In hormone replacement therapy, the dominant is still oral medication, mainly estrogen supplementation, progesterone supplementation, and estrogen-progestin combination supplementation. So, when the doctor prescribes many patients will be confused again, why only give me estrogen, I next door to Aunt Lee’s nephew’s second aunt estrogen and progestin should be used ah? Let’s first understand why we need to add progestin. Adding progesterone to protect the lining of the uterus The previous article focused on the importance of estrogen supplementation during menopause, so why add progesterone? We know that estrogen causes the lining of the uterus to thicken, and that progesterone must be present in order for it to shed and produce menstruation. If there is a lack of progesterone, the lining of the uterus remains in a state of hyperplasia, creating a potential for cancer. Therefore, for women with an intact uterus, the use of estrogen alone will increase the risk of endometrial cancer, and supplementation with the right amount of progesterone can counteract the endometrial growth effect caused by estrogen, thus protecting the endometrium. However, in women who have had their uterus removed, the addition of progestin is usually not necessary. When to use it alone and when to combine it? So let’s take a look at which hormone therapy regimen is appropriate for which specific group of people. But once again, the treatment of menopause is very complex, the specific use of drugs or listen to your doctor’s advice, here we are just a simple list. 1.Simple estrogen therapy: suitable for women who have had their uterus removed and do not need to protect the endometrium. Specific medication: e.g. estradiol valerate 0.5~2mg/day, continuous application. 2. Progesterone-only treatment: For women in the transition period of menopause, the purpose is to adjust the menstrual disorders that occur during the decline of ovarian function. If there is no menstruation for more than two months, progesterone is needed to let the endometrium fall off and prevent endometrial lesions. Specific medication: Dydrogesterone 10 mg or oral progesterone 100~200 mg once a day for 10~15 days and then stop the medication. So when will the medication be completely stopped? If you don’t have menstruation after stopping the medicine, then combine the situation of menstrual blood after stopping the medicine for the last few times to consider whether you have already gone through menopause, and you can try to stop the medicine after menopause. 3.Oestrogen + progestin combination ①It is suitable for premenopausal or postmenopausal women who have an intact uterus but still wish to have menstruation. This dosing pattern is to simulate the normal physiological cycle, adding progestin to estrogen for 10~14 days per month and then stopping the drug for 2~7 days. However, taking estrogen and progestin separately will cause a lot of inconvenience to patients, and it is easy to take them by mistake or miss them. Now there are some estrogen and progestin composite preparations, such as Clomid and Fenmoton, the advantage is that it is convenient to take, although not conducive to individualized adjustment, but it can meet the requirements of most patients. Specific medication: Clomid 1 tablet per day, without interruption for 21 days: first take 11 white tablets (containing estrogen), followed by 10 light orange-red tablets (containing estrogen and progesterone), 21 days after the withdrawal of 7 days. Fenotropil: a total of 28 tablets, one tablet a day, the first 14 tablets (containing estrogen), the second 14 tablets (containing estrogen and progesterone), a course of 28 days, on the 29th day from the start of the next course of treatment, continue to take the drug without interruption. You should continue to take the medicine even when you have your period, and you can’t just stop taking it, as it may cause abnormal bleeding. ② Postmenopausal women who are older or do not want to have menstruation. The treatment is to take estrogen and progesterone every day without stopping. Specific medication: such as supplemental Jiale 1 ~ 2 mg / day, and at the same time add dydrogesterone 5 mg / day or micronized progesterone 50 ~ 100 mg / day, every day to take without stopping. How long does the entire course of hormone replacement therapy take? There is no mandatory limit on the duration of treatment for several options in hormone replacement therapy, except for progesterone therapy alone. Since women who develop premature ovarian failure before the age of 45, and especially before the age of 40, are at a higher risk of cardiovascular disease and osteoporosis, they can benefit more from hormone replacement therapy, which should therefore be continued at least until the normal age of menopause of about 55 years. However, all patients during treatment should have at least 1 physical examination per year. This is used to assess the current benefit of treatment and whether the benefit outweighs the risk of causing other diseases. The final decision on the length of treatment and whether to continue the application is based on the evaluation. How can I make up for a missed dose? Regardless of the hormone replacement regimen, an occasional missed dose is unlikely to have any effect. However, how do I make up for a missed dose? If you notice a missed dose within 8 hours, you can take a replacement dose immediately. For women who are menstruating, if you see blood as a result of a missed dose, you should stop taking the medication and wait until the next cycle begins. Doctors usually recommend taking the medication at night before going to bed, as this is a more regular time and the patient’s mood is relatively stable, so it is not easy to miss a dose. Knowing why you take your medication, and why you take it the way you do, there is one more important thing not to forget. That is the regular review review, the following article will give you details.