HRT can make a significant contribution to alleviating menopausal symptoms and improving quality of life.A basic distinction is made between systemic and local hormone replacement therapy (HRT). Which form is most suitable should be decided on an individual basis in consultation with your gynecologist.
Based on the results of the "Women Health Initiative" study, the widespread opinion at the time that HRT was associated with major risks still persists today. In fact, it has now been shown in many cases that the benefits outweigh the risks in the vast majority of cases. An assessment of the results of the WHI study can be found here.
Systemic hormone replacement therapy
With systemic hormone replacement therapy (HRT), the hormones are absorbed into the bloodstream and thus affect the entire body. There are therefore potential risks and side effects associated with its use.
The main short-term side effects of taking hormones are stomach pain, breast tenderness, depression, swelling in the legs, fatigue, headaches, irritability, back pain and vaginal bleeding. However, these side effects are usually easy to manage and diminish after a few weeks, which is why it is recommended to take them for at least 3 months. Rare long-term effects can include an increased risk of conditions such as blood clots, stroke and certain cancers. However, the benefits of HRT outweigh the risks.
Systemic hormone therapy can be in the form of pills, capsules, patches, creams, gels, or most recently a transdermal spray. For systemic hormone therapies either mono-hormone therapy with estrogen or progestin (replacing progesterone) or a combined hormone therapy (estrogen and progestin) are available. Different approaches are recommended according to the individual case.
Local hormone replacement therapy
Local hormone therapy involves estrogen creams, suppositories, vaginal tablets, vaginal rings or vaginal gels to provide relief for vaginal dryness, painful intercourse and bladder problems. This approach focuses on the affected area without affecting the whole body and is usually associated with a very low risk and very few side effects.
What dosage and for how long?
The right dose varies for each woman based on her symptoms, age, and family history. In the past, everyone was given a high dose, but nowadays physicians work with patients to find the best dose. Treatment usually starts with a small dose and can be increased gradually if needed.
How long a woman takes hormone therapy depends on individual circumstances. If hormones are applied through the skin, the therapy is generally safe for healthy women. Women can try the hormones for a few months or years and then decide together with their doctor whether to continue or reduce the dose. Short-term hormone therapy is usually given for 2-3 years, but not more than 5 years. If no contraindication appears, long-term HRT can be used until the end of life.
Stopping hormone therapy suddenly can cause temporary menopausal symptoms in about 50% of women. To avoid this, it is recommended to gradually lower the dose under the physician's guidance. Some women may consider trying complementary medicine as they gradually stop taking hormones.
