings, etc.) from age 40 until one year after menopause (the last menstrual period).
The age at which the menopausal transition begins largely coincides with the age at which menopausal symptoms begin.
What are the symptoms of menopause?
1. Menstrual disorders: They are characterized by irregular menstrual cycles, prolonged periods, and excessive or excessive menstrual flow. If menopause occurs for more than 60 days, menopause is apparently underway, but menstruation may occur again after a few months.
2. Vasodilatory symptoms and cardiovascular lesions: hot flashes and sweating, which can last from 1 to 5 years or even longer. Severe cases may affect life, work and sleep. The risk of atherosclerosis and coronary artery disease increases after menopause due to increased abnormalities in glucose and lipid metabolism.
3. Neurological and psychiatric symptoms: palpitations, dizziness, headache, insomnia, mood swings such as anxiety and irritability, depression, loss of emotional control, etc.
4, genitourinary tract symptoms: vaginal dryness, painful intercourse, recurrent vaginitis, urethritis.
5, osteoporosis: As estrogen levels decline after menopause, loss of bone density begins to accelerate. In the first 5 to 10 years after menopause, women suffer a loss of 2 to 4% of bone density per year.
All of these symptoms are caused by estrogen deficiency!
Why should we pay attention to perimenopausal treatment?
The life expectancy of women in China’s major cities is now over 80 years, but the healthy life expectancy is only about 65 years, which means that they will be in a state of disease for the last 15 years or more of their lives. This shows that women’s aspirations are not only to live longer, but also to live a healthy life.
Perimenopause is a very special stage for women, and many of them experience hot flashes and sweating, bone and joint muscle pain, insomnia and other symptoms that seriously affect their quality of life. The reason why older people are prone to fractures after a fall is that osteoporosis is caused, and osteoporosis is caused by estrogen deficiency.
As a reminder, perimenopause is the budding stage of many degenerative diseases in the elderly, such as cardiovascular diseases, osteoporosis and cerebrovascular diseases. Taking advantage of this critical time to intervene during perimenopause can not only improve symptoms, but also greatly reduce the occurrence of age-related diseases, thus serving to enhance healthy life expectancy.
How to choose the best time for treatment?
The “window of opportunity” for “hormone supplementation therapy (MHT)” is before the age of 60, within 10 years of menopause, when MHT is most beneficial, least risky and safest to start.
Since women can secrete estrogen before menopause to maintain healthy blood vessels and have a follow-up effect, women’s blood vessels are relatively healthy before age 60 or within 10 years of menopause, and this is the most appropriate “window” for estrogen therapy.
If no hormone treatment is given during this period, irreversible bone density loss and cardiovascular sclerosis will occur by the age of 60, and if hormone treatment is used beyond the age of 60, not only will there be no therapeutic effect, but cardiovascular disease will be aggravated.
Therefore, the earlier MHT treatment is started, the better it is for women’s health.
Is there a time limit for MHT? Does it cause cancer?
The average age of menopause in women is around 50 years old. If a woman is treated with MHT for 10 years, can she continue hormone supplementation after 10 years, i.e. after the age of 60? If no new contraindications are evaluated, it is possible to continue the application.
Many women have this misconception that talking about “hormones” is scary and can easily cause cancer. Hormone therapy includes estrogen and progestin. The role of estrogen, as mentioned earlier, is to relieve menopausal symptoms, while the role of progestin is to protect the uterine lining and prevent endometrial hyperplasia and cancer.
If a hysterectomy is performed, only estrogen supplementation is sufficient. Women with a uterus should be treated with a combination of estrogen and progestin.
The estrogen currently used is a natural estrogen with few side effects. The progestins chosen are also close to natural ones, such as dydrogesterone and micronized progesterone. Numerous studies have found that Fentanyl, Advil and Levitra, which contain 3 hormones (estrogen, progestin and androgen) do not increase or even decrease the risk of breast cancer and are safe. Conversely, MHT should not be used in patients with these two cancers.
How to use MHT correctly?
After talking about the benefits of MHT, but not all people can take MHT?
You must go to a regular hospital and be evaluated by an experienced physician to make sure you understand the indications and contraindications for hormone therapy and to promptly address any problems that arise during use so that women can get the most benefit with the lowest risk.
MHT is safe for women who have no contraindications but have indications for MHT; for those with contraindications, other methods can be used to improve the body’s condition or prevent disease, including soy isoflavones or the consumption of soy products and herbs. For those with cautionary conditions, MHT can be selected according to the specific condition and followed up closely.
What are the items that must be examined before using MHT?
1, Adequate consultation (including medical history, family history) and informed choice.
2. gynecological examination, breast examination, cervical cancer screening and biochemical examinations such as liver and kidney function, lipids and blood glucose, in addition to ultrasound examination of the pelvis and breast.
How to choose MHT?
1. According to different situations, individualized methods and ways of selecting MHT are used, and regular follow-ups and evaluations are conducted during the course of treatment to change the treatment plan and adjust the drug dosage according to the treatment response and changes in expectations of MHT, and the lowest effective dosage for the individual is used as much as possible.
2.Postmenopausal women generally use the continuous combination of estrogen and progestin or tibolone.
If the perimenopausal women only have menstrual disorders, progestin alone can be used to adjust menstruation; if the menstrual disorders are accompanied by obvious symptoms, sequential estrogen and progestin treatment should be used.
4. For hysterectomized patients, a single estrogen can be chosen. For those with obvious symptoms of genitourinary tract atrophy, local vaginal estrogen is effective, but continuous treatment is needed to maintain the efficacy.
Can I take MHT for uterine fibroids?
Uterine fibroids are common gynecological conditions that shrink or subside after menopause. Studies have shown that the development of fibroids is closely related to estrogen and progesterone. The use of MHT for perimenopausal fibroids requires the lowest effective dose of progestin, depending on the patient’s condition.
With the use of oral hormones, no increase in the size of the fibroids was observed during the follow-up period. MHT should be monitored closely during treatment and discontinued immediately if excessive growth or abnormal vaginal bleeding occurs, and the dosing regimen should be individualized to the patient, with small oral doses being effective in improving symptoms associated with menopause. The patient should be followed up with regular ultrasound examinations of the uterus and the size of the fibroids.