The menopausal transition can be smooth for some women but distressing for many. Those who suffer severe hot flashes (sudden sweating and burning sensation), irritability, mood swings, low or no sex drive, genital itching after sex, clouded memory, depression, anxiety, sleeplessness or insomnia, frequent falls due to weak bones, during the transition phase, the condition can be debilitating. Doctors recommend menopausal hormone therapy (MHT) when the symptoms are unmanageable and for those with a very early onset of these symptoms.
At 44, Sheela (name changed on request), a homemaker from Kanpur, experienced sudden and frequent episodes of sweating due to hot flashes, extreme vaginal dryness coupled with depression. After one year of extreme suffering, in January 2022 she consulted Dr Sushma Tomar, Obstetrician-Gynecologist, Fortis Hospital, Kalyan, Mumbai, who thoroughly examined her and treated her with menopause hormone therapy for nearly 6 months.
Dr Tomar explains that MHT includes a combination of estrogen and progesterone hormone doses for a certain period until the estrogen and progesterone hormones in the body are partially regulated to reduce menopausal symptoms.
“In women whose uterus has been removed through hysterectomy, the therapy does not prescribe progesterone,” says Dr Meghana Reddy, Senior Consultant Obstetrics Gynecology and Laparoscopic Surgery, Rainbow Children’s Hospital, Marathahalli, Bengaluru. She adds that menopausal symptoms are seen even among women who have undergone uterus removal.
Women and the role of estrogen and progesterone hormones
Estrogen is crucial for protecting the heart, brain, and bone health, explains Dr Reddy. Equally essential is progesterone, which is critical for the normal functioning of the uterus, says Dr Tomar. “It also reduces anxiety, hot flashes, night sweats, and other menopausal symptoms,” says Dr Tomar.
Who needs menopausal hormone therapy?
MHT is not the first line of treatment, says Dr Tomar. However, all women who have intolerable symptoms which are not managed through counselling sessions, meditation, yoga, exercise, or other alternative therapies require MHT, explains Dr Tomar.
The age of onset of menopausal symptoms is another determining factor. Dr Reddy explains that all women below 40 years, who are going through early menopausal symptoms need menopausal hormonal therapy, irrespective of whether the symptoms are mild or severe. Not just that. Early menopause also translates to increased vulnerability to bone health issues.
The body mass index of a woman also becomes a determining factor for MHT. Dr Nirmala Chandrashekar, gynecological oncologist, BGS Gleneagles Global Hospital, Bangalore reasons out, “Leaner women, who are known to have lower body mass index will be at higher risk for bone issues during menopausal transition.”
Dr Reddy, thus emphasizes, “every woman who shows menopausal symptoms must get gynecological screening to prevent strokes or Alzheimer’s or osteoporosis and other such issues.”
Who is eligible for menopausal hormone therapy?
Women must take a pap smear (a test of the cervix or colon for cervical screening), mammography (a test to study the breasts), and sonography (an ultrasound tool to study the uterus). This helps to rule out malignancy before undertaking MHT, advises Dr Tomar.
Types of menopausal hormone therapy
There are four different types of hormonal therapy based on the drug delivery form. It could be transdermal, oral, or surgical administration of the medicine. They are:
Vaginal creams: Creams are largely advised for extreme vaginal dryness.
Oral pills: These pills which can be for regulating estrogen and progesterone hormone are advised for multiple or more severe symptoms.
Skin patches: They are transdermal (drugs administered by sticking the sticky patch on the skin) and consist of estrogen hormone. They are known as Estradiol skin patches. However, Dr Reddy warns, “these are less advised due to chances of overdosage.”
Hormonal intrauterine device (IUD): A T-shaped plastic device is inserted into the uterus and it releases progestin hormone.
The type of therapy depends on the severity of the symptoms seen and is also left to an individual’s choice.
Menopausal hormone therapy: Duration of use
Though beneficial, MHT has to be a time-bound therapy, say experts. “Menopausal hormone therapy must not be taken for more than 6 months, opines Dr Nirmala, adding that in very few cases, it can be up to one year, depending on the treating gynecologist’s discretion based on the condition of the person.
When to initiate hormone therapy?
“MHT is best suited at the onset of menopause because the symptoms are at the peak in the first two or three years of menopausal transition,” describes Dr Reddy. She adds that undergoing the therapy for three to six months at the onset of transition can help the women manage the symptoms in the most critical years.
Side effects of menopausal hormonal therapy:
Although hormone therapy helps to reduce menopausal symptoms, few studies indicate that women who have undergone hormone therapy are at higher risk of breast cancer. Also, prolonged hormone therapy intake can increase uterus complications, advises Dr Nirmala. “Estrogen creams are free from any side effects, and it can also correct the cause,” says Dr Reddy.
Who is not eligible for hormone therapy?
The following women cannot take MHT, advises Dr Tomar:
- Those who have or had a previous history of breast, ovarian, or endometrial cancer
- Those who have lumps in the breast, suffered stroke, prolonged history of hypertension, blood sugar, or other cardiac symptoms
Menopausal hormone therapy helps women in the menopausal transition phase. Those experiencing early menopause (below 40 years), require MHT, apart from those, aged above 40 years with severe menopausal symptoms. MHT includes mild to high doses of estrogen and progesterone hormones for a stipulated period, depending on a person’s condition.