Facts about the therapy

Hormone replacement for menopausal symptoms

Hormone replacement therapy can usually effectively alleviate severe symptoms during menopause.

(Bild: stock.adobe.com/COLLANGES / BSIP – stock.adobe.com)

The hormonal changes during the menopause (absence of the last menstrual period) lead to - sometimes very severe - symptoms for many women. How hormone replacement therapy can help and what risks it can entail.

The lack of female sex hormones that occurs during the menopause leads to symptoms such as hot flushes, night sweats, feelings of anxiety in the chest or heart rhythm disturbances in many women. Hormone replacement therapy (HRT) can be useful depending on the level of suffering or pre-existing conditions. There are several options, as Professor Dr. Doris Maria Gruber, a gynaecologist in Vienna, reports in the specialist magazine "Ärzte Krone".

"The therapy depends on the individual symptoms. At the beginning of the menopause - this can sometimes be around the age of 40 - there is usually a weakness of the corpus luteum, which is why pure progesterone therapy can be started. Due to their favorable effect and side effect profiles, natural progesterone or dydrogesterone are suitable here," says Prof. Gruber.

The lack of hormones can be compensated for with appropriate preparations.

(Bild: stock.adobe.com/angellodeco - stock.adobe.com)

Oestrogen therapy alone over a longer period of time increases the risk of uterine cancer (however, there is no increase in the risk of breast cancer) and should therefore only be used in women who have had their uterus removed. Otherwise, a combination therapy with oestrogen and progestogen is recommended.

If a symptomatic androgen deficiency develops in the postmenopause, therapy with dehydroepiandrosterone acetate (DHEA) can be used. This hormone is involved in the production of testosterone and oestrogen in the body.

The optimal window of opportunity for starting hormone replacement therapy varies from person to person. "In most cases, a maximum period of up to 10 years around the last menstrual period is used.

Univ.-Prof. Dr. Doris Maria Gruber, Gynäkologin

Bild: Sabine Hauswirth

Start and duration of therapy
When should you start therapy? Basically when symptoms occur. The optimal time window ("window of opportunity") varies from person to person. "In most cases, a maximum period of up to 10 years around the last bleeding is used. However, the later HRT is started, the less efficiently symptoms can be prevented or treated and potential side effects may also be more frequent after a 10-year interval," says Prof. Gruber.

Mögliche Alternativen

Ist eine Hormonersatztherapie nicht möglich oder unerwünscht, gibt es noch andere Optionen:

•  Phytotherapie, Isoflavone
• Serotonin-Wiederaufnahmehemmer, Serotonin-Noradrenalin-Wiederaufnahmehemmer
• kognitive Verhaltenstherapie
• weitere therapeutische Maßnahmen wie Akupunktur oder Hypnotherapie
• Lebensstilmodifikation (körperliche Bewegung, Sport, Verzicht auf Nikotin und Alkohol)

It is best to start with the lowest possible dosage, which can then be increased if necessary. According to the expert, there is basically no limit to the duration of therapy if the symptoms are alleviated and there are no other health problems. It is important to monitor and adjust the therapy regularly. However, it is not primarily about achieving the reference values in the hormone findings, but rather about the patient's subjective well-being.

Hormone replacement therapy is not recommended for women with hormone-dependent tumors, a family history of breast cancer, after the blockage of a blood vessel due to a blood clot or after a cardiovascular event such as a heart attack.